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https://www.readbyqxmd.com/read/27923694/neuropsychiatric-performance-in-patients-with-cirrhosis-who-is-normal
#1
REVIEW
Sara Montagnese, Michele De Rui, Paolo Angeli, Piero Amodio
Normal neuropsychiatric performance in cirrhosis has been traditionally defined by the absence of any degree of hepatic encephalopathy (HE) and/or the absence of psychometric or neurophysiological abnormalities, by comparison with reference data from the healthy population. It is our impression that as our understanding and management of end-stage liver disease continues to change, the concept of normal neuropsychiatric performance may also need updating. This review explores novel and possibly more pragmatic interpretations of neuropsychiatric "normality" by comparison with top personal performance, in terms of risk of overt HE/brain failure and in relation with events such as liver transplantation, decompensation, acute-on-chronic liver failure (ACLF) and Transjugular Intrahepatic Portal-systemic Shunt (TIPS) placement...
December 3, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27922089/elderly-patients-have-an-altered-gut-brain-axis-regardless-of-the-presence-of-cirrhosis
#2
Jasmohan S Bajaj, Vishwadeep Ahluwalia, Joel L Steinberg, Sarah Hobgood, Peter A Boling, Michael Godschalk, Saima Habib, Melanie B White, Andrew Fagan, Edith A Gavis, Dinesh Ganapathy, Phillip B Hylemon, Karen E Stewart, Raffi Keradman, Eric J Liu, Jessica Wang, Patrick M Gillevet, Masoumeh Sikaroodi, F Gerard Moeller, James B Wade
Cognitive difficulties manifested by the growing elderly population with cirrhosis could be amnestic (memory-related) or non-amnestic (memory-unrelated). The underlying neuro-biological and gut-brain changes are unclear in this population. We aimed to define gut-brain axis alterations in elderly cirrhotics compared to non-cirrhotic individuals based on presence of cirrhosis and on neuropsychological performance. Age-matched outpatients with/without cirrhosis underwent cognitive testing (amnestic/non-amnestic domains), quality of life (HRQOL), multi-modal MRI (fMRI go/no-go task, volumetry and MR spectroscopy), blood (inflammatory cytokines) and stool collection (for microbiota)...
December 6, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27919127/-deceased-donor-kidney-transplantation-from-a-liver-transplantation-recipient
#3
Shuhei Koike, Takashi Kobayashi, Yoshiyuki Okada, Shinsuke Shibuya, Kaoru Sakai, Yukari Tanaka, Shusuke Akamatsu, Hiromitsu Negoro, Naoki Terada, Toshinari Yamasaki, Yoshiyuki Matsui, Takahiro Inoue, Tomomi Kamba, Yumi Umeya, Toshimi Kaido, Osamu Ogawa
We report a 40-year-old man with end-stage renal disease due to IgA nephropathy who underwent deceased donor kidney transplantation. The donor was diagnosed to be brain-dead due to cerebral hemorrhage after her second liver transplantation for non-viral liver cirrhosis. Intraoperative 1-hour biopsy of the graft kidney revealed moderate global glomerular sclerosis (22%) and interstitial fibrosis (40%) consistent with underlying nephrosclerosis or calcineurin inhibitor nephrotoxicity. Although hemodialysis was needed until the graft began functioning several days after the kidney transplantation, the postoperative clinical course thereafter was uneventful and the graft functioned well with stable serum creatinine levels around 2...
October 2016: Hinyokika Kiyo. Acta Urologica Japonica
https://www.readbyqxmd.com/read/27914003/n-terminal-pro-b-type-natriuretic-peptide-levels-are-linked-with-modified-child-pugh-classification-in-patients-with-nonalcoholic-cirrhosis-nt-probnp-and-liver-cirrhosis
#4
Abdulbaki Kumbasar, Mehtap Navdar, Esra Ataoglu, Isil Uzunhasan, Kadir Ergen, Sule Poturoglu, Filiz Basinoglu, Fatih Yilmaz, Mustafa Yenigun, Fuat Sar, Ozgur Tanriverdi
Excess N-terminal pro-brain natriuretic peptide secretion has been linked to cirrhosis in previously studies. The relationship of plasma N-terminal pro-brain natriuretic peptide levels and cardiac dysfunction determined by echocardiography were investigated in patients with nonalcoholic cirrhosis and a control group of chronic hepatitis. This study was designed as a cross-sectional study. Thirty-two men and thirty-three women who gave informed consent who were followed-up for chronic liver failure were enrolled...
December 2, 2016: Cell Biochemistry and Biophysics
https://www.readbyqxmd.com/read/27895414/hepatic-encephalopathy-ever-closer-to-its-big-bang
#5
EDITORIAL
Pablo A Souto, Ariel R Marcotegui, Lisandro Orbea, Juan Skerl, Juan Carlos Perazzo
Hepatic encephalopathy (HE) is a neuropsychiatric disorder that commonly complicates the course of patients with liver disease. Despite the fact that the syndrome was probably first recognized hundreds of years ago, the exact pathogenesis still remains unclear. Minimal hepatic encephalopathy (MHE) is the earliest form of HE and is estimated to affect more that 75% of patients with liver cirrhosis. It is characterized by cognitive impairment predominantly attention, reactiveness and integrative function with very subtle clinical manifestations...
November 14, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27861375/trends-of-do-not-resuscitate-consent-and-hospice-care-utilization-among-noncancer-decedents-in-a-tertiary-hospital-in-taiwan-between-2010-and-2014-a-hospital-based-observational-study
#6
Hsiao-Ting Chang, Ming-Hwai Lin, Chun-Ku Chen, Pesus Chou, Tzeng-Ji Chen, Shinn-Jang Hwang
Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27847646/hyperammonemia-is-associated-with-increasing-severity-of-both-liver-cirrhosis-and-hepatic-encephalopathy
#7
Abidullah Khan, Maimoona Ayub, Wazir Mohammad Khan
Background. Hyperammonemia resulting from chronic liver disease (CLD) can potentially challenge and damage any organ system of the body, particularly the brain. However, there is still some controversy regarding the diagnostic or prognostic values of serum ammonia in patients with over hepatic encephalopathy, especially in the setting of acute-on-chronic or chronic liver failure. Moreover, the association of serum ammonia with worsening Child-Pugh grade of liver cirrhosis has not been studied. Objective. This study was conducted to solve the controversy regarding the association between hyperammonemia and cirrhosis, especially hepatic encephalopathy in chronically failed liver...
2016: International Journal of Hepatology
https://www.readbyqxmd.com/read/27775818/rifaximin-has-no-effect-on-hemodynamics-in-decompensated-cirrhosis-a-randomized-double-blind-placebo-controlled-trial
#8
Nina Kimer, Julie Steen Pedersen, Troels Malte Busk, Lise Lotte Gluud, Lise Hobolth, Aleksander Krag, Søren Møller, Flemming Bendtsen
BACKGROUND AND RATIONALE: Decompensated cirrhosis is characterized by disturbed systemic and splanchnic hemodynamics. Bacterial translocation from the gut is considered the key driver in this process. Intestinal decontamination with rifaximin may improve hemodynamics. This double-blind, randomized, controlled trial investigates the effects of rifaximin on hemodynamics, renal function and vasoactive hormones. METHODS: We randomized 54 stable out-patients with cirrhosis and ascites to rifaximin 550 mg BD (n=36) or placebo BD (n=18)...
October 24, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27730496/modification-in-csf-specific-gravity-in-acutely-decompensated-cirrhosis-and-acute-on-chronic-liver-failure-independent-of-encephalopathy-evidences-for-an-early-blood-csf-barrier-dysfunction-in-cirrhosis
#9
Nicolas Weiss, Matteo Rosselli, Sarah Mouri, Damien Galanaud, Louis Puybasset, Banwari Agarwal, Dominique Thabut, Rajiv Jalan
Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific gravity of cerebrospinal fluid measured by CT is able to estimate blood-cerebrospinal fluid-barrier permeability. This study aimed to assess cerebrospinal fluid specific gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy...
October 11, 2016: Metabolic Brain Disease
https://www.readbyqxmd.com/read/27703637/intracranial-hemorrhage-induced-uncontrolled-seizure-in-a-deceased-donor-liver-transplant-patient-a-case-report
#10
Seung-Young Oh, Hannah Lee, Yang-Hyo Park, Ho Geol Ryu
Seizure is the second most common neurologic complication after liver transplantation and may be caused by metabolic abnormalities, electrolyte imbalance, infection, and immunosuppressant toxicity. A 61-year-old male patient underwent liver transplantation due to hepatitis B virus-related liver cirrhosis with portal systemic encephalopathy. The immediate postoperative course of the patient was uncomplicated. However, on postoperative day (POD) 6, weakness developed in both lower extremities. No abnormal findings were detected on a brain computed tomography (CT) scan on POD 8, but a generalized tonic clonic seizure developed which was difficult to control even with multiple antiepileptic drugs...
October 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27696270/new-technologies-new-insights-into-the-pathogenesis-of-hepatic-encephalopathy
#11
Luisa Baker, Bernard Lanz, Fausto Andreola, Javier Ampuero, Anisha Wijeyesekera, Elaine Holmes, Nicolaas Deutz
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome which frequently accompanies acute or chronic liver disease. It is characterized by a variety of symptoms of different severity such as cognitive deficits and impaired motor functions. Currently, HE is seen as a consequence of a low grade cerebral oedema associated with the formation of cerebral oxidative stress and deranged cerebral oscillatory networks. However, the pathogenesis of HE is still incompletely understood as liver dysfunction triggers exceptionally complex metabolic derangements in the body which need to be investigated by appropriate technologies...
September 30, 2016: Metabolic Brain Disease
https://www.readbyqxmd.com/read/27621721/creutzfeldt-jakob-disease-analysis-of-four-cases
#12
Ali Al Balushi, Marshall W Meeks, Ghazala Hayat, Jafar Kafaie
BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive neurodegenerative disease that almost always results in death in under a year from onset of symptoms. Here, we report four cases of CJD with different clinical presentations diagnosed at our institution over a 2-year period. CASES: The first patient is an 82-year-old woman who presented with depression, cognitive decline, and word-finding difficulty over 4 weeks. The patient deteriorated neurologically to akinetic mutism and death within 6 weeks of presentation...
2016: Frontiers in Neurology
https://www.readbyqxmd.com/read/27531677/hyperfibrinolysis-increases-blood-brain-barrier-permeability-by-a-plasmin-and-bradykinin-dependent-mechanism
#13
Oscar A Marcos-Contreras, Sara Martinez de Lizarrondo, Isabelle Bardou, Cyrille Orset, Mathilde Pruvost, Antoine Anfray, Yvann Frigout, Yannick Hommet, Laurent Lebouvier, Joan Montaner, Denis Vivien, Maxime Gauberti
Hyperfibrinolysis is a systemic condition occurring in various clinical disorders such as trauma, liver cirrhosis, and leukemia. Apart from increased bleeding tendency, the pathophysiological consequences of hyperfibrinolysis remain largely unknown. Our aim was to develop an experimental model of hyperfibrinolysis and to study its effects on the homeostasis of the blood-brain barrier (BBB). We induced a sustained hyperfibrinolytic state in mice by hydrodynamic transfection of a plasmid encoding for tissue-type plasminogen activator (tPA)...
November 17, 2016: Blood
https://www.readbyqxmd.com/read/27529042/progressive-multifocal-leukoencephalopathy-in-a-hiv-negative-immunocompetent-patient
#14
T Nanda
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease most common in immunodeficient patients. It occurs due to reactivation of the John Cunningham Virus (JCV) and carries a poor prognosis, with a median life expectancy of 6 months. We report a case of a 66-year-old man with a history of HCV related cirrhosis (HCV) and hepatocellular carcinoma (HCC) who was found to have PML in the setting of a negative viral load in the CSF and a CD4+ >200. He initially presented with two weeks of mild confusion and word-finding difficulty concerning for hepatic encephalopathy...
2016: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/27488112/a-longitudinal-study-of-patients-with-cirrhosis-treated-with-l-ornithine-l-aspartate-examined-with-magnetization-transfer-diffusion-weighted-imaging-and-magnetic-resonance-spectroscopy
#15
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
https://www.readbyqxmd.com/read/27484427/-a-man-with-slowly-progressive-dyspnea-on-exertion
#16
S T Lauren, S O Simons, A I J Arens
A 42-year-old man with a medical history of liver cirrhosis and portal hypertension was admitted to the hospital because of slowly progressive shortness of breath and hypoxemia. The diagnosis hepatopulmonary syndrome was confirmed by a pulmonary perfusion scan with 99m Tc-albumin. The scan showed a right-left shunt, because the 99m Tc-albumin transited the lungs and appeared in the brain, the thyroid gland, the kidneys and the spleen. The patient received a liver transplantation, which is considered the only definitive treatment...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27478349/hypopituitarism-presenting-as-adrenal-insufficiency-and-hypothyroidism-in-a-patient-with-wilson-s-disease-a-case-report
#17
Hae Won Lee, Jin Du Kang, Chang Woo Yeo, Sung Woon Yoon, Kwang Jae Lee, Mun Ki Choi
Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism...
August 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27471133/metronidazole-induced-encephalopathy-in-alcoholic-liver-disease-a-diagnostic-and-therapeutic-challenge
#18
Nikhil Sonthalia, Sunil V Pawar, Ashok R Mohite, Samit S Jain, Ravindra G Surude, Pravin M Rathi, Qais Contractor
BACKGROUND: Acute encephalopathy in a patient with alcoholic liver disease (ALD) is a commonly encountered emergency situation occurring most frequently due to liver failure precipitated by varying etiologies. Acute reversible cerebellar ataxia with confusion secondary to prolonged metronidazole use has been reported rarely as a cause of encephalopathy in patients with ALD. CASE REPORT: We describe a decompensated ALD patient with recurrent pyogenic cholangitis associated with hepatolithiasis who presented to the emergency department with sudden-onset cerebellar ataxia with dysarthria and mental confusion after prolonged use of metronidazole...
October 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27458853/galactin-3-and-brain-natriuretic-peptide-versus-conventional-echocardiography-in-the-early-detection-of-cirrhotic-cardiomyopathy
#19
Wael A Abbas, Soheir M Kasem Ahmed, Amal M Abdel Aal, Amal A Mahmoud, Mohamed O Abdelmalek, Mohamed A Mekky, Mohamed A A Abozaid, Ahmed K Ibrahim
BACKGROUND/AIMS: Cirrhotic cardiomyopathy (CCM) is defined as an abnormal heart structure and function in cirrhotic patients. CCM includes systolic and diastolic dysfunction, electrophysiological abnormalities, and structural changes, both microscopic and macroscopic. Currently, there is no one diagnostic test that can identify patients with CCM. Evaluation of the validity of galactin-3 and brain natriuretic peptide (BNP) as biomarkers in the early detection of CCM in comparison to conventional echocardiography...
July 2016: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
https://www.readbyqxmd.com/read/27421188/isolated-traumatic-brain-injury-in-patients-with-cirrhosis-do-different-treatment-paradigms-result-in-increased-mortality
#20
Simone Langness, Todd W Costantini, Alan Smith, Vishal Bansal, Raul Coimbra
BACKGROUND: Cirrhosis is associated with increased mortality in trauma, yet its effects on outcomes after traumatic brain injury (TBI) are unclear. We hypothesized that cirrhosis adversely effects mortality and increases complications after TBI. METHODS: Cirrhotic patients with isolated TBI were matched with noncirrhotic TBI patients in a 3:1 ratio based on age, sex, injury mechanism, and injury severity score at our academic, level 1 trauma center. RESULTS: Of the 8,748 patients with isolated TBI, 65 patients had concurrent cirrhosis...
June 18, 2016: American Journal of Surgery
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