[The prognosis and life expectancy in liver cirrhosis after the onset of hepatic coma].
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Hepatic Encephalopathy↗
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[Hepatic coma].
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Hepatic Encephalopathy↗
[Clinical aspects and therapy of hepatic coma].
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Hepatic Encephalopathy↗
[Hepatic coma].
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Hepatic Encephalopathy↗
[Applications of current research on hepatic coma].
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Hepatic Encephalopathy↗
[ON SOME CAUSES OF HEPATIC COMA].
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Hepatic Encephalopathy↗
[Hepatic coma].
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Hepatic Encephalopathy↗
Increased levels of pregnenolone and its neuroactive metabolite allopregnanolone in autopsied brain tissue from cirrhotic patients who died in hepatic coma.
It has been suggested that neurosteroids with agonist properties at the central GABA-A receptor are implicated in the pathogenesis of hepatic encephalopathy (HE) in chronic liver disease. In order to address this issue, gas chromatography/mass spectrometry was used to measure the neurosteroids pregnenolone, allopregnanolone, and tetrahydrodeoxycorticosterone (THDOC) in postmortem brain tissue from controls, cirrhotic patients who died without HE, a patient who died in uremic coma, and cirrhotic patients who died in hepatic coma. Exposure of rat cerebral cortical membranes to brain extracts from hepatic coma patients resulted in a 53% (p < 0.001) increase in binding of [3H]muscimol, a GABA-A receptor ligand. Subsequent GC/MS analysis showed that concentrations of the GABA-A receptor agonist neurosteroid allopregnanolone were significantly increased in brain tissue from hepatic coma patients compared to patients without HE or controls (p < 0.001). Brain allopregnanolone concentrations were significantly correlated with the magnitude of induction of [3H]muscimol binding (r2 = 0.82, p < 0.0001). Concentrations of allopregnanolone comparable to those observed in hepatic coma brains are pathophysiologically relevant. Concentrations of the neurosteroid precursor pregnenolone were also increased in brain tissue from hepatic coma patients, while those of a second neurosteroid THDOC were below the levels of detection in all groups. Brain concentrations of benzodiazepine receptor ligands estimated by radioreceptor assay were not significantly increased in cirrhotic patients with or without hepatic coma. These findings suggest that increased levels of allopregnanolone rather than "endogenous benzodiazepines" offer a cogent explanation for the phenomenon of "increased GABAergic tone" previously proposed in HE.
Adult↗
Citrulline as a diagnostic parameter and a major amino acid constituent of cerebrospinal fluid in hepatic coma.
Free amino acids of cerebrospinal fluid and serum in hepatic coma have been studied. Citrulline was found to form about 80% of the total free amino acids in cerebrospinal fluid, whereas serum contained slightly higher levels of tyrosine, methionine, phenylalanine and glutamine. The higher level of citrulline in cerebrospinal fluid may be attributed to the inhibition of argininosuccinic acid synthetase in this disease.
Argininosuccinate Synthase↗
Effects of methanethiol on erythrocyte membrane stabilization and on Na+,K+-adenosine triphosphatase: relevance to hepatic coma.
Methanethiol (CH3SH) has been implicated in the pathogenesis of hepatic coma. Studies are presented to identify the possible biochemical basis of anesthesia-like effects of methanethiol and those features which distinguish such effects from common anesthetics and may represent the basis of its toxicity. CH3SH was found to stabilize erythrocyte membranes against hypotonic hemolysis at relatively low concentrations. At 37 degrees C the AH25 value for human erythrocyte antihemolysis was observed at a concentration of 0.34 mumol of CH3SH bound per mg of erythrocyte protein. Similar results were obtained with rat erythrocytes. This property of CH3SH is in common with other anesthetic agents. Anesthetic agents also inhibit the membrane-associated Na+,K+-adenosine triphosphatase (ATPase); however, for effective and nontoxic agents of this type the inhibition of ATPase activity is elicited at concentrations which are at least an order of magnitude higher than those which influence the membrane stability characterized by the antihemolysis effect (P. Seeman, Pharmacol. Rev. 24: 583-655, 1972). CH3SH was also found to inhibit the membrane Na+,K+-ATPase activity. The I25 value for the inhibition of human erythrocyte ATPase activity was obtained at CH3SH concentration of 0.12 mM which corresponded to 0.3 mumol of CH3SH bound per mg of erythrocyte membrane protein. Rat erythrocyte membrane ATPase was somewhat more sensitive to CH3SH. In all cases the binding of CH3SH to erythrocytes occurred primarily on the membrane. These results indicate that no differential exists with respect to the dose-response of these two activities associated with human erythrocyte membrane.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Electroencephalography in hepatic coma: therapy with hemoperfusion (author's transl)].
Six patients (two men and four women) aged between 15 and 60 years in hepatic coma stage IV and with very severe EEG changes were treated with hemoperfusion. The causes leading to coma were acute virus hepatitis A in two cases, hepatitis B in three cases, and Amanita intoxication in one case. Only the patient with Amanita intoxication survived. On admission to the hospital, there were very severe EEG changes of stage IV in all patients. They preceded the clinical manifestation of coma stage IV up to one day in half of the patients who were at most in coma stage II at this time. At the beginning of therapy better survival chances are reported in the lower coma stages. On the basis of the severely pathological EEG findings preceding the clinical coma in a proportion of the patients, an earlier start of therapy should thus be demanded.
Adolescent↗
[Experience with the treatment of acute hepatic coma using extracorporeal perfusion of heterologous liver and exchange transfusion].
Extracorporeal pig liver perfusion was adopted in 2 patients with acute hepatic coma due to fulminant hepatitis. Exchange transfusion was used in a third patient, while a fourth was subjected to both procedures. A marked haematological improvement was noted in all cases. Yet, three patients died without showing any clinical benefit. In the fourth case, coma regressed and gradual improvement to the point of complete recovery was achieved. Liver perfusion and exchange transfusion in the same patient were attended by very different clinical effects, though each procedure produced a comparable improvement at the blood chemistry data. Careful analysis of the data suggests that the difference was attributable to discrepancies between the degree of tissue purification achieved.
Acute Disease↗
Hemodialysis versus cross hemodialysis in experimental hepatic coma.
In this study, the effects of conventional hemodialysis on experimental hepatic coma have been compared with those of hemodialysis against blood from a normal donor which allows exchanges without mixing of blood. cuprophan and polyacrylonitrile membranes were compared. Cross hemodialysis with a donor resulted in rpompt but transient recovery of consciousness, whichever membrane was used. Cuprophan hemodialysis without donor had no effect. Polacrylonitrile hemodialysis without donor allowed progressive and prolonged improvement in the consciusness level and the electroencephalograms. Therefore, clearance of middle molecular weight substances was more effective than exchange with a donor. Preliminary results in man showed total recovery of consciousness in six of ten patients with acute liver failure and coma and partial recovery from complete grade IV coma to grade II encephalopathy in two patients. These two patients reacted when called by their name by opening their eyes and obeying simple orders.
Acrylic Resins↗
[Pulmonary complications in hepatic coma].
Incidence and extent of pulmonary complications were evaluated retrospectively in 101 patients with hepatic coma (34 patients with acute liver failure, 57 patients with hepatic encephalopathy and 10 patients with mixed forms). 76 patients (73.3%) had pulmonary complications (pulmonary edema 57 cases, pneumonia 20 cases, tracheobronchitis 30 cases). Lethality of the group with pulmonary complications was 97% as compared to 16% in the group without pulmonary complications. Pathogenesis of pulmonary complications is not completely clear; different mechanisms are being discussed like central mechanisms, vascular lesions caused by metabolic or toxic factors, cardiac failure, and increased susceptibility to infection. In 9 out of 59 cases (15.3%) with respiratory failure no morphological changes could be observed in the lungs; in these cases intrapulmonary shunts might have been the cause for the pulmonary complications. The incidence of pulmonary complications increased by a factor of 2.4 during intensive care unit treatment of the patients; this increase shows, that intensive care unit treatment still has to be improved.
Adult↗
Hemodiafiltration treatment of deep hepatic coma by protein passing membrane: case report.
Based on the assumption that middle molecules that induce hepatic coma occur in the plasma of patients with fulminant hepatic failure (FHF), the authors have developed a hemodiafiltration (HDF) method using a large-pore poly(methylmethacrylate) (PMMA) membrane that allows proteins to pass through. PMMA HDF resulted in complete recovery of deep coma and long-term survival in a patient with severe FHF. Although a large-scale controlled trial is needed, PMMA HDF is believed to be promising as a future artificial liver support.
Adult↗
[RECOVERY IN 2 CASES OF HEPATIC COMA].
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Adolescent↗