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

In patients maintained on regular haemodialysis in Newcastle upon Tyne the development of osteomalacia is substantially reduced when water used to prepare dialysate is deionised. After 1--4 years of dialysis, osteomalacia was evident in 15% of patients on deionised water in 70% of patients on softened water from the same source. The close association of dialysis encephalopathy and osteomalacia suggests a common aetiology. Both diseases occur in centres with a high tap-water aluminium content. Serum-aluminium concentrations were raised in patients undergoing regular haemodialysis in the Northern Region of England. Those using softened water had higher concentrations than those using deionised water. Patients on softened water who had encephalopathy or dementia had serum-aluminium concentrations similar to those of patients using the same water-supplies without symptoms of these diseases, but they had been treated for longer. The evidence that aluminium absorption from dialysate causes osteomalacia and encephalopathy is strong enough to justify the expense of treating water by deionisation, reverse osmosis, or both in centres where tap-water aluminium is high.
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PMID:Osteomalacic dialysis osteodystrophy: Evidence for a water-borne aetiological agent, probably aluminium. 7 95

Brain-aluminium concentrations were found to be significantly higher in 7 patients dying with dialysis encephalopathy (mean 15.9 microgram aluminium/g dry weight) than in 11 dialysed controls (4.4 microgram/g) and in 2 uraemic patients who were not dialysed (2.7 microgram/g). The grey matter from the patients with dialysis encephalopathy contained about three times as much aluminium as white matter. The results suggest that dialysis with untreated and/or softened tap-water (aluminium concentration 0.1-1.2 mg/1) makes the major contribution to brain-aluminium levels; dialysis with deionised water (aluminium concentration normally less than 0.02 mg/1) and intake of phosphate-binding AL(OH)3 gel are less important. Brain aluminium levels remain elevated for up to four years after restoration of good renal function by transplantation. The association of dialysis encephalopathy with high levels of aluminium in the brain and in the dialysis water emphasises the potential neurotoxicity of aluminium in man.
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PMID:Brain-aluminium concentration in dialysis encephalopathy. 7 45

A survey of 1293 patients in eighteen dialysis centres in Great Britain showed a highly significant rank correlation of the incidence of both fracturing dialysis osteodystrophy (osteomalacic dialysis osteodystrophy) and dialysis encephalopathy with the aluminium content of water used to prepare dialysate.
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PMID:Fracturing dialysis osteodystrophy and dialysis encephalopathy. An epidemiological survey. 8 61

Clinical and Neuropathological data on sixteen cases of progressive myoclonic encephalopathy are reported. This neurological syndrome appears after an average duration of thirty two months of haemodialysis and leads to death in four and a half months, and is characterized by myoclonus, speech disorder, epileptic seizures, and mental-status changes. At first, clinical signs and symptoms are related to haemodialysis, later they become permanent. An early diagnosis is based on EEG which is the only useful laboratory test, demonstrating bisynchronous slow-wave bursts. The caracteristic histopathologic findings are neuronal depopulation, lipofuscin accumulation, and appearance of Neurofibrillary degeneration, especially in Motor cortex, red nucleus and dentato-olivary systems. It seems to be justified to attribute P.M.D.E. to aluminium chronic poisonning; the source of the aluminium intoxication is not aluminium containing phosphate-binding gels but intravenously administreted tape-water. The intracellular binding of aluminium is shown from a histochemical study employing fluorescent stain Morin.
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PMID:[Progressive myoclonic encephalopathy in dialysis patients. Clinical, electroencephalographic and neuropathological study. Pathogenetic discussion]. 10 55

The authors carried out high flow intestinal lavage during gastrointestinal bleeding in cirrhotics in order to obtain rapid elimination of blood from the intestine and thereby reduce the risk of encephalopathy. The fluid used had been developed for preparation of the colon for surgery and was responsible for water and electrolyte disturbances with water and salt retention. Without criticising the principle of lavage in the prevention of encephalopathy, the authors express certain reserves with regard to the use of this solution and suggest the use of a sodium-free substance remaining within the intestinal lumen (hypertonic mannitol) which does not cause any water/electrolyte imbalance, is more effective and would appear to have a slight though definite action on the resorption of ascites.
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PMID:[Hydroelectrolytic disturbances secondary to high flow lavage used for the prevention of posthemorrhagic encephalopathy in cirrhosis]. 30 Jan 56

The authors reports the results of 171 cases of portal systemic by pass operations out of a total of 200 cases operated on between 1968 and 1974. These 171 patients all presented with a syndrome of portal hypertension with oesophageal varices and all had previously bled. Their age lay in 70 p. cent of cases between 40 and 60 years and the cause of hypertension was in 96 p. cent of cases an intra-hepatic block. 41 p. cent were included in the risk group A according to Child's classification, 51 p. cent in Group B and 8 p. cent in Group C. The routine operation was side-to-side portacaval anastomosis (75 p. cent). The operative mortality was 5.2 p. cent in all with 1 p. cent in cases with risk A, and 15 p. cent in cases with risk C. The fall in portal pressure was on average 15 cm of water, i.e. 41 p. cent of the initial pressure. The overall survival after 5 years was 65 p. cent, 70 p. cent for risk A and 26 p. cent for risk C. In 69 p. cent of cases the cause of death was liver failure. Encephalopathy, studied in 76 patients over an average period of 3 years, occurred in 39 p. cent of cases, and in 13 p. cent of the latter it was serious. In the 12 p. cent of survivors, we noted recurrent hemorrhage, but in only 2.5 p cent of cases did the bleeding definitely come from oesophageal varices. In the light of these results, the authors judge positively the surgical treatment of portal hypertension.
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PMID:[Immediate and late results of 171 therapeutic portal systemic by pass operations (author's transl)]. 30 46

Rapid digestive irrigation makes it possible to remove all the blood contained in the intestine of the cirrhotic suffering from a gastrointestinal haemorrhage. With this procedure, used 62 times during 110 haemorrhages occurring in 57 patients with portal hypertension due to cirrhosis, there was statistically significant prevention (p is less than 0.001) against complications of post-haemorrhagic encephalopathy, but there was no action where neurological and psychiatric problems had already developed. The excellent tolerance of mannitol in a concentration of 100 mg/l, and in particular the absence of any untoward effects on water and electrolyte balance, made it possible to reduce fluid intake to 2000 ml in 2 hours without diminishing its effectiveness, the technique thus being simple and easy to apply.
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PMID:[Post-haemorrhagic encephalopathy in cirrhosis. Prevention by digestive irrigation with 100 mg/l mannitol (author's transl)]. 30 38

The authors present a 60-year-old patient undergoing periodic hemodialysis who, 3 years after beginning the treatment, developed a clinical picture consisting of disturbances of language, motor dispraxia, loss of memory and concentration, irritability, great change of personality, myoclonias and asterixis. This led progressively to a total loss of motor coordination, including speech. He died 5 months later in a state of dementia, psychosis and incontinence of sphincters. The symptomatology increased after hemodialysis sessions. The normal analytical studies carried out in these cases (electrocardiogram, electromyography, complete roentgenologic study) and also Zn, Cu, and ceruloplasmin measurements were normal. The electroencephalogram showed only a slow tracing with delta waves. Various etiopathogenic possibilities are commented on, as for example alterations in the dialysis water, the use of detergents in cleaning the artificial kidney, a syndrome of imbalance, a decrease in the body potassium and poisoning caused by certain metals such as tin, zinc and aluminium or by drugs which contain benzodiazepine derivatives. The authors conclude that the picture corresponds to a metabolic encephalopathy.
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PMID:[Dementia and hemodialysis (author's transl)]. 43 Nov 64

Sampling of brain tissue of two patients who died of dialysis encephalopathy syndrome have been studied using a combined electron microscope-electron microprobe x-ray analyzer. X-ray microanalysis showed that aluminium is present in high concentration in lysosomes of brain cells. This concentration is approximately one thousand-fold that which is normally measured in the grey matter. In these lysosomes, aluminium is present in needle like microcrystalline form of 0.006 micron diameter and 0.08 micron long on the average; in these crystals, aluminium is associated with phosphorus in a ratio of one atom of aluminium per atom of phosphorus. Similar lesions have been observed in the rat after intraperitoneal injections of water-soluble aluminium salts.
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PMID:[Progressive myoclonic encephalopathy in dialysis patients: presence of high concentrations of aluminium in the lysosomes of the cerebral cells (author's transl)]. 53 Aug 24

A midline stereotaxic lesion in rats destroying the periventricular tissue (lamina terminalis and preoptic-anterior hypothalamic periventricular stratum) surrounding the anteroventral third ventricle (AV3V) produces adipsia without other marked behavioral changes. Although food consumption is reduced in animals rendered adipsic by the lesion, feeding continued and intake is comparable to that of water-deprived-sham-lesioned animals. About half the rats recover drinking after a period of adipsia, but the others never resume water intake and become moribund. An analysis of urinary output indicates that adipsic animals fail to reduce urine volume and continue to elaborate an inappropriately dilute urine. The periventricular lesion-induced adipsia without compensating antidiuresis produces a significant rise in plasma protein, sodium, osmolality, and urea nitrogen which if untreated often results in acute encephalopathy leading to death. These data suggest that preoptic-anterior hypothalamic periventricular tissue houses vital neural elements which function in the modulation of water ingestive and conservation mechanisms directed at the maintenance of body fluid homeostasis.
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PMID:Periventricular preoptic-hypothalamus is vital for thirst and normal water economy. 62 68


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