Clinical and Biochemical Parameters of Nutrition to Predict Hepatic Encephalopathy in Cirrhotic Patients / 대한소화기학회지

BACKGROUND/AIMS: Protein-calorie malnutrition is a common complication in cirrhosis. Protein restriction for the treatment of hepatic encephalopathy (HE) may cause disease progression and poor prognosis. Therefore, we evaluated important clinical parameters for nutritional state in cirrhotic patients with or without HE to predict the development of HE. METHODS: Twenty-two cirrhotic patients were divided into two groups; group A-13 patients without HE and group B-9 patients with HE. Clinical and biochemical parameters, serum proteins {serum albumin, insulin-like growth factor-1 (IGF-1), transferrin, leptin, etc}, immunologic parameters and anthropometry were measured. RESULTS: Child-Pugh score and Model for End-stage Liver Disease (MELD) scale were higher in group B (p<0.01). After correction of various factors affecting nutritional assessment, especially of Child-Pugh score and MELD scale, leptin was higher in group B (p<0.05). There was no difference in anthropometric measurements. Transferrin correlated inversely with MELD scale in group A (p<0.01). IGF-1 correlated inversely with total lymphocyte count in group B (p<0.05). Leptin correlated with Child-Pugh scores, total lymphocyte count and mid-arm muscle cirumference in group A (p<0.05, p<0.05 and p<0.05, respectively), and correlated inversely with CD8 in group B (p<0.05). CONCLUSIONS: Leptin level is higher in patients with HE, and further studies for parameters of nutrition to predict HE in many cirrhotic patients will be needed.

Aphasic Status Epilepticus: Two Cases / 대한간질학회지

BACKGROUND & SIGNIFICANCE: Aphasic status epilepticus is an uncommon presentation of a simple partial status epilepticus characterized by prolonged speech impairment with clinical-EEG correlation in the absence of an altered level of consciousness. There has been no published report in Korea. This study reports two adult patients with prolonged aphasia and EEG abnormalities. CASES: Total three episodes of aphasic status epilepticus were documented in two patients. Patients were right-handed 58-year-old and 79-year-old women. The cause was intracranial plasma cell granuloma involving left temporal lobe and old left temporo-parietal hemorrhage respectively. Aphasic symptoms of these patients were characterized by difficult comprehension and jargon speech with clear consciousness. The duration of aphasia ranged 9-14 days. EEG showed continuous periodic lateralized sharp waves in one patient and discrete rhythmic theta to alpha activities in left temporo-parieto-occipital region in the other patient. COMMENTS: Although rare in adults, aphasic status epilepticus should be considered in the differential diagnosis of aphasia.