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Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiopulmonary bypass-associated encephalopathy is thought to be due in part to continuous microembolization of the brain with gas microbubbles more than 40 microns in diameter during bypass. Current barrier filter technology cannot effectively remove such small microbubbles in fragile fluids such as blood. The design concepts for a new nonbarrier ultrasound-based fluid filtration system (an "acoustic filter") capable of filtering small microbubbles from blood are presented. The acoustic filter uses a field of high-intensity ultrasound to push microbubbles down an acoustic gradient, where they can be collected and removed. To test the filtration efficiency of the system, a Doppler ultrasound bubble detector was built. By monitoring the prefilter and postfilter Doppler signal an assessment of filtration efficiency was made. A suspension of stable albumin-encapsulated microbubbles (4 to 32 microns) were used as a model of the microbubble contaminants that might be found in the arterial return line of the heart-lung machine. Inactivated, the acoustic filter neither removed nor added microbubbles to the fluid. Activated, the acoustic filter provided total or near-total clearing of microbubbles. We conclude that the acoustic filter can remove microbubbles from a cardiopulmonary bypass-like apparatus.
J Thorac Cardiovasc Surg 1992 Dec
PMID:The acoustic filter: an ultrasonic blood filter for the heart-lung machine. 145 29

Although most commonly performed portal decompressive procedures control bleeding effectively, postoperative morbidity and mortality remains a serious problem in these patients. Both distal splenorenal shunts (DSRS) and small-diameter portacaval H-grafts (PCHG) are reported to produce decreased rates of postoperative encephalopathy. We prospectively evaluated 69 patients in whom 27 PCHG and 45 DSRS were performed over a seven-year interval. There were no significant preoperative differences between these groups. Operative mortality was 12.9% overall. DSRS was associated with decreased intraoperative blood transfusions and operative time. Postoperatively, DSRS was associated with significantly less encephalopathy, other postoperative complications, and ascites. Recurrent variceal bleeding was seen in three patients treated with PCHG and two patients with DSRS. We conclude that both DSRS and PCHG are effective in preventing recurrent variceal bleeding, but DSRS remains our procedure of choice because of its decreased rates of postoperative complications.
J Cardiovasc Surg (Torino)
PMID:Comparison between selective distal splenorenal shunt and small diameter H-graft portosystemic shunt. 278 25

This is the first report of the use of a free jejunal autograft vascularized by the internal thoracic (internal mammary) artery and vein to restore continuity of the digestive tract after total gastrectomy and distal 65% esophagectomy for recurrent bleeding esophagogastric varices caused by unshuntable extrahepatic portal hypertension. The procedure was used in two young adults who, because of numerous previous abdominal operations, had a severely scarred and contracted intestinal mesentery that precluded conventional use of the small or large intestine with an intact blood supply to bridge the gap between the upper thoracic esophagus and the abdominal jejunum. Before referral, the two patients had 21 and eight bouts of variceal hemorrhage, respectively, that necessitated a cumulative total of 108 and 74 units of blood transfusion, necessitated 17 and 12 admissions to the hospital, and failed to respond to four and five operations and 14 and 18 sessions of endoscopic sclerotherapy. After extensive esophagogastrectomy combined with a free jejunal autograft, both patients have done well during follow-up of 9 and 3 years, respectively. Both have been in good to excellent health with stable weight, freedom from digestive tract bleeding, normal liver function, and no encephalopathy. These results confirm our recently reported conclusions regarding the uniform long-term effectiveness of extensive esophagogastrectomy in the treatment of unshuntable extrahepatic portal hypertension and suggest that thoracic and general surgeons familiar with microvascular techniques may find the free jejunal autograft to be useful in various circumstances in which it is necessary to replace all or a substantial part of the thoracic esophagus.
J Thorac Cardiovasc Surg 1994 Aug
PMID:Free jejunal autograft combined with extensive esophagogastrectomy for unshuntable extrahepatic portal hypertension. 804 Nov 82

A 55-year-old man with hepatic cirrhosis, gastroesophageal varices, ascites, slight abdominal pain, and transient encephalopathy experienced unexpected spontaneous relief of his symptoms during hospitalization. Percutaneous transhepatic portography showed an aneurysmal intrahepatic portosystemic venous shunt. Three years later, the shunt was still patent and had led to disappearance of the patient's varices and ascites. The patient remains stable 6 years later.
Cardiovasc Intervent Radiol
PMID:Spontaneous aneurysmal intrahepatic portosystemic venous shunt. 818 34

A 57-year-old woman presented with hepatic encephalopathy, cirrhosis, and a dual-channel portosystemic venous shunt (PSVS). The shunt was treated successfully by embolization with steel coils via retrograde systemic venous access. Encephalopathy resolved. This new approach is considered safer than the previously reported percutaneous transhepatic route or the mesenteric venous route, requiring a mini-laparotomy.
Cardiovasc Intervent Radiol
PMID:Therapeutic embolization of intrahepatic portosystemic shunts by retrograde transcaval catheterization. 840 89

A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS.
Cardiovasc Intervent Radiol
PMID:Post-TIPS hepatic encephalopathy treated by occlusion balloon-assisted retrograde embolization of a coexisting spontaneous splenorenal shunt. 865 49

A 43-year-old non-cirrhotic woman suffered from encephalopathy caused by an extrahepatic portosystemic shunt between the ileal vein and inferior vena cava via the right gonadal vein. Percutaneous transcatheter embolization with stainless steel coils was performed by the retrograde systemic venous approach. Encephalopathy improved dramatically.
Cardiovasc Intervent Radiol
PMID:Treatment of hepatic encephalopathy by retrograde transcaval coil embolization of an ileal vein-to-right gonadal vein portosystemic shunt. 913 49

The average age of patients undergoing cardiac surgery and the number of comorbidities they possess will continue to increase as surgical technology advances. Toxic/metabolic encephalopathy, hemispheric strokes, hypoxic injury, and peripheral nerve lesions all can occur as a result of cardiac surgery. Therefore, an understanding of the neurologic risk, recognizable syndromes, and preventative measures will continue to be important. Careful preoperative assessment, operative risk factor reduction, and careful postoperative assessments and management may reduce the neurologic risk for cardiac surgery.
Prog Cardiovasc Dis
PMID:Neurologic complications of cardiac surgery. 1101 28

Hyponatremic encephalopathy is a well-known complication of surgical procedures. This syndrome has not been described in the cardiology literature. We report three patients who developed acute hyponatremia with life-threatening encephalopathy following an invasive cardiac procedure. Diagnosis and treatment were delayed because of a lack of awareness for the syndrome among the cardiology staff. The diagnosis of hyponatremia should be suspected in any patient who develops behavioral or neurological manifestations following an invasive cardiac procedure. Prompt diagnosis and treatment are essential to avoid permanent neurological damage or death.
Catheter Cardiovasc Interv 2001 Aug
PMID:Acute symptomatic hyponatremia complicating invasive cardiac procedures: a report of three patients. 1151 10

Both stroke and encephalopathy are associated with significantly longer lengths of stay in the hospital and with significantly higher rates of mortality. Those at risk for either stroke or encephalopathy, or both of these adverse outcomes after surgery, can be identified prior to surgery using information available to physicians. For those at higher risk for these outcomes, we suggest the following: 1) An imaging study of the brain, performed prior to surgery, may indicate the degree of cerebrovascular disease. At present we do not have this information on most patients. 2) The status of arteriosclerotic disease of the aorta should be determined prior to surgery or at the time of surgery. 3) For those with significant aortic and cerebrovascular disease, alternatives to the conventional ways of performing coronary artery bypass grafting (CABG) should be considered. These alternatives include percutaneous transluminal coronary angioplasty, off-pump surgery, and CABG using filters or inputs from the pump that selectively protect the brain.
Curr Treat Options Cardiovasc Med 2004 06
PMID:Encephalopathy and Stroke After Coronary Artery Bypass Grafting. 1509 8


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