476
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Abstract
A clinicopathological study was undertaken in 15 cases of massive hepatic necrosis after shock. The GOT and GPT level exceeded 1000 units in 10 cases. The 15 cases consisted of 3 diagnosed as fulminant hepatitis clinically and 12 diagnosed as disseminated intravascular coagulation (DIC) or multiple systemic organ failure (MOF) from the unremarkableness of liver dysfunction. It was noteworthy that sepsis and surgery were closely associated with these lesions. The weight of the liver at autopsy ranged from 800 to 2,700 g. Liver necrosis was macroscopically characterized by clear demarcation of the necrotic areas sharply separated from the surrounding liver parenchyma, showing the appearance of so-called "map-like necrosis". Microscopically, the lesions in these subjects showed mainly the pattern of centrilobular necrosis. As observed in the burn shock case (case 12), the shock which provoked in different phases of time seemed to have repeated its attack. These liver necroses were considered to result from severe systemic circulatory disturbance or intrahepatic circulatory disturbance. The possibility is indicated that the generalized or univisceral Shwartzman reaction, and repeated and combined severe shock participated in the pathogenesis. Fibrin thrombi aggrevate tissue perfusion and accelerate anoxia. Heparin therapy seemed effective in these cases if administered at an appropriate time.
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477
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478
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Ede RJ, Gimson AE, Bihari D, Williams R. Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure. J Hepatol 1986; 2:43-51. [PMID: 3081622 DOI: 10.1016/s0168-8278(86)80007-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Raised intracranial pressure due to cerebral oedema is a major cause of death in fulminant hepatic failure and in the present study we have carried out a controlled clinical trial of continuous hyperventilation in the prevention of this complication. Twenty patients were electively hyperventilated to maintain PaCO2 between 3.5 and 5 kPa. In the other 35 patients mechanical ventilation was instituted only if severe hypoxia or hypercapnia occurred. Cerebral oedema, diagnosed clinically or by a rise in intracranial pressure to greater than 30 mm Hg, occurred in 85% of hyperventilated patients and in 86% of those not so treated. Although there was no significant reduction in the number of episodes of cerebral oedema in the hyperventilated patients (4.8 episodes/24 h) as compared with the controls (5.3 episodes/24 h), hyperventilation did appear to delay the onset of coning but on the basis of these results could not be recommended to be used routinely as a prophylactic measure in the prevention of cerebral oedema in this condition.
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479
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Gómez Rodríguez F, Villanueva JL, Puertas Montenegro M, Zamora Madaria E. [Concomitant chronic subdural hematoma and hepatic encephalopathy]. Rev Clin Esp 1985; 177:296-7. [PMID: 4081205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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480
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481
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Tsuji H, Murai K, Kajiwara E, Akagi K, Ikeda M, Fujishima M, Ayukawa K, Iwaki T. [An autopsy case of spontaneous bacterial peritonitis associated with fulminant type A hepatitis]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 1985; 82:1960-4. [PMID: 3906200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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482
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Blauhut B, Kramar H, Vinazzer H, Bergmann H. Substitution of antithrombin III in shock and DIC: a randomized study. Thromb Res 1985; 39:81-9. [PMID: 4035650 DOI: 10.1016/0049-3848(85)90123-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In 51 shock patients with DIC Antithrombin III (AT III) substitution, heparin or a combination of both substances respectively was administered. In the two groups which had been given AT III substitution the concentration of AT III rose considerably higher than the activity. There was a drop of the platelet count in both groups which had received heparin. C1 esterase inhibitor was diminished in the beginning but spontaneously increased in all groups. This increase was slowest in the group without substitution of AT III. The blood loss in cases of traumatic shock was considerably higher in the group which had received both substances. The consumption of AT III concentrates was slightly higher in the combined therapy group than in the AT III group. The duration of symptoms of DIC was considerably shorter in the two substituted groups than in the heparin group. It is concluded that additional administration of heparin does not improve the effect of AT III substitution in patients with DIC and that side effects such as thrombocytopenia and an increased blood loss are likely to develop when both substances are given simultaneously.
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483
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Shahid A, Qureshi H, Zuberi SJ. Electrolytes derangement in portal systemic encephalopathy (a preliminary study). J PAK MED ASSOC 1985; 35:211-4. [PMID: 3930779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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484
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Sakurai S. [Test yourself: nursing keypoints. Nursing of a patient with liver cirrhosis and hepatic coma]. KURINIKARU SUTADI = CLINICAL STUDY 1985; 6:721-6. [PMID: 3850266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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485
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Lichtigfeld FJ. Hepatic encephalopathy and delirium tremens--double jeopardy. S Afr Med J 1985; 67:880. [PMID: 4002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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486
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Uribe M, Ballesteros A, Strauss R, Rosales J, Garza J, Villalobos A, Briones A, Garcia Ramos G. Successful administration of metoclopramide for the treatment of nausea in patients with advanced liver disease. A double-blind controlled trial. Gastroenterology 1985; 88:757-62. [PMID: 3881309 DOI: 10.1016/0016-5085(85)90147-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A double-blind comparison of metoclopramide versus placebo was performed on 8 cirrhotic patients with nausea (8 cases) and heartburn (3 of the 8 cases) plus mild portal-systemic encephalopathy. As metoclopramide is a dopamine antagonist and dopamine-inadequate neurotransmission has been implicated in the pathogenesis of hepatic coma, this study was also designed to evaluate the effects of metoclopramide on mental state. The study included basal, placebo, metoclopramide, and final periods; each period lasted for 2 wk. Throughout the study patients received 3 g/day of neomycin and an 1800-cal diet containing 40 g/day of mixed protein. During the placebo and metoclopramide phases patients received either two 10-mg metoclopramide capsules t.i.d. or identical placebo capsules. During the study, biweekly liver function tests and portal-systemic encephalopathy parameters were evaluated. A self-evaluation for the presence of nausea and heartburn was also obtained. To monitor the dopamine-blockade effect of metoclopramide, serum prolactin levels were measured. Metoclopramide significantly suppressed the subjective signs of nausea (7 of 8 cases) and heartburn (all cases). Serum prolactin levels were 22 +/- 21 ng/ml, 30 +/- 31 ng/ml, 110 +/- 57 ng/ml (p less than 0.01), and 18.6 +/- 2 ng/ml during basal, placebo, metoclopramide, and final periods, respectively. In spite of these signs of dopamine blockade, no deterioration in mental state, asterixis, electroencephalograms, blood ammonia levels, or psychometric testings were observed. In addition, no extrapyramidal signs were noticeable during any period of the study. One patient presented transient somnolence at the end of the metoclopramide period. We conclude that dopamine blockade is not associated with the appearance of portal-systemic encephalopathy. Metoclopramide is a safe and effective treatment for nausea and heartburn in patients with advanced liver disease.
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487
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Garden OJ, Motyl H, Gilmour WH, Utley RJ, Carter DC. Prediction of outcome following acute variceal haemorrhage. Br J Surg 1985; 72:91-5. [PMID: 3871650 DOI: 10.1002/bjs.1800720205] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In order to identify factors predicting survival following acute variceal haemorrhage, data were collected prospectively from 100 admissions in 70 patients managed by a standard policy employing oesophageal tamponade, injection sclerotherapy and, if necessary, oesophageal transection. Of the ten predictive factors identified by univariate analysis, only prothrombin ratio, serum creatinine and the presence of encephalopathy on admission were shown by stepwise logistic regression to have independent significance. The derived regression equation allowed clearer identification than conventional scoring systems of high and low risk groups and successfully predicted outcome in 90 per cent of admissions.
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488
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Abstract
Organic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxic-metabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.
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489
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Abstract
The authors present a retrospective study of 50 patients with hepatic encephalopathy treated at the University Hospital, Faculty of Medicine of Ribeirão Preto since 1959 and discuss clinical, laboratory and anatomo-pathologic aspects. The diagnoses of the different types of liver disease as well as the factors that triggered the episodes of hepatic coma and pre-coma are reported and the role of the measurement of arterial blood gases in establishing the diagnosis is emphasized.
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490
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Pillans PI, Robins AH, Straughan JL. Drug therapy in patients with hepatic encephalopathy--suggested guidelines for sedation and treatment of delirium tremens. S Afr Med J 1984; 66:711. [PMID: 6495116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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491
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Akatsuka R, Ichijo S, Nakagawa Y, Kanno S, Yamauchi K. [Nursing care of the patient in multiple organ failure induced by hepatic failure]. [KANGO GIJUTSU] : [NURSING TECHNIQUE] 1984; 30:1775-81. [PMID: 6567703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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492
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Gupta OK, Sikka KK. Plasmodium falciparum malaria and acute fulminant hepatitis. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1984; 32:921. [PMID: 6394586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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493
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Aiello D, Enrichens F, Mao P, Benedetto G, Manconi P, Foco A, Curti B, Rozzio G, Grande L, Motto PC. [Supportive parenteral nutrition in the cirrhotic surgical patient ]. Minerva Med 1984; 75:1993-6. [PMID: 6435026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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494
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Cammarata S, De Merra F, Pasquali GF, Bertolotti MG. [Case of hepatic coma with lateral conjugate deviation of gaze]. RIVISTA DI NEUROLOGIA 1984; 54:335-9. [PMID: 6505544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The forced horizontal deviation of gaze, persisting more then 48 hours, has been observed during a rapidly developing hepatic coma in a patient whose post mortem examination did not reveal any structural lesion involving the central nervous system.
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495
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Gleysteen JJ, Klamer TW. Peritoneovenous shunts: predictive factors of early treatment failure. Am J Gastroenterol 1984; 79:654-8. [PMID: 6465113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Death or uncorrectable shunt malfunction occurred within 4 months in a majority (23) of 39 consecutive alcoholics who had peritoneovenous shunts. Clinical, biochemical, and operative variables in these patients were reviewed to detect factors that might predict early failure. Hepatorenal disease, expressed as the sum of total bilirubin and creatinine greater than 4 mg/dl, characterized 15 of 18 early deaths and was a reliable preoperative criterion of clinical outcome (p less than 0.001). Except for prothrombin elevation, abnormal coagulation indices did not predict early failure. Encephalopathy was more prevalent in patients who died (p less than 0.05). Among operative variables, failure to drain ascites was associated with more hospital deaths (p less than 0.05) and documentation of venous catheter placement in a central location reduced likelihood of early shunt malfunction (p less than 0.001). Preference for the LeVeen or Denver shunt did not affect the rate of early shunt malfunction. The overriding predictive factor was hepatorenal disease, both obvious and occult, by which judicious patient selection may avoid early death in surgical palliation for intractable alcoholic ascites.
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496
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Shuvalova EP, Rakhmanova AG, Shcherba IV. [Late outcome of viral hepatitis associated with acute hepatic insufficiency]. KLINICHESKAIA MEDITSINA 1984; 62:10-3. [PMID: 6492698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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497
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Pittella JE. Hepatic encephalopathy in patients with hepatosplenic schistosomiasis mansoni. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1984; 119:739. [PMID: 6732484 DOI: 10.1001/archsurg.1984.01390180099018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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498
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Zatevakhin II, Krylov LB, Ivanov AS, Sabirov BU. [Lymphosorption in the treatment of mechanical jaundice complicated by acute hepatic insufficiency]. Khirurgiia (Mosk) 1984:35-40. [PMID: 6708363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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499
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Shahid A, Qureshi H, Zuberi SJ. Disorders of renal function in hepatic coma. J PAK MED ASSOC 1984; 34:28-30. [PMID: 6422087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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500
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Raper R, Ibels L, Lauer C, Barnes P, Lunzer M. Fulminant hepatic failure due to allopurinol. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1984; 14:63-5. [PMID: 6590011 DOI: 10.1111/j.1445-5994.1984.tb03591.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A 58-year-old Chinese woman was admitted to hospital with a presumed hypersensitivity reaction to allopurinol. Her illness was characterised by high fever, eosinophilia, exfoliative dermatitis and jaundice. She developed fulminant hepatic failure and septicemia with a fatal outcome. Clinical details are presented and the possible relationship of allopurinol hypersensitivity to renal impairment is discussed.
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