Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The specificity of anatomo-clinical observations were investigated on 776 out of 982 consecutive persons hospitalized at the University Psychiatric Clinic of Geneva. Discriminant function analysis shows that most of the anatomical classes (no dementia, senile dementia, Alzheimerized senile dementia and Alzheimer's presenile dementia, vascular dementia, combined dementia nnd undefined form of encephalopathy) are at least partially separable (less than 50% overlap). On the basis of anatomical criteria, Alzheimer's presenile dementia is not separable from Alzheimerized senile dementia, and senile dementia is not separable from combined dementia. Differentiation between the anatomical classes is improved by a preliminary analysis based on clinical diagnosis. Senile plaques account for 43.4% of the total variation between the anatomical classes. The coefficient of agreement between anatomical and clinical diagnosis is 0.27, which is highly significant. The diagnosis of senile dementia has a poor specificity, while the diagnosis of senile Alzheimerized dementia has a better one. The diagnosis of combined dementia has to be reserved for cases with a similar intensity of vascular and degenerative changes. Alzheimer's presenile dementia has a distinct dominant hereditary pattern and must be considered a separate entity. The high specificity of the diagnosis of Alzheimer's presenile dementia makes it possible to conduct epidemiologic and genetic surveys based on clinical data.
 ...
PMID:Specificity of the clinical diagnosis of dementia. 115 60

We report on our experience with a modified version of the distal splenorenal shunt (DSRS) initially described by Warren. Since 1976 more than 150 shunts have been done in the department. The first part of this study shows the long-term results of a series of 100 consecutive patients treated electively. The estimated survival at 80 months was around 30%. On the other hand, the median survival rate (68 months) and the five-year survival (52%) of Child's A patients differed significantly from those of Child's B patients (8 months and 15%, respectively). These results suggested that the modified DSRS was an effective and relatively safe procedure for the elective treatment of variceal bleeding and warranted a prospective and randomized trial to compare DSRS and endoscopic sclerotherapy (ES). In the second part of the study, in which ES was compared with DSRS, both modalities showed a similar survival rate, although patients in the DSRS group had a higher incidence of encephalopathy and patients in the ES group were more prone to rebleed. It was concluded that ES was a good alternative to DSRS for the elective treatment of esophageal variceal bleeding. If orthotopic liver transplant is considered the only definitive mode of treatment for the elective management of portal hypertension, the DSRS should be reserved for patients in whom ES has not been totally effective, or varices are located predominantly in the fundus of the stomach.
 ...
PMID:The modified distal splenorenal shunt in the elective treatment of variceal hemorrhage. 182 61

In this study, the side-to-side (MCS-SS) and end-to-side (MCS-ES) mesocaval shunt were performed in two groups of thioacetamide (TAA)-induced cirrhosis of rats. The anastomotic stoma was made equal to the calibre of mesenteric veins. It was found that the portal vein pressure after MCS-SS was lower than that after MCS-ES owing to the more effective drainage of both extra- and intrahepatic portal blood flow. It was also found that with MCS-SS, some inflow from the superior mesenteric vein was reserved to irrigate the liver and the content of insulin in the portal vein was not affected. The authors came to the conclusion that MCS-SS was superior to MCS-ES for less likely causing post-shunt encephalopathy and the deterioration of hepatic function.
 ...
PMID:[A comparative experimental study of side-to-side and end-to-side mesocaval shunt]. 209 69

Based on the experience reported herein, the following conclusions have been made: (1) Although nonoperative means, including sclerotherapy, have an important role in the management of bleeding varices, they are not definitive means of treating recurrent variceal hemorrhage. (2) Because of the maintenance of hepatopetal flow and splanchnic venous hypertension, a selective shunt is associated with a lower incidence of encephalopathy and provides a better quality of life than does a nonselective shunt. Thus, an elective distal splenorenal shunt is the elective operation of choice for recurrent variceal hemorrhage. (3) Nonselective shunts can be performed with similar expectation of patient survival as selective shunts, but because of increased encephalopathy, should be reserved for emergency operations, in cases of unsuitable venous anatomy, and in those patients with intractable ascites. (4) A well-conceived elective shunt procedure can be performed with low operative mortality and long-term patency, results in significant survival, and is still considered the "gold standard" for treatment of variceal bleeding.
 ...
PMID:Selective and nonselective shunts for variceal bleeding. A prospective study of 103 patients. 661 Oct 93

Injection sclerotherapy is the mainstay of treatment for acute variceal bleeding and for long-term management after a variceal bleed in 1993. However, the new technique of oesophageal variceal ligation may prove to be superior, either alone or in combination with low dose sclerotherapy. Pharmacological therapy for acute variceal bleeding is widely used and somatostatin appears to be the most effective agent. Long-term pharmacological therapy with beta-blockade is becoming increasingly accepted and some centres even use it as the primary therapy instead of sclerotherapy. Surgical shunts and major devascularization and transection procedures are mostly reserved for the failures of sclerotherapy, although certain groups utilize the Warren distal splenorenal shunt for the majority of fitter patients. Shunting may well prove to be more effective in long-term management than extensive devascularization and transection operations. The new interventional radiological technique, TIPS, is an exciting alternative procedure but it is unlikely to be accepted for widespread use because of increasing reports of encephalopathy and of late occlusion due to neointimal hyperplasia. TIPS's main role is as a bridge to transplantation for the failures of sclerotherapy oesophageal variceal banding.
 ...
PMID:[Treatment of portal hypertension]. 772 95

Is transjugular intrahepatic portosystemic shunt (TIPS) preferable to a surgical shunting procedure in patients who are expected to benefit from a portal-systemic shunt? Since randomized trials comparing these procedures have not yet been reported, we attempted to define the present best therapeutic strategy by reviewing both the recent literature on TIPS and surgical shunting and our first experience with TIPS. The results suggest that TIPS is just as effective as surgical shunting but is associated with a lower morbidity and mortality. Procedure related deaths seem rare. In our series of 16 patients there was one death within 30 days. Seven early complications including stent dislodgement, early occlusion, encephalopathy and haemolysis were noted. The incidence of long-term complications, especially encephalopathy and shunt occlusion, seems comparable for both shunting procedures. Major advantages of TIPS are its therapeutic efficacy in patients with ascites and the fact that the technical difficulties of performing liver transplantation are not increased. We conclude that TIPS, performed by an experienced team, is at present the procedure of choice in patients who are candidates for a portal-systemic shunt, especially in patients in whom liver transplantation is a future option. Surgical shunts can be reserved for patients in whom TIPS is not feasible or has failed.
 ...
PMID:Transjugular intrahepatic portosystemic shunt. Requiem for the surgical portosystemic shunt? 801 71

The course of pregnancy in three patients with portal hypertension is described. The cause of portal hypertension was cirrhosis in one and portal vein obstruction in two (one of these had previous shunt surgery). The patient with cirrhosis had an episode of encephalopathy at week 27, the rest of the patients had an uneventful pregnancy. All three had preterm vaginal deliveries at week 33, 31 and 37 of pregnancy. The clinical features of pregnancy in women with portal hypertension was reviewed in the literature. There is agreement that the risk of preterm delivery increases and pregnancy does not influence maternal prognosis. Vaginal delivery can be anticipated in most women and cesarean section is reserved for obstetric indications. Pregnancy in these women should be managed in tertiary care centers with close collaboration between perinatologists, internists and surgeons.
 ...
PMID:[Pregnancy and portal hypertension]. 827 39

Liver cirrhosis is associated with malnutrition in 10 to 90% of cases, following different authors. This prompted us to compare our previous studies with recent literature data in order to review this topic from a practical standpoint. Several pathophysiological factors are blamed for this state and mainly protein and lipid-restricted diets from among these. Some lean and fat body mass indices predictive of malnutrition are proposed taking into account the influence of liver disease in their evaluation. Nitrogen balance derangements and liposoluble vitamins and carotenoids plasma decrease are highlighted as sensitive nutritional parameters. After a brief review of amino acid, glucose and lipid metabolic derangements, some nutritional guidelines are provided by distinguishing oral selective supports from the parenteral nutrition. The latter, being reserved to moderate-severe encephalopathy or to hemorrhagic conditions, is proposed following an algorithm which takes into account different nutritional principles as a function of the severity of the clinical condition. During the first period (24-48 hrs) parenteral fluids, electrolytes, dextrose and whole blood or derivatives (when necessary) are provided; lactulose or lactitol via nasogastric tube, or by enema, are started as well. During the following 48-72 hrs branched-chain amino acids alone or enriched solutions are added taking into account an optimum calorie/nitrogen ratio. Finally, vegetable lipids, vitamins and oligoelements can be added if intravenous nutrition must be maintained, with a view of warranting the most complete nutritional approach to these severely malnourished patients.
 ...
PMID:[Nutrition and malnutrition in hepatic cirrhosis]. 851 55

Bartonella (Rochalimaea) henselae is a common cause of cat-scratch disease. This newly identified bacterium is also the cause of several other clinical syndromes, including bacillary angiomatosis, bacillary peliosis hepatitis and splenitis, and acute and relapsing bacteremia. A high percentage of young cats carry B. henselae. Fortunately, serious complications of B. henselae infections are rare in immunocompetent patients. Cat-scratch disease is usually a self-limited illness that does not necessarily require antibiotic therapy. Severe or persistent cases respond well to several antibiotics, including erythromycin and doxycycline. Cat-scratch disease should be included in the differential diagnosis of serious neurologic disease, particularly when regional lymphadenopathy develops suddenly in a previously healthy patient who owns a cat. Treatment of uncomplicated central nervous system disease is generally supportive. Antibiotic therapy is reserved for patients with atypical or severe involvement, including encephalopathy and retinitis. Other internal and cutaneous manifestations of B. henselae infection have recently been described. These potentially life-threatening infections respond well to antibiotic therapy, even in immunocompromised patients.
 ...
PMID:Cat-scratch disease and related clinical syndromes. 910 5

Fulminant hepatic failure is a devastating illness that carries considerable mortality and affects patients with previously healthy livers. Although the etiology of FHF remains unclear in a significant number of cases, viral hepatitis and drug-induced liver injury account for the majority of identifiable causes. The clinical presentation varies widely, but is always characterized by the presence of encephalopathy. Markedly elevated transaminases are seen, but do not correlate with extent of liver injury. Prothrombin time, bilirubin, creatinine, and arterial pH are prognostic indicators of survival in FHF. FHF and its consequences must be readily recognized so that appropriate triage and treatment can be administered. All patients should be managed in an intensive care setting pending transfer to a liver transplantation center. Supportive care remains the mainstay of treatment, with liver transplantation reserved for select patients.
 ...
PMID:Fulminant hepatic failure. 956 13


1 2 3 Next >>