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Minimal hepatic encephalopathy

Yan Yin, Hong Xiao, Jirimutuya Han, Weiyi Zhang, Jianguo Cheng, Tao Zhu
BACKGROUND: It has been observed that patients with liver dysfunction need lower dose anesthetic compared patients with normal liver function. The minimum amount of volatile anesthetic to achieve an optimal depth of anesthesia for these patients is still unclear. In this study, Minimum alveolar concentration (MAC) of the sevoflurane was determined using an electric stimulation and the effect of severity of liver dysfunction on the MAC was observed in cirrhotic patients. METHODS: Thirty patients undergoing upper abdominal surgery were divided into the following groups: group N (normal liver function), group A (Child-Pugh grade A) and group B (Child-Pugh grade B-C)...
October 18, 2016: BMC Anesthesiology
Kishore Kv, Ravi K
No abstract text is available yet for this article.
January 2016: Journal of the Association of Physicians of India
Ying Li, Huaijun Liu, Jiping Yang, Xin Tian, Haiqing Yang, Zuojun Geng
AIM: Our objective is to explore key changes in brain functions in relation to minimal hepatic encephalopathy (MHE). Moreover, we incorporated both resting-state functional MRI (fMRI) and arterial spin labeling (ASL) to enhance the detection of MHE. METHODS: We conducted fMRI scanning for 56 MHE patients and 66 healthy controls. Region functional connectivity (FC) was carried out to assess the connectivity status between pair of regions among 90 brain regions. Additionally, blood flood (BF) status was measured by ASL for all subjects...
October 7, 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Cedric Peleman, Michael Camilleri
Rifaximin is beneficial in the treatment of minimal hepatic encephalopathy (MHE). Kang et al. (Clin Transl Gastroenterol 7: e187; doi:10.1038/ctg.2016.44) investigated the effects of rifaximin in a mouse model of MHE-associated microbiota without concomitant liver disease. In addition to some impact on the composition of microbiota, rifaximin altered bacterial functions, ameliorated local and systemic inflammation, and reduced enterocyte glutaminase activity. We discuss these effects as well as the interpretation of the permeability studies, given the potential interaction of dysbiosis with dysfunctional intestinal barrier, leading to systemic inflammation and increased uptake of bacterial metabolites that contribute to MHE in the presence of hepatic dysfunction...
October 6, 2016: Clinical and Translational Gastroenterology
Seiichiro Kojima, Hiroyuki Ito, Shinji Takashimizu, Hitoshi Ichikawa, Tomohiro Matsumoto, Terumitsu Hasebe, Norihito Watanabe
A 64-year-old woman treated for anemia and ascites exhibited hepatic encephalopathy. Abdominal ultrasonography and computed tomography (CT) showed communication between the portal vein and the middle hepatic vein, indicating an intrahepatic portosystemic venous shunt (PSS). Since hepatic encephalopathy of the patient was resistant to medical treatment, interventional radiology was performed for the treatment of shunt obliteration. Hepatic venography showed anastomosis between the hepatic vein branches, supporting the diagnosis of idiopathic portal hypertension (IPH)...
September 2016: Acta Radiologica Open
Carmina Montoliu, Vicente Felipo
No abstract text is available yet for this article.
September 20, 2016: Metabolic Brain Disease
Nasser Mousa, Ahmed Abdel-Razik, Ashraf Zaher, Magdy Hamed, Gamal Shiha, Narmin Effat, Sherif Elbaz, Rania Elhelaly, Mohamed Hafez, Niveen El-Wakeel, Waleed Eldars
BACKGROUND: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. METHODS: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs)...
September 2016: Therapeutic Advances in Gastroenterology
Davide Festi, Giovanni Marasco, Federico Ravaioli, Antonio Colecchia
Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4)...
July 2016: Recenti Progressi in Medicina
Dae J Kang, Genta Kakiyama, Naga S Betrapally, Jeremy Herzog, Hiroshi Nittono, Phillip B Hylemon, Huiping Zhou, Ian Carroll, Jing Yang, Patrick M Gillevet, Chunhua Jiao, Hajime Takei, William M Pandak, Takashi Iida, Douglas M Heuman, Sili Fan, Oliver Fiehn, Takao Kurosawa, Masoumeh Sikaroodi, R B Sartor, Jasmohan S Bajaj
OBJECTIVES: Rifaximin has clinical benefits in minimal hepatic encephalopathy (MHE) but the mechanism of action is unclear. The antibiotic-dependent and -independent effects of rifaximin need to be elucidated in the setting of MHE-associated microbiota. To assess the action of rifaximin on intestinal barrier, inflammatory milieu and ammonia generation independent of microbiota using rifaximin. METHODS: Four germ-free (GF) mice groups were used (1) GF, (2) GF+rifaximin, (3) Humanized with stools from an MHE patient, and (4) Humanized+rifaximin...
2016: Clinical and Translational Gastroenterology
Rani H Shayto, Rachel Abou Mrad, Ala I Sharara
Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler's diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis...
August 7, 2016: World Journal of Gastroenterology: WJG
Nicolas Weiss, Pierre Barbier Saint Hilaire, Benoit Colsch, Foucauld Isnard, Suleiman Attala, Augustin Schaefer, Maria Del Mar Amador, Marika Rudler, Foudil Lamari, Frédéric Sedel, Dominique Thabut, Christophe Junot
BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a neurological complication observed in patients with liver disease and/or porto-systemic shunt. The proportion of cirrhotic patients developing overt HE is about 20%, and 60-80% of cirrhotic patients exhibit mild cognitive impairment potentially related to minimal HE. However, the pathophysiological mechanisms of HE remain poorly understood. In this context, metabolomics was used to highlight dysfunction of metabolic pathways in cerebrospinal fluid (CSF) samples of patients suffering from HE...
August 9, 2016: Journal of Hepatology
C-F Tsai, C-J Chu, Y-P Wang, P-Y Liu, Y-H Huang, H-C Lin, F-Y Lee, C-L Lu
BACKGROUND: Sleep-wake disturbances are common in patients with cirrhosis and have a considerable effect on health-related quality of life; however, the underlying mechanism behind the phenomenon is unclear. Cytokines are involved in the mediation of signalling pathways regulating fibrogenesis, leading to cirrhosis. In addition, increased cytokines could contribute to sleep disturbances. AIM: To determine the relationship between pro-inflammatory cytokines and sleep disturbance in cirrhotic patients...
October 2016: Alimentary Pharmacology & Therapeutics
Natalia Arias, Marta Méndez, Jorge L Arias
Minimal hepatic encephalopathy (MHE) has been shown to affect daily functioning, quality of life, driving and overall mortality. However, little is known about treating or diagnosing early impairments involved in MHE. We studied one of its precipitating factors, portal hypertension. The purpose was to evaluate an enhancement in neuronal metabolism through low-light-level therapy (LLLT) and whether this therapy has effects on behavioural task acquisition. Rats were trained to perform a stimulus-response task using the Morris water maze...
November 2016: Lasers in Medical Science
Vijay P B Grover, Mark J W McPhail, Marzena Wylezinska-Arridge, Mary M E Crossey, Julie A Fitzpatrick, Louise Southern, Brian K Saxby, Nicola A Cook, I Jane Cox, Adam D Waldman, Novraj S Dhanjal, Aluel Bak-Bol, Roger Williams, Marsha Y Morgan, Simon D Taylor-Robinson
The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences...
August 3, 2016: Metabolic Brain Disease
Stefan Golaszewski, Patrick B Langthaler, Kerstin Schwenker, Cristina Florea, Monica Christova, Francesco Brigo, Eugen Trinka, Raffaele Nardone
Minimal hepatic encephalopathy (MHE) represents the earliest stage of hepatic encephalopathy (HE). MHE is characterized by cognitive function impairment in the domains of attention, vigilance and integrative function, while obvious clinical manifestations are lacking. In the present study, we aimed at assessing whether subjects with MHE showed alterations in synaptic plasticity within the motor cortex. Previous findings suggest that learning in human motor cortex occurs through long-term potentiation (LTP)-like mechanisms...
July 2016: Brain Research Bulletin
Mircea Alexandru Badea, Vasile Liviu Drug, Mihaela Dranga, Otilia Gavrilescu, Gabriela Stefanescu, Iolanda Popa, Catalina Mihai, Cristina Cijevschi-Prelipcean
The psychometric hepatic encephalopathy score (PHES) is frequently used as a "gold standard" for the diagnosis of minimal hepatic encephalopathy (MHE). In Romania, there are currently no widely available tests for the detection of MHE. In this study we aimed to standardize the PHES in a healthy Romanian population and to estimate the prevalence of MHE in a group of Romanian patients with liver cirrhosis. A total of 260 healthy volunteers and 106 patients with liver cirrhosis were included in the study. The five neuropsychological tests comprising the PHES were administered to all enroled subjects...
July 27, 2016: Metabolic Brain Disease
Ana Carolina Kogawa, Selma Gutierrez Antonio, Hérida Regina Nunes Salgado
Rifaximin is a gut-selective oral antimicrobial that has no systemic adverse effects compared with placebo. It is used for the treatment of hepatic encephalopathy, traveler's diarrhea, irritable bowel syndrome, Clostridium difficile infection, ulcerative colitis, and acute diarrhea. The crystalline form present in rifaximin, α, has minimal systemic absorption compared to the amorphous form. The objective of this study was to obtain polymorphic forms of rifaximin using recrystallization processes. The forms were characterized and studied by thermal analysis, X-ray powder diffraction, scanning electron microscopy, and solubility testing...
July 2016: Journal of AOAC International
Emi Yoshimura, Tatsuki Ichikawa, Hisamitsu Miyaaki, Naota Taura, Satoshi Miuma, Hidataka Shibata, Takuya Honda, Fuminao Takeshima, Kazuhiko Nakao
The diagnosis of minimal hepatic encephalopathy (MHE) is more difficult in comparison to the diagnosis of overt hepatic encephalopathy (OHE), as patients with MHE do not exhibit overt neurological deficits and must be diagnosed using specialized equipment. However, identifying MHE is critical for patients with cirrhosis, and a simple screening test is required. The present study aimed to evaluate the associations between MHE, clinical characteristics and questionnaire items regarding sleep disturbances and cirrhosis-related symptom score (CSS)...
August 2016: Biomedical Reports
M S Attia, Najlaa S Al-Radadi
A new, precise, and very selective method for increasing the impact and assessment of 3-nitrotyrosine (3-Nty) as a biomarker for early diagnosis of liver cirrhosis with minimal hepatic encephalopathy (MHE) disease was developed. The method depends on the formation of the ion pair associate between 3-nitrotyrosine and the optical sensor binuclear Pt-2-pyrazinecarboxylic acid (pca)-Bipyridine (bpy) complex doped in sol-gel matrix in buffer solution of pH 7.3. The binuclear Pt (pca)(bpy) has +II net charge which is very selective and sensitive for [3-Nty](-2) at pH 7...
December 15, 2016: Biosensors & Bioelectronics
Alba Moratalla, Javier Ampuero, Pablo Bellot, Rocío Gallego-Durán, Pedro Zapater, Manuela Roger, Blanca Figueruela, Belén Martínez-Moreno, José M González-Navajas, José Such, Manuel Romero-Gómez, Rubén Francés
BACKGROUND&AIM: Minimal hepatic encephalopathy is associated with poor prognosis and mortality in patients with cirrhosis. We aimed at investigating whether bacterial-DNA translocation affects hyperammonemia and neurocognitive scores in patients with mHE according to the use of lactulose. METHODS: Observational study including 72 mHE cirrhotic patients, as defined by a psychometric hepatic encephalopathy score (PHES)<-4 and/or a Critical Flicker Frequency (CFF)<39Hz...
July 7, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
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