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Li J, Wan S, Wen F, Li Q, Cui Y, Lu Z, Lin H. Liver Transplantation Reverses Hepatic Myelopathy in the Decompensated Phase of Cirrhosis: Case Report and Literature Review. J Clin Transl Hepatol 2024; 12:436-442. [PMID: 38638382 PMCID: PMC11022064 DOI: 10.14218/jcth.2023.00487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 04/20/2024] Open
Abstract
Hepatic myelopathy (HM) is a rare neurological complication in the end stage of many liver diseases and is characterized by bilateral spastic paraparesis without sensory and sphincter dysfunction. It occurs owing to metabolic disorders and central nervous system dysfunction associated with cirrhosis. Without timely and effective clinical intervention, the prognosis of these patients is devastating. Although liver transplantation (LT) is an effective treatment for HM, the prognosis of these patients remains unsatisfactory. Early recognition and diagnosis of this disease are essential for improving patient prognosis. Here, we report a case of hepatitis B virus-associated decompensated cirrhosis with HM. The patient recovered well after LT. We also summarize the clinical characteristics and post-transplant outcomes of 25 patients with HM treated by LT through 2023, including this case.
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Affiliation(s)
| | | | - Fukai Wen
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Qingyu Li
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yifeng Cui
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhaoyang Lu
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Han Lin
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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2
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De Gasperi A, Petrò L, Cerutti E. Liver Transplantation and the Elderly Candidate: Perioperative Considerations. Anesthesiol Clin 2023; 41:595-611. [PMID: 37516497 DOI: 10.1016/j.anclin.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Pioneered by Thomas Starzl in the early 1970s, liver transplant (LT) is nowadays often considered a final intervention and standard of care to cure many forms of acute and chronic end-stage liver diseases. Started in recipients younger than 60 years old, LT indications are now much broader, and at least, one-fifth of the candidates are older than 65 years. Problems associated with ageing and frailty in LT recipients and their impact on the entire perioperative course are discussed according to a modern anesthesiological perspective and the anesthesiologist covering the role of the perioperative (transplant) physician.
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Affiliation(s)
| | - Laura Petrò
- ANRI1 - Emergency and Intensive Care, ASST Ospedale Giovanni XXIII, Bergamo, Italy; ASST Papa Giovanni XXII, Piazza MSO 1, 24100 Bergamo, Italy
| | - Elisabetta Cerutti
- Anestesia e Rianimazione dei Trapianti e Chirurgia Maggiore, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60020, Ancona, Italy; Azienda Ospedaliero Universitaria "Ospedali Riuniti", Via Conca 71, 60020, Ancona, Italy
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3
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Nascimento H, Malaquias MJ, Pinto CM, Sá Silva J, Rochate D, Fraga C, Alves JE, Ramos C, Gandara J, Ferreira S, Lopes V, Cavaco S, Pessegueiro Miranda H, Almeida A, Magalhães M. Trace Element Imbalances in Acquired Hepatocerebral Degeneration and Changes after Liver Transplant. BIOLOGY 2023; 12:804. [PMID: 37372089 DOI: 10.3390/biology12060804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
Brain manganese (Mn) accumulation is a key feature in patients with acquired hepatocerebral degeneration (AHD). The role of trace elements other than Mn in AHD needs to be clarified. In this study, using inductively coupled plasma mass spectrometry, we aimed to evaluate blood levels of trace elements in patients with AHD before and after liver transplantation (LT). Trace element levels in the AHD group were also compared with those of healthy controls (blood donors, n = 51). Fifty-one AHD patients were included in the study (mean age: 59.2 ± 10.6 years; men: 72.5%). AHD patients had higher levels of Mn, Li, B, Ni, As, Sr, Mo, Cd, Sb, Tl and Pb and a higher Cu/Se ratio, and lower levels of Se and Rb. Six patients (two women; mean age 55 ± 8.7 years) underwent LT, and there was an improvement in neurological symptoms, a significant increase in the Zn, Se and Sr levels, and a decrease in the Cu/Zn and Cu/Se ratios. In summary, several trace element imbalances were identified in AHD patients. Liver transplantation resulted in the improvement of neurological manifestations and the oxidant/inflammatory status. It is possible that observed changes in trace element levels may play a role in the pathophysiology and symptomatology of AHD.
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Affiliation(s)
- Henrique Nascimento
- Neurology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Maria João Malaquias
- Neurology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Catarina Mendes Pinto
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - José Sá Silva
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Dina Rochate
- Hematology Service, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - Cristina Fraga
- Hematology Service, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - José Eduardo Alves
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Cristina Ramos
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Judit Gandara
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Sofia Ferreira
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Vítor Lopes
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Sara Cavaco
- Neuropsychology Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Helena Pessegueiro Miranda
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Agostinho Almeida
- Laboratório Associado para a Química Verde (Associated Laboratory for Green Chemistry) of the Network of Chemistry and Technology (LAQV/REQUIMTE), Department of Chemical Sciences, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal
| | - Marina Magalhães
- Neurology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
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4
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Nyholm B, Obling L, Hassager C, Grand J, Møller J, Othman M, Kondziella D, Kjaergaard J. Superior reproducibility and repeatability in automated quantitative pupillometry compared to standard manual assessment, and quantitative pupillary response parameters present high reliability in critically ill cardiac patients. PLoS One 2022; 17:e0272303. [PMID: 35901103 PMCID: PMC9333219 DOI: 10.1371/journal.pone.0272303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Quantitative pupillometry is part of multimodal neuroprognostication of comatose patients after out-of-hospital cardiac arrest (OHCA). However, the reproducibility, repeatability, and reliability of quantitative pupillometry in this setting have not been investigated.
Methods
In a prospective blinded validation study, we compared manual and quantitative measurements of pupil size. Observer and device variability for all available parameters are expressed as mean difference (bias), limits of agreement (LoA), and reliability expressed as intraclass correlation coefficients (ICC) with a 95% confidence interval.
Results
Fifty-six unique quadrupled sets of measurement derived from 14 sedated and comatose patients (mean age 70±12 years) were included.
For manually measured pupil size, inter-observer bias was -0.14±0.44 mm, LoA of -1.00 to 0.71 mm, and ICC at 0.92 (0.86–0.95). For quantitative pupillometry, we found bias at 0.03±0.17 mm, LoA of -0.31 to 0.36 mm and ICCs at 0.99. Quantitative pupillometry also yielded lower bias and LoA and higher ICC for intra-observer and inter-device measurements.
Correlation between manual and automated pupillometry was better in larger pupils, and quantitative pupillometry had less variability and higher ICC, when assessing small pupils. Further, observers failed to detect 26% of the quantitatively estimated abnormal reactivity with manual assessment.
We found ICC >0.91 for all quantitative pupillary response parameters (except for latency with ICC 0.81–0.91).
Conclusion
Automated quantitative pupillometry has excellent reliability and twice the reproducibility and repeatability than manual pupillometry. This study further presents novel estimates of variability for all quantitative pupillary response parameters with excellent reliability.
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Affiliation(s)
- Benjamin Nyholm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Laust Obling
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marwan Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Ferreira GDSA, Watanabe ALC, Trevizoli NC, Figueira AVF, Caja GON, Murta MCB, Ferreira CA, Moreira ML, Couto CDF. Refractory Hypernatremia and Osmotic Demyelination Syndrome After Liver Transplantation: A Case Report. Transplant Proc 2022; 54:1376-1379. [PMID: 35760624 DOI: 10.1016/j.transproceed.2022.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/13/2022] [Indexed: 11/15/2022]
Abstract
Osmotic demyelination syndrome is an uncommon neurologic condition, characterized by noninflammatory demyelination involving the pons and other areas of the central nervous system. As chronic hyponatremia is frequently associated with cirrhosis, patients undergoing liver transplantation are at an increased risk for developing this condition. We report the case of a patient who developed refractory hypernatremia and osmotic demyelination syndrome after liver transplantation. The patient was a 40-year-old man, who underwent liver transplantation for the treatment of cryptogenic cirrhosis, and had a preoperative sodium level of 128 mmol/L. Although there were no intraoperative complications, the patient showed signs of mental confusion and drowsiness in the second postoperative day, and we noticed an increase to 136 mmol/L in his serum sodium. Treatment with 5% dextrose and desmopressin was initiated, but his serum sodium continued to increase steadily, while his neurologic condition gradually worsened. Serum sodium rose to 157 mmol/L, and a magnetic resonance imaging of the brain showed extensive lesions consistent with osmotic demyelination syndrome. The clinical condition of the patient continued to deteriorate until his death 17 days after the transplant. Although the occurrence of this syndrome after liver transplantation is well described, the steady increase in serum sodium despite early treatment, as described in this case, is highly unusual, and highlights the great attention that must be taken with monitoring and control of serum sodium in patients who undergo liver transplant in the context of chronic hyponatremia. This manuscript is compliant with the Helsinki Congress and the Istanbul Declaration.
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6
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Zhu Z, Liu Y, Wu W, Huang D, Guo Y, Zheng H, Wang N, Xu Z, Li X, Qin J, Liu L, Nashan B. Liver Transplantation Reverses Hepatic Myelopathy in Hepatitis B-Related Decompensated Liver Cirrhosis: Case Report and Review of the Literature. Transplant Proc 2021; 54:158-160. [PMID: 34961599 DOI: 10.1016/j.transproceed.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
Severe neurologic complications after chronic liver disease greatly affect the patient's quality of life. Hepatic myelopathy (HM) is a rare but devastating disease, in chronic liver disease. The limbs of patients with HM show slowly progressive symmetrical spastic paralysis without sensory loss. Management of this severe neurologic complication is challenging. These patients often require timely and effective clinical intervention. Although liver transplantation is one of the effective treatments for HM, the prognosis of these patients remains poor, many of them spend their lives in wheelchairs. Here, we report a patient with HM after hepatitis B virus related decompensated liver cirrhosis who recovered well after liver transplant. This work was carried out in compliance with the Helsinki Congress and the Declaration of Istanbul.
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Affiliation(s)
- Zebin Zhu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Yang Liu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Wu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Dehao Huang
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Yafei Guo
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Hao Zheng
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Ning Wang
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Zhijun Xu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Xuefeng Li
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Jiwei Qin
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Lianxin Liu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Björn Nashan
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
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7
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Morega S, Cătălin B, Simionescu CE, Sapalidis K, Rogoveanu I. Cerebrolysin Prevents Brain Injury in a Mouse Model of Liver Damage. Brain Sci 2021; 11:brainsci11121622. [PMID: 34942925 PMCID: PMC8699728 DOI: 10.3390/brainsci11121622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Liver damage can lead to secondary organ damage by toxic substances and catabolic products accumulation which can increase the permeability of blood-brain barrier, leading to cognitive impairment. The only real treatment for end stage liver failure is grafting. With some, but not all, neurological symptoms subsiding after transplantation, the presence of brain damage can impair both the short and long-term outcome. We tested if Cerebrolysin can prevent brain injury in an experimental model of non-viral liver damage in mice. Behavior, abdominal ultrasound evaluation and immunohistochemistry were used to evaluate the animals. No ultrasound or behavior differences were found between the control and treated animals, with both groups displaying more anxiety and no short-term memory benefit compared to sham mice. Cerebrolysin treatment was able to maintain a normal level of cortical NeuN+ cells and induced an increase in the area occupied by BrdU+ cells. Surprisingly, no difference was observed when investigating Iba1+ cells. With neurological complications of end-stage liver disease impacting the rehabilitation of patients receiving liver grafts, a neuroprotective treatment of patients on the waiting lists might improve their rehabilitation outcome by ensuring a minimal cerebral damage.
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Affiliation(s)
- Shandiz Morega
- U.M.F. Doctoral School Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Bogdan Cătălin
- Experimental Research Centre for Normal and Pathological Aging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (B.C.); (C.E.S.)
| | - Cristiana Eugenia Simionescu
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (B.C.); (C.E.S.)
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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8
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Gabr RM, El Salmawy DA, Basheer MA, Khairy M, Elkholy SH. Relation between the severity of liver cirrhosis and neurological symptoms, nerve conduction study results, and motor unit number estimation. J Viral Hepat 2021; 28:1312-1318. [PMID: 34048134 DOI: 10.1111/jvh.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/02/2021] [Accepted: 05/16/2021] [Indexed: 01/29/2023]
Abstract
Liver cirrhosis is a global health problem that can be associated with several neurological manifestations. We aimed to assessment of the relation between the severity of the liver cirrhosis and the neurological symptoms, nerve conduction studies (NCS), as well as detecting subclinical neuropathic affection using motor unit number estimation (MUNE) technique. This cross-sectional study was conducted on 56 cirrhotic patients and 61 age- and sex-matched healthy controls. Neurological manifestations, Child-Pugh classification, Model for End-Stage Liver Disease score, NCS and MUNE using a modified spike-triggered averaging technique were studied. Forty-five (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently reported manifestation, followed by fatigue and then numbness. NCS abnormality was significantly related to the presence of neurological symptoms (p < 0.001) and not only to peripheral numbness. Only fatigue was significantly related to the lower MUNE values (p < 0.017). Child-Pugh classification progression was significantly related to the presence of fatigue and abnormal NCS results (p < 0.001); no similar relation was detected between the Child-Pugh classification and the MUNE value (p = 0.103). Higher MELD scores were significantly related to NCS abnormalities (p = 0.014) and negatively correlated, although not significantly, with the MUNE values (r = -0.246 and p = 0.067). The progression of liver cirrhosis was related to the presence of neurological manifestations and nerve conduction abnormalities. Nerve conduction abnormalities may be present even in the absence of clinical numbness. A decline in motor unit number could explain the pathophysiology of fatigue in cirrhotic patients.
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Affiliation(s)
- Reem M Gabr
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina A El Salmawy
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mye A Basheer
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Khairy
- Endemic Medicine Department and Hepatology unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Saly H Elkholy
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure. LIVER RESEARCH 2021. [DOI: 10.1016/j.livres.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Machado JÚnior PAB, Ziliotto RD, Ferreira APVN, Buson TM, Couto CMD, Pissaia Junior A. USE OF THE STROOP ENCEPHALAPP FOR COVERT HEPATIC ENCEPHALOPATHY SCREENING IN CIRRHOTIC PATIENTS IN SOUTHERN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:399-403. [PMID: 33237215 DOI: 10.1590/s0004-2803.202000000-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Covert hepatic encephalopathy (CHE) is difficult to detect due to the lack of easily applicable screening tools. The Stroop EncephalApp is a smartphone application already validated for CHE screening. However, its applicability to the Brazilian population is not known. OBJECTIVE To estimate the prevalence of CHE and evaluate the use of Stroop EncephalApp in a cirrhotic population in Brazil. METHODS In this cross-sectional study, we evaluated 99 patients previously diagnosed with liver cirrhosis in a Private Hospital in Curitiba/PR. Patients were initially submitted to the mini mental state examination (MMSE) to exclude individuals with dementia. After, the Psychometric Hepatic Encephalopathy Score (PHES) test was performed and lastly, the Stroop EncephalApp test. Results were adjusted for age, sex and education levels to evaluate the accuracy of the app on detecting the disease, comparing its results with the gold standard method (PHES). Patients with one or more of the following were excluded: dementia, inadequate MMSE score, illiteracy, color blindness, history of drugs/alcohol abuse within the past 3 months and previous or actual episodes of encephalopathy. The statistical analysis was performed by SPSS 2.0 and the significance adopted by 5%. RESULTS We included 82 individuals in the final analysis. Among these patients, 29 were diagnosed with CHE by the PHES test (35.36% prevalence) and 28 of those obtained equal diagnosis by the Stroop EncephalApp (96.6% sensitivity). A total of 53 patients obtained negative results for CHE by PHES, while the Stroop test classified 27 of them as having the disease. In the multivariate analysis, high levels of education were associated with better performance during the tests. No significant relationship was observed between age and sex with the probability of diagnosing CHE through the PHES test.
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Affiliation(s)
| | - Rafaela Deneka Ziliotto
- Pontifícia Universidade Católica do Paraná (PUCPR), Escola de Medicina, Curitiba, PR, Brasil
| | | | - Thiago Mesquita Buson
- Pontifícia Universidade Católica do Paraná (PUCPR), Escola de Medicina, Curitiba, PR, Brasil
| | | | - Alcindo Pissaia Junior
- Pontifícia Universidade Católica do Paraná (PUCPR), Escola de Medicina, Curitiba, PR, Brasil.,Hospital Nossa Senhora das Graças (HNSG), Serviço de Hepatologia, Curitiba, PR, Brasil
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11
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Malaquias MJ, Pinto CM, Ramos C, Ferreira S, Gandara J, Almeida A, Cavaco S, Miranda HP, Magalhães M. Acquired hepatocerebral degeneration and hepatic encephalopathy: one or two entities? Eur J Neurol 2020; 27:2396-2404. [DOI: 10.1111/ene.14486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 12/31/2022]
Affiliation(s)
- M. J. Malaquias
- Neurology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - C. M. Pinto
- Neuroradiology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - C. Ramos
- Neuroradiology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - S. Ferreira
- Hepatic Pancreatic Transplantation Unit Centro Hospitalar Universitário do Porto Porto Portugal
| | - J. Gandara
- Hepatic Pancreatic Transplantation Unit Centro Hospitalar Universitário do Porto Porto Portugal
| | - A. Almeida
- Chemistry Science Department Faculdade de Farmácia Universidade do Porto Porto Portugal
| | - S. Cavaco
- Neuropsychology Unit Centro Hospitalar Universitário do Porto Porto Portugal
| | - H. P. Miranda
- Hepatic Pancreatic Transplantation Unit Centro Hospitalar Universitário do Porto Porto Portugal
| | - M. Magalhães
- Neurology Department Centro Hospitalar Universitário do Porto Porto Portugal
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12
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Evaluation of Preoperative and Postoperative S100β and NSE Levels in Liver Transplantation and Right Lobe Living-Donor Hepatectomy: A Prospective Cohort Study. Transplant Proc 2020; 53:16-24. [PMID: 32605771 DOI: 10.1016/j.transproceed.2020.04.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/10/2020] [Accepted: 04/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS This study aimed to evaluate plasma neuron-specific enolase (NSE) and S100β levels in orthotopic liver transplantation. MATERIALS AND METHODS A total of 56 patients who underwent orthotopic liver transplantation were divided into 3 groups. Healthy donors (group D), end-stage liver failure (ESLF) patients (recipient, group R), and ESLF patients diagnosed with hepatic encephalopathy (HE, group HE). Prognosis, preoperative routine laboratory findings, serum NSE, and S100β in samples obtained preoperation and first and sixth months postoperation were analyzed. RESULTS Serum NSE and S100β levels were significantly higher in ESLF patients compared to healthy donors, particularly during the preoperative period. There was a significant decrease in serum NSE and S100β in ESLF patients during the postoperative measurement periods compared to preoperative levels. Serum NSE and S100β levels measured at 3 different time points showed no significant difference between ESLF patients and ESLF patients with HE. However, the recent Model of End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores showed a significant correlation with serum NSE and S100β in ESLF patients diagnosed with HE. Serum NSE and S100β levels in healthy donors significantly increased within the first month following hepatectomy and decreased in the sixth month following surgery. CONCLUSION Although serum NSE and S100β levels significantly decreased with improved liver function in recipients following liver transplantation, there was no complete recovery within 6 months after surgery. The increase in serum levels of NSE and S100β in donors measured following hepatectomy was detected to remain slightly higher in the sixth postoperative months.
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13
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Ferrarese A, Morelli MC, Carrai P, Milana M, Angelico M, Perricone G, Belli LS, Marrone G, Grieco A, Martini S, Manini MA, Fagiuoli S, Toniutto P, Galeota Lanza A, Bhoori S, Petta S, Giannini EG, Burra P. Outcomes of Liver Transplant for Adults With Wilson's Disease. Liver Transpl 2020; 26:507-516. [PMID: 31901209 DOI: 10.1002/lt.25714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
Wilson's disease (WD) is a rare genetic disorder with protean manifestations. Even if liver transplantation (LT) could represent an effective therapeutic option for patients with end-stage liver disease, it has remained controversial in the presence of neuropsychiatric involvement. This study aimed to examine the frequency of adult LT for WD in Italy, focusing on the disease phenotype at the time of LT. A retrospective, observational, multicenter study was conducted across Italy exploring the frequency and characteristics of adults transplanted for WD between 2006 and 2016. A total of 29 adult WD patients underwent LT during the study period at 11 Italian LT centers (accounting for 0.4% of all LTs performed), and 27 of them were considered in this analysis (male/female, n = 9/18; age at LT, 29 years [19-60 years]; median Model for End-Stage Liver Disease score at LT, 27 [6-49]). Isolated hepatic phenotype was the indication for LT in 17 (63%) patients, whereas 2 (7%) patients underwent LT for neurological impairment on compensated liver disease. Overall 1- and 5-year patient survival was excellent (88% and 83%, respectively). Neuropsychiatric symptoms early after LT completely recovered in only a few patients. In conclusion, WD remains an uncommon, unusual indication for LT in Italy, displaying good post-LT graft and patient survival. Because isolated neuropsychiatric involvement represents a rare indication to LT, more data are needed to properly assess the value of LT for WD in this subset of patients.
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Affiliation(s)
- Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Maria Cristina Morelli
- Department for Care of Organ Failures and Transplants, Internal Medicine for the Treatment of Severe Organ Failures, University Hospital - Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School and Hospital, Pisa, Italy
| | - Martina Milana
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Mario Angelico
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giovanni Perricone
- Gastroenterology and Hepatology Department, Liver Unit, Azienda Socio Sanitaria Territoriale, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Saverio Belli
- Gastroenterology and Hepatology Department, Liver Unit, Azienda Socio Sanitaria Territoriale, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Marrone
- Liver Transplant Medicine Unit, Gastroenterological Area, Department of Gastroenterological, Endocrine and Metabolic Sciences, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Grieco
- Liver Transplant Medicine Unit, Gastroenterological Area, Department of Gastroenterological, Endocrine and Metabolic Sciences, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Martini
- Gastrohepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Matteo Angelo Manini
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Department of Medical Area, Udine University Hospital, Udine, Italy
| | | | - Sherrie Bhoori
- Department of Surgery and Oncology, Istituto Nazionale Tumori Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino, Instituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genoa, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
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14
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Sousa AL, Salgado P, Alves JE, Silva S, Ferreira S, Magalhães M. Uncommon Movement Disorders in Chronic Hepatic Disease with Response to Rifaximin. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-649. [PMID: 31413898 PMCID: PMC6691909 DOI: 10.7916/tohm.v0.649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Background Chronic hepatic disease can present with extrapyramidal symptoms. We describe two cases that presented with highly unusual movement disorders: ballism and gait freezing. Case report Patient 1 is a 42-year-old man with previous episodes of hepatic encephalopathy (HE) who presented with upper limb dystonia and generalized chorea that progressed to ballism. Patient 2 is a 55-year-old woman who presented with pronounced gait freezing. In both patients, features of HE and acquired hepatocerebral degeneration coexisted. They improved markedly, though transiently, with rifaximin. Discussion Ammonia-reducing treatments should be considered in patients presenting with movement disorders due to chronic liver disease.
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Affiliation(s)
- Ana L Sousa
- Neurology Department, Centro Hospitalar do Porto, Porto, PT
| | - Paula Salgado
- Neurology Department, Centro Hospitalar do Porto, Porto, PT
| | - José E Alves
- Neuroradiology Department, Centro Hospitalar do Porto, Porto, PT
| | - Sara Silva
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, PT
| | - Sofia Ferreira
- Liver Transplantation Unit, Centro Hospitalar do Porto, Porto, PT
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15
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Comparison of 2 Automated Pupillometry Devices in Critically III Patients. J Neurosurg Anesthesiol 2019; 32:323-329. [DOI: 10.1097/ana.0000000000000604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Weiss N, Thabut D. Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury. Liver Transpl 2019; 25:469-487. [PMID: 30697911 DOI: 10.1002/lt.25420] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023]
Abstract
Orthotopic liver transplantation (LT) remains the only way to definitively cure patients with the most severe liver diseases. Because the survival rate is now fairly high, important questions about neurological sequelae or quality of life after LT have emerged. Indeed, LT represents a peculiar situation because up to 30% of patients present with neurological symptoms after LT compared with only 4% after cardiac transplant and 0.5% after renal transplant. These postoperative neurological symptoms have long been interpreted as sequelae of hepatic encephalopathy (HE). However, postoperative decompensation of an unknown cerebral condition due to the pathophysiology of cirrhosis or undiagnosed neurodegenerative disorders or aging constitute other possibilities that are underrecognized. Some patients who undergo LT for acute liver failure and patients with cirrhosis without episodes of HE and without any previous cerebral alteration also display post-LT neurological symptoms. This latter situation speaks in favor of a direct adverse effect of either general anesthesia, the surgical procedure, or factors related to the postoperative intensive care unit (ICU) environment. The role of inflammation, which has been described in the ICU setting, could also be a crucial determinant. In this review, we will discuss the neurological complications associated with LT, the neurocognitive complications after LT, and how to assess the LT-related neurological or neurocognitive complications. Furthermore, we will review the various hypotheses surrounding post-LT neurocognitive impairment and will conclude with recommendations for future directions.
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Affiliation(s)
- Nicolas Weiss
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Assistance Publique - Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Département de Neurologie, Unité de Réanimation Neurologique, Sorbonne Université, Paris, France.,Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, INSERM, Paris, France
| | - Dominique Thabut
- Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, INSERM, Paris, France.,Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Assistance Publique - Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Service d'Hépato-Gastroentérologie, Unité de Soins Intensifs d'Hépato-Gastroentérologie, Sorbonne Université, Paris, France
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17
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Hanada M, Soyama A, Hidaka M, Nagura H, Oikawa M, Tsuji A, Kasawara KT, Mathur S, Reid WD, Takatsuki M, Eguchi S, Kozu R. Effects of quadriceps muscle neuromuscular electrical stimulation in living donor liver transplant recipients: phase-II single-blinded randomized controlled trial. Clin Rehabil 2019; 33:875-884. [PMID: 30607983 DOI: 10.1177/0269215518821718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of neuromuscular electrical stimulation on quadriceps muscle strength and thickness in liver transplantation patients. DESIGN Phase-II, randomized, parallel-group, allocation-concealed, assessor-blinded, single-center controlled trial. SETTING Inpatient rehabilitation sector. SUBJECTS Patients following living donor liver transplantation. INTERVENTIONS The quadriceps muscle stimulation and the control groups received bilateral muscle electrical stimulation on the quadriceps and tibialis anterior muscles, respectively. Neuromuscular electrical stimulation sessions in both groups were conducted for 30 minutes per session, once per day for five weekdays over four weeks by a physical therapist. MAIN MEASURES Quadriceps muscle strength and quadriceps muscle thickness. RESULTS Neuromuscular electrical stimulation was applied to the quadriceps muscles group ( n = 23) or the tibialis anterior muscle in the control group ( n = 22). The decrease in quadriceps muscle thickness differed significantly between both groups on postoperative day 30 (median -3 vs -8, P < 0.01). The changes in predicted quadriceps strength and 6 minutes walking distance were not significantly different between groups (quadriceps strength median -12% vs -5%, P = 0.40; 6 minutes walking distance median -18 vs -21 m, P = 0.74). CONCLUSION Neuromuscular electrical stimulation of the quadriceps muscle for liver transplantation recipients was able to maintain the quadriceps muscle thickness after surgery. Future larger scale studies are needed to consider the effectiveness of neuromuscular electrical stimulation and how to incorporate this intervention in the overall strategy of the physical therapy program.
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Affiliation(s)
- Masatoshi Hanada
- 1 Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan.,2 Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Akihiko Soyama
- 3 Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Hidaka
- 3 Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Nagura
- 1 Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Masato Oikawa
- 1 Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Ayumi Tsuji
- 4 Department of Nurse, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Sunita Mathur
- 2 Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,5 Canadian National Transplant Research Program, University of Alberta, Edmonton, AB, Canada
| | - W Darlene Reid
- 2 Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Mitsuhisa Takatsuki
- 3 Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- 3 Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- 1 Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan.,6 Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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18
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Gómez Gavara C, Esposito F, Gurusamy K, Salloum C, Lahat E, Feray C, Lim C, Azoulay D. Liver transplantation in elderly patients: a systematic review and first meta-analysis. HPB (Oxford) 2019; 21:14-25. [PMID: 30146227 DOI: 10.1016/j.hpb.2018.07.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Elderly recipients are frequently discussed by the scientific community but objective indication for this parameter has been provided. The aim of this study was to synthesize the available evidence on liver transplantation for elderly patients to assess graft and patient survival. METHODS A literature search of the Medline, EMBASE, and Scopus databases was carried out from January 2000 to August 2018. Clinical studies comparing the outcomes of liver transplantation in adult younger (<65 years) and elderly (>65 years) populations were analyzed. The primary outcomes were patient mortality and graft loss rates. This review was registered (Number CRD42017058261) as required in the international prospective register for systematic review protocols (PROSPERO). RESULTS Twenty-two studies were included involving a total of 242,487 patients (elderly: 23,660 and young: 218,827) were included in this study. In the meta-analysis, the elderly group had patient mortality (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 0.97-1.63; P = 0.09; I2 = 48%) and graft (HR: 1.09; 95% CI: 0.81-1.47; P = 0.59; I2 = 12%) loss rates comparable to those in the young group. CONCLUSIONS Elderly patients have similar long-term survival and graft loss rates as young patients. Liver transplantation is an acceptable and safe curative option for elderly transplant candidates.
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Affiliation(s)
- Concepción Gómez Gavara
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France; Department of Surgery, Royal Free Campus, UCL Medical School, Pond Street, London, NW3 2QG, UK
| | - Francesco Esposito
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Kurinchi Gurusamy
- Department of Surgery, Royal Free Campus, UCL Medical School, Pond Street, London, NW3 2QG, UK
| | - Chady Salloum
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Eylon Lahat
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Cyrille Feray
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France; Unité INSERM 955, Créteil, France
| | - Chetana Lim
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Daniel Azoulay
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France; Unité INSERM 955, Créteil, France.
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19
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Zhao H, Yue Z, Wang L, Fan Z, He F, Dong X, Liu F. Benefits of Early Treatment for Patients with Hepatic Myelopathy Secondary to TIPS: A Retrospective Study in Northern China. Sci Rep 2018; 8:15184. [PMID: 30315180 PMCID: PMC6185955 DOI: 10.1038/s41598-018-33216-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for reducing portal pressure. Hepatic myelopathy (HM), a rare complication of chronic liver diseases, remains obscure in terms of treatment and prognosis. We aimed to determine an optimal treat strategy for patients with HM after TIPS. Twenty-nine patients who developed HM after TIPS were stratified by time-lapse from onset to treatment: group A (n = 16), <6 months; group B (n = 13), ≥6 months. Therapeutic measures included shunt-limiting and medical treatments. Overall survival, lower-limb muscle strength, Fugl-Meyer score, Barthel index, and serum ammonia were recorded. Median survival time in group A or B was 30 months or 16.5 months, respectively (log rank p = 0.0172). All patients in group A obtained improvement in grading of muscle strength (p < 0.0001), Fugl-Meyer score (p = 0.0021), and Barthel index (p = 0.0003), particularly male patients and those subjected to shunt-limiting. Serum ammonia levels were decreased significantly in both group A (p = 0.0007) and group B (p = 0.0007). Collectively, once HM is confirmed after TIPS, active intervention is imperative and urgent, especially within the first 6 months from onset of symptom. TIPS shunt-limiting is particularly beneficial for rehabilitation in patients with early-onset HM.
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Affiliation(s)
- Hongwei Zhao
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhendong Yue
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Wang
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Fan
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Fuliang He
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqun Dong
- Department of Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA.
| | - Fuquan Liu
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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20
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Abstract
Acute liver failure (ALF) is an uncommon syndrome with a highly variable and unpredictable clinical course. The initial diagnostic evaluation is typically performed in a non-intensive care unit (ICU) setting, like the emergency department or general hospital ward. Prompt restoration of intravascular volume with intravenous fluids and correction of electrolyte, metabolic, and acid-base disturbances are important initial interventions in the management of ALF and can be safely accomplished in non-ICU settings in many patients. Similarly, therapies such as administration of N-acetylcysteine for acetaminophen-induced ALF and other cause-specific interventions can also be administered in non-ICU settings, thus minimizing delay.
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Affiliation(s)
- Andres F Carrion
- Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX 79905, USA.
| | - Paul Martin
- Gastroenterology and Hepatology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA
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21
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Philips CA, Kumar L, Augustine P. Partial splenic artery embolization for severe hepatic myelopathy in cirrhosis. Hepatology 2018; 67:1169-1171. [PMID: 29059463 DOI: 10.1002/hep.29597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/02/2017] [Accepted: 10/13/2017] [Indexed: 01/08/2023]
Abstract
Hepatic myelopathy (HM) is a devastating but rare complication of cirrhosis and portal hypertension that profoundly affects quality of life and improves only with liver transplantation. We present a case where progressive severe spastic paraparesis due to HM was substantially reversed with partial splenic artery emobilization (PSAE). (Hepatology 2018;67:1169-1171).
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Affiliation(s)
- Cyriac Abby Philips
- Hepatology and Liver Transplant Medicine, PVS Memorial Hospital Ltd., Cochin, Kerala, India
| | - Lijesh Kumar
- Interventional and Diagnostic Radiology, PVS Memorial Hospital Ltd., Cochin, Kerala, India
| | - Philip Augustine
- Gastroenterology, PVS Memorial Hospital Ltd., Cochin, Kerala, India
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