ABSTRACT
OBJECTIVES: Previous evoked potential studies indicated central impairments of somatosensory function in patients suffering from hepatic encephalopathy (HE). The aim of this study was to quantify the somatosensory perception in patients with minimal and overt HE. MATERIALS AND METHODS: Forty-two patients with liver cirrhosis and HE up to grade 2 and 12 age-matched healthy controls underwent a comprehensive graduation of HE including the West Haven criteria, the critical flicker frequency (CFF), and neuropsychometric testing. Quantitative sensory testing, standardized by the German Research Network on Neuropathic Pain, was performed on both hands. RESULTS: Pain and mechanical detection thresholds were unchanged in HE. Tests of thermal processing revealed that patients with HE of grade 2 perceive cold at lower temperatures (cold detection threshold) and need a higher temperature difference to distinguish between warm and cold (thermal sensory limen). These impairments correlated with the CFF. A correction for attention deficits by performing partial correlations using neuropsychometric test results canceled these correlations. CONCLUSIONS: The present findings demonstrate an impairment of temperature perception in HE. The extent of this impairment correlates with HE severity as quantified by the CFF. The attenuation of the correlations after correction for attention deficits suggests a strong role of attention deficits for the impaired thermal perception. Thus, it provides initial evidence for a central impairment of thermal processing in HE due to alterations in high-level processes rather than due to peripheral neuropathic processes, which are a frequent complication in patients with liver cirrhosis.
Subject(s)
Hepatic Encephalopathy/complications , Hepatic Encephalopathy/physiopathology , Somatosensory Disorders/etiology , Adult , Aged , Evoked Potentials, Somatosensory/physiology , Female , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/physiopathology , Male , Middle AgedSubject(s)
Esophageal Diseases/surgery , Esophagus/physiology , Esophageal Diseases/physiopathology , Female , Humans , Manometry , Middle Aged , PeristalsisABSTRACT
Pseudoaneurysms of the hepatic artery are a rare cause for upper gastrointestinal hemorrhage and usually become clinically evident within 5 months from the inciting traumatic event. We report a case of recurrent massive upper gastrointestinal hemorrhage from a hepatic artery pseudoaneurysm sustained in an automobile accident 2 yr before the first episode of bleeding. Difficulty in early diagnosis and treatment of hepatic artery aneurysm remain the major reason for the associated high mortality. Angiography has proven to be the most consistent and effective method of diagnosis. Treatment is surgical.
Subject(s)
Aneurysm/complications , Gastrointestinal Hemorrhage/etiology , Hepatic Artery , Abdominal Injuries/complications , Adult , Aneurysm/etiology , Aneurysm/surgery , Humans , Male , Time FactorsABSTRACT
A variety of intestinal and extraintestinal neoplasms has been associated with Peutz-Jeghers syndrome, although to our knowledge, there has been no reported case of associated pancreatic neoplasm. We report a 38-yr-old man with Peutz-Jeghers syndrome and pancreatic adenocarcinoma and review current literature regarding a neoplastic diathesis in these patients.
Subject(s)
Adenocarcinoma/diagnosis , Neoplasms, Multiple Primary/diagnosis , Pancreatic Neoplasms/diagnosis , Peutz-Jeghers Syndrome/diagnosis , Adenocarcinoma/pathology , Adult , Humans , Male , Pancreatic Neoplasms/pathology , Peutz-Jeghers Syndrome/diagnostic imaging , Peutz-Jeghers Syndrome/pathology , RadiographyABSTRACT
The effect of acute and chronic administration of ethanol on jejunal and ileal water and electrolyte transport was studied in healthy volunteers by the triple lumen intestinal perfusion technique. The acute perfusion of a glucose-free electrolyte solution containing 2 to 10 g per 100 ml of ethanol in the jejunum or ileum did not cause any significant alterations of sodium or water transport. In contrast, the administration of a folate-deficient diet and ethanol for 2 weeks produced a marked reduction in sodium and water absorption or a small net secretion (control, mean +/-SE: H2O = 0.91 +/- 0.06 ml per min, Na = 130 +/- 8 micronEq per min per 30 cm of intestine versus H2O = -0.13 +/- 0.14 ml per min, Na = -20 +/- 29 micronEq per min per 30 cm, P less than 0.001). These changes were not accompanied by a reduction in serum folate levels. The administration of ethanol with a folate-supplemented diet also produced significant but less pronounced changes in sodium and water transport control: H2O = 1.33 +/- 0.2 ml per min, Na = 185 +/- 34 micronEq per min per 30 cm of intestine versus H2O = 0.48 +/- 0.17 ml per min, Na =65 +/- 16 micronEq per min per 30 cm of intestine, P less than 0.05). From this study it appears that the diarrhea seen in chronic alcoholics can be explained in part by the effect of ethanol on intestinal sodium transport, without any accompanying changes in serum folate levels.
