The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
Andrea K. Cheatham - One of the best experts on this subject based on the ideXlab platform.
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Portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunt: Results of a prospective controlled study
Hepatology, 1994Co-Authors: Arun J. Sanyal, Arthur M. Freedman, Mitchell L. Shiffman, Preston P. Purdum, Velimir A. Luketic, Andrea K. CheathamAbstract:: Portosystemic Encephalopathy is a common complication of surgical portacaval shunts. Recently, transjugular intrahepatic portosystemic shunts have been proposed to produce portal decompression in a manner analogous to a side-to-side portacaval shunt, but with less morbidity. The incidence and clinical spectrum of portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunts, however, had not been previously prospectively defined. We therefore prospectively studied portosystemic Encephalopathy in 30 patients undergoing transjugular intrahepatic portosystemic shunts and compared these findings with 25 patients concurrently undergoing sclerotherapy (controls). At entry, both study groups were comparable. Portosystemic Encephalopathy was assessed by examining and grading mental status, asterixis, plasma ammonia and trail making tests. The portosystemic Encephalopathy index was calculated from these parameters. Nine of 30 patients with transjugular intrahepatic portosystemic shunts experienced 24 episodes of acute portosystemic Encephalopathy during follow-up; 6 of 9 had a history of portosystemic Encephalopathy before transjugular intrahepatic portosystemic shunts and 5 of these 6 patients had Child C cirrhosis. Mental status and asterixis scores as well as portosystemic Encephalopathy index worsened significantly in the first month after transjugular intrahepatic portosystemic shunts but showed some improvement thereafter. Increasing age, a medical history of portosystemic Encephalopathy and trail scores for part B greater than 100 sec were predictors of portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunts. Portosystemic Encephalopathy could be managed medically in all but one patient who underwent liver transplant. In contrast, there were no significant changes in mental status, asterixis, ammonia or trail scores over time in sclerotherapy controls. Only six episodes of Encephalopathy occurred in endoscopic sclerotherapy patients over the duration of the study. Thus, overall risk of portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunts was higher than during sclerotherapy.
Xuefeng Wang - One of the best experts on this subject based on the ideXlab platform.
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Seizures in steroid-responsive Encephalopathy.
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2020Co-Authors: Aolei Lin, Xuefeng WangAbstract:Steroid-responsive Encephalopathy is a general term for diseases that are characterized by diffuse brain injury and respond well to corticosteroids or immunosuppressive agents, including Hashimoto's Encephalopathy (HE), limbic encephalitis (LE), systemic lupus erythematosus Encephalopathy (SLEE), antineutrophil cytoplasmic antibodies (ANCA)-associated systemic vasculitis Encephalopathy (AASV), viral encephalitis (VE), and primary central nervous system lymphoma (PCNSL). Epilepsy and status epilepticus are the main manifestations of steroid-responsive Encephalopathy. The spectrum of "autoimmune epilepsy" diseases, which has been approved by the epilepsy diagnostic recommendations of the International Antiepileptic League, is characterized by a high prevalence of epilepsy in central nervous system (CNS) autoimmune diseases and a variety of neuron-specific autoantibodies. Steroid-responsive Encephalopathy with different causes may have different pathogeneses and has been suggested to be associated with some internal commonality producing seizure as the main symptom. Determining the regularity of seizures caused by steroid-responsive Encephalopathy and implementing appropriate measures will help us improve the prognosis of patients. This paper summarizes the epidemiology, seizure onset, seizure type, and other characteristics of seizures in steroid-responsive Encephalopathy (including HE, LE, SLEE, ANCA-associated systemic vasculitis Encephalopathy, VE, and PCNSL) and then discusses the use of antiepileptic drugs to treat steroid-responsive Encephalopathy.
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Application of Plasma Exchange in Steroid-Responsive Encephalopathy.
Frontiers in Immunology, 2019Co-Authors: Yuting Jiang, Xin Tian, Xuefeng WangAbstract:Plasma exchange has been widely used in autoimmune neurological diseases and is the standard treatment for myasthenia gravis crisis and Guillain-Barre syndrome. A growing body of research suggests that, in the clinical application of steroid-responsive Encephalopathy, such as for Hashimoto's Encephalopathy, limbic encephalitis, systemic lupus erythematosus Encephalopathy, ANCA-associated vasculitis Encephalopathy, and acute disseminated encephalomyelitis, plasma exchange is a safe, and effective option when steroids or other immunosuppressive therapies are ineffective in the short term or when contraindications are present. Additionally, plasma exchange can also be used alone or in combination with steroids, immunoglobulins, or other immunosuppressive agents to treat steroid-responsive Encephalopathy. This paper reviews the clinical application of plasma exchange in steroid-responsive Encephalopathy, including its indications, onset time, course, curative effects, and side effects.
Arun J. Sanyal - One of the best experts on this subject based on the ideXlab platform.
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Portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunt: Results of a prospective controlled study
Hepatology, 1994Co-Authors: Arun J. Sanyal, Arthur M. Freedman, Mitchell L. Shiffman, Preston P. Purdum, Velimir A. Luketic, Andrea K. CheathamAbstract:: Portosystemic Encephalopathy is a common complication of surgical portacaval shunts. Recently, transjugular intrahepatic portosystemic shunts have been proposed to produce portal decompression in a manner analogous to a side-to-side portacaval shunt, but with less morbidity. The incidence and clinical spectrum of portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunts, however, had not been previously prospectively defined. We therefore prospectively studied portosystemic Encephalopathy in 30 patients undergoing transjugular intrahepatic portosystemic shunts and compared these findings with 25 patients concurrently undergoing sclerotherapy (controls). At entry, both study groups were comparable. Portosystemic Encephalopathy was assessed by examining and grading mental status, asterixis, plasma ammonia and trail making tests. The portosystemic Encephalopathy index was calculated from these parameters. Nine of 30 patients with transjugular intrahepatic portosystemic shunts experienced 24 episodes of acute portosystemic Encephalopathy during follow-up; 6 of 9 had a history of portosystemic Encephalopathy before transjugular intrahepatic portosystemic shunts and 5 of these 6 patients had Child C cirrhosis. Mental status and asterixis scores as well as portosystemic Encephalopathy index worsened significantly in the first month after transjugular intrahepatic portosystemic shunts but showed some improvement thereafter. Increasing age, a medical history of portosystemic Encephalopathy and trail scores for part B greater than 100 sec were predictors of portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunts. Portosystemic Encephalopathy could be managed medically in all but one patient who underwent liver transplant. In contrast, there were no significant changes in mental status, asterixis, ammonia or trail scores over time in sclerotherapy controls. Only six episodes of Encephalopathy occurred in endoscopic sclerotherapy patients over the duration of the study. Thus, overall risk of portosystemic Encephalopathy after transjugular intrahepatic portosystemic shunts was higher than during sclerotherapy.
M Merli - One of the best experts on this subject based on the ideXlab platform.
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pharmacological prophylaxis of hepatic Encephalopathy after transjugular intrahepatic portosystemic shunt a randomized controlled study
Journal of Hepatology, 2005Co-Authors: Oliviero Riggio, Andrea Masini, C Efrati, Francesca Nicolao, S Angeloni, Filippo Maria Salvatori, Mario Bezzi, A F Attili, M MerliAbstract:Background/Aims Hepatic Encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt (TIPS), especially during the first months. Aim of this study was to compare two different treatments (lactitol 60g/day, rifaximin 1200mg/day) with no-treatment in the prevention of post-TIPS hepatic Encephalopathy. Methods Seventy-five consecutive cirrhotics submitted to TIPS were randomized to receive either one of the above treatments or no-treatment. The main end-point was the occurrence of an episode of overt hepatic Encephalopathy during the first month post-TIPS. Before the procedure and weekly thereafter the patients were evaluated by examining their mental status, asterixis, ammonia and trail-making-test Part-A (TMT-A). Results The three groups were comparable for age, sex, etiology, Child-Pugh-score, post-TIPS porto-systemic gradient, previous hepatic Encephalopathy, basal values of ammonia and psychometric performance. Twenty-five patients developed hepatic Encephalopathy (33%, CI 95%=22–45%). One-month incidence was similar in the three groups ( P =0.97). Previous hepatic Encephalopathy (Relative Hazard=3.79;1.27–11.31) and basal-TMT-A Z -score>1.5 (RH=3.55;1.24–10.2) were predictors of post-TIPS Encephalopathy at multivariate analysis. A Conclusions Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic Encephalopathy during the first month after a TIPS.
Di Nino G - One of the best experts on this subject based on the ideXlab platform.
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wernicke s Encephalopathy and pancreatic Encephalopathy after necrotic hemorrhagic pancreatitis a case report
Minerva Anestesiologica, 2009Co-Authors: E Zangheri, A Pigna, F Bova, Rita Maria Melotti, Roberta Dalessandro, Emilia Amanti, Di Nino GAbstract:This case report describes a case of acute necrotic-hemorrhagic pancreatitis complicated by Wernicke's encephatopathy (WE) and stresses the importance of a correct dietetic regimen. A 39-year-old Chinese male patient with negative remote pathological anamnesis was hospitalized in the Medical Department with a diagnosis of gallstones. The clinical course was complicated with the onset of acute pancreatitis. Enteral fasting was imposed with intravenous feeding without vitamin supplementation. The progressive worsening of the clinical, radiodiagnostic and laboratory profile combined with deterioration in the state of consciousness promoted, on the 36th day exploratory laparotomy revealed necrotic-hemorrhagic pancreatitis. The patient was, therefore, admitted to the Intensive Care Unit in a deep coma. The recent medical history, neurological examination, and encephalic computed tomography suggested a revealing diagnosis of WE combined with pancreatic Encephalopathy.
