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

In 59 patients with respiratory insufficiency due to chronic obstructive pulmonary disease (COPD) the relationship between the state of consciousness, the blood gases and blood ammonia were studied. Interindividually, a significant correlation was found between the encephalopathy and SaO2, PaCO2 or ammonia, and also between the blood gases and ammonia. On the other hand, an intraindividual study, performed on patients with minor cerebral dysfunction, showed that only PaCO2 was significantly correlated with the stage of consciousness. Ammonia did not appear to have a neurotoxic influence. The ammonia level seemed to be influenced primarily by other factors than the blood gases, although there was a borderline influence of SaO2 on aterial ammonia and a significant influence of PaCO2-HCO3 and pH on venous ammonia.
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PMID:Respiratory failure: correlation between encephalopathy, blood gases and blood ammonia. 0 6

It is proposed that hyperammonaemia in liver cirrhosis or after portacaval shunt contributes to plasma neutral aminoacid imbalance and to increased activity of the blood-brain neutral amino-acid transport system. Plasma neutral aminoacid concentrations are deranged, partly, but not completely, because ammonia stimulates glucagon secretion; a high rate of gluconeogenesis and hyperinsulinaemia follow. Brain uptake of neutral aminoacids rises because ammonia stimulates brain-glutamine synthesis, which results in rapid exchange of brain glutamine for plasma neutral aminoacids. Hyperammonaemia therefore contributes to encephalopathy indirectly, by raising the brain concentration of neutral aminoacids which after neurotransmitter metabolism, rather than directly, by toxic effects on neuronal metabolism.
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PMID:Hyperammonaemia, plasma aminoacid imbalance, and blood-brain aminoacid transport: a unified theory of portal-systemic encephalopathy. 9 Aug 64

A new and sensitive method for determination of octanoate in serum by gas-liquid chromatography is described. It was validated by mass spectrometry. Octanoate concentrations were determined in the serum of 61 fasting cirrhotic patients of which 47 also had hepatic encephalopathy. Concentrations in arterial and venous blood were higher in cirrhotic patients with encephalopathy than in those without and higher in the latter than in controls. Arterial concentrations were higher than venous concentrations and octanoate and ammonia varied independently. A predominant endogenous origin is likely. Data obtained from studies using palmitic acid labeled at different loci suggest that recovered serum octanoate was formed mostly by incomplete oxidation of long chain fatty acids. Sodium octanoate infusion to rhesus monkeys studied polygraphically induces a temporary coma.
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PMID:[Hyperoctanoatemia and the hepatic encephalopathy of cirrhosis. 150 dosages in 61 patients (author's transl)]. 11 76

Eighteen adult chacma baboons were fed Cannabis sativa, the plant material being incorporated into their food. They were divided into three equal groups. Group 1 animals were fed on 2% cannabis in food for 4 months, after which 2 animals remained on 2%, 2 were given 4% and 2 6% cannabis in food for the next 4 months. They became mildy apathetic. Five gained weight. Serum glucose, potassium and CO2 values decreased. Neuropathological examination of their brains did not show any significant abnormality. Group 2 animals were fed 10% cannabis for several weeks. They ate less and lost weight, and later became very apathetic. Right temporal biopsies were done in all and in 3 the tissue was analysed for glutamine, glutamate, tryptophan, ammonia and cyclic AMP. No significant change was found. Serum glucose and CO2 levels rose and potassium levels fell. Blood cholesterol values decreased in 3 of the 9 males. Group 3 animals were fed 6% cannabis for 2--4 months. Radio-immunoassay of sera and urine showed the presence of cannabinoids. They became apathetic, and 5 lost weight. Serum glucose and potassium levels (measured in the males) decreased. No neuropathological lesions were found in the brains, apart from an incidental leptomeningitis in 1 animal which died suddenly. The question of cannabis encephalopathy is discussed.
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PMID:Effects of the oral administration of Cannabis sativa (dagga) on chacma baboons (Papio ursinus). 11 92

Twenty-three patients bleeding from varices had mesocaval H-grafts using Dacron prosthetic material. There were 21 men and two women with ages ranging from 37 to 60 years. There were 11 elective and 12 emergency procedures. Five patients (17%) were classified as Child's class A, seven (34%) as class B, and 11 (49%) as class C. An operative mortality of 17% was noted in the entire group, with one late death due to hepatic failure. All deaths occurred in emergency cases belonging to class C. Technical difficulties were encountered more often in the hands of less experienced surgeons. A high rate of shunt patency and minimal problems with postoperative encephalopathy were noted despite abnormal results of ammonia tolerance tests postoperatively. Lack of hepatopedal flow was noted postoperatively compared with preoperative angiograms. There were no serious adverse effects from diversion of blood from the liver in our surviving patients. The interposition mesocaval shunt is a technically safe and easy procedure in the hands of experienced surgeons. We continue to recommend the mesocaval shunt until other methods prove better than this operation.
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PMID:Interposition mesocaval shunt for bleeding esophageal varices: clinical, hemodynamic, and metabolic changes. 15 18

A lactulose colonic washout (pH 4.5) was administered to six male patients with portal systemic encephalopathy. Estimation of blood ammonia levels and electroencephalography were performed before and after each treatment. Five patients recorded a significant fall in blood ammonia level as a result of lactulose therapy (P less than .025). In the sixth subject, an enema with buffered physiological saline, pH 4.5, induced a fall in ammonia which was not increased by subsequent lactulose solution. Improvement in the electroencephalogram was recorded in all periods where a lactulose colonic washout produced a fall in blood ammonia level.
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PMID:The rectal administration of lactulose. 24 Mar 47

In 75 cases of histologically verified liver cirrhosis the plasma amino acids were determined by ion exchange chromatography and the results were correlated with different liver function tests as prothrombin time, pseudocholinesterase, serum albumin, GOT, bilirubin and venous ammonia. Out of these parameters prothrombin time, pseudocholinesterase and serum albumin significantly correlated with the sum of branched-chain amino acids and with the Fischer's quotient (molar ratio of branched-chain and aromatic amino acids). Methionin and aromatic amino acids inversely correlated with these parameters, additionally methionin positively correlated with bilirubin and GOT. By comparing plasma amino acid levels in cirrhotics without and with hepatic encephalopathy (grade 3 or 4) no significant differences were found. "Fischer's quotient" showed an overlap in patients with and without encephalopathy. Therefore the precipitation of hepatic encephalopathy is not fully explained by the changes in plasma amino acids. Therapeutic administrations of specially mixtures of amino acids with a high content in branched-chain and a low content in aromatic amino acids correct the plasma amino inbalance for a short time and improves hepatic encephalopathy.
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PMID:Plasma amino acids in hepatic encephalopathy. 29 Jul 44

It has been recently proposed that hepatic encephalopathy could be due to the accumulation of octopamine acting as a false neurotransmitter, and the increase of ammonia might reflect this accumulation. The simultaneous determination of octopamine and ammonia was performed in 88 cases with or without encephalopathy. The correlation between the two substances appeared to be good (P less than 0.01; r = 0.5), except in shunted patients. All the cases with low octopamine and high ammonia were patients who had been submitted to surgical portal-systemic anastomosis. This finding does not seem to be coincidental; in this type of patients, the mechanism of hepatic encephalopathy could involve other beta-hydroxyphenylethanolamines in addition to octopamine. The presence of the inhibition of the reaction of transmethylation constantly observed during octopamine plasma assay is in favour of this hypothesis.
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PMID:Octopamine and ammonia plasma levels in hepatic encephalopathy. 32 Nov 53

In a double-blind, randomized study the efficacy of lactulose was compared with neomycin-sorbitol in 45 episodes of acute nitrogenous portal-systemic encephalopathy (PSE) induced by dietary protein, azotemia, or gastrointestinal hemorrhage. All patients had underlying cirrhosis, and at the time of randomization had encephalopathy of at least grade 2 severity and arterial ammonia concentrations greater than 150 microgram/100 ml. Two thirds of the patients in each group returned to normal mental status and more than 80% in each group showed at least one grade improvement in mental state. In addition, there was equivalent improvement in asterixis, in the performance of the Number Connection Test, in the electroencephalographic pattern, and in arterial ammonia concentration. The principal difference between the two groups was a greater reduction in stool pH after lactulose therapy than after neomycin-sorbitol therapy. One patient randomized to neomycin-sorbitol had to be withdrawn from the study because of persistent vomiting related to the administration of the medication. Otherwise there were no complications attributable to therapy in either group. These data suggest that neomycin-sorbitol and lactulose are equally effective in the treatment of acute nitrogenous portal-systemic encephalopathy.
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PMID:Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trial. 35 73

A randomized double-blind clinical comparison of bromocriptine, a new dopamine agonist, and placebo was performed on 7 cirrhotic patients with chronic portal systemic encephalopathy (PSE). Before given either medication, patients were stabilized with a standard treatment (neomycin and cathartics). Serial semiquantitative assessments were done, including mental state, asterixis, number connection test, electroencephalogram, and ammonia blood levels. Three patients developed signs of precoma while ingesting both placebo and bromocriptine. Two patients experienced precoma only with placebo, and another patient only while taking bromocriptine. One patient remained awake throughout the study. All patients responded initially to neomycin and cathartics. Bromocriptine proved not to be significantly superior to placebo and was always inferior to standard treatment. During treatment with bromocriptine, 3 patients experienced constipation. This may be partially responsible for the ineffectiveness in the treatment of PSE.
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PMID:Treatment of chronic portal systemic encephalopathy with bromocriptine: a double-blind controlled trial. 37 77


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