ABSTRACT
Forty-one patients with fulminant hepatic failure and coma underwent 180 periods of haemodialysis with polyacrylonitrile membrane (AN 69 HD). Hepatic failure was due to viral hepatitis in 40 and drugs in one. Total recovery of consciousness occurred in 17 patients (43.6%), and partial in seven (17.9%)--that is, an overall figure of 61.5%. Regain of consciousness was not related to liver regeneration as assessed by levels of factor V and hepatocyte volume fraction. At the time of the first haemodialysis, neurological status was significantly impaired in the patients who could not be aroused. Mean duration of coma grade IV averaged 6.1 +/- 4.3 days and mean duration of illness until death or decerebration 8.6 +/- 8.3 days. Of the 17 patients who totally regained consciousness, nine recovered and eight died (three from intercurrent complications and five with no liver regeneration).
Subject(s)
Hepatic Encephalopathy/therapy , Renal Dialysis , Acrylonitrile , Adolescent , Adult , Aged , Amino Acids/blood , Consciousness , Electroencephalography , Female , Humans , Liver/pathology , Liver Regeneration , Male , Membranes, Artificial , Middle AgedSubject(s)
Calcinosis/etiology , Celiac Plexus , Lymphatic Diseases/etiology , Silicosis/complications , Aged , Humans , Male , SyndromeSubject(s)
Cholestasis/enzymology , Coenzyme A Ligases/biosynthesis , Hexosyltransferases/biosynthesis , Bilirubin , Cholestasis/drug therapy , Cholestasis/etiology , Clofibrate/analogs & derivatives , Clofibrate/pharmacology , Enzyme Induction/drug effects , Glucuronates , Glutethimide/pharmacology , Humans , Phenobarbital/pharmacologySubject(s)
Amyloidosis/complications , Polycythemia/etiology , Dysgammaglobulinemia/complications , Female , Humans , Male , Middle Aged , Ovum , Polycythemia/complicationsSubject(s)
Hepatic Encephalopathy/etiology , Hepatitis/complications , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle AgedSubject(s)
Hepatic Encephalopathy/etiology , Hepatitis/complications , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , PrognosisSubject(s)
Enzyme Induction/drug effects , Liver/enzymology , Phenobarbital/pharmacology , Bile Acids and Salts/metabolism , Bilirubin/metabolism , Cholestasis/drug therapy , Cholestasis/enzymology , Chronic Disease , Gilbert Disease/drug therapy , Gilbert Disease/enzymology , Humans , Infant, Newborn , Jaundice/congenital , Jaundice/drug therapy , Jaundice, Neonatal/drug therapy , Jaundice, Neonatal/enzymology , Liver/cytology , Osteomalacia/chemically induced , Phenobarbital/adverse effects , Phenobarbital/therapeutic use , Porphyrias/chemically inducedABSTRACT
19 patients with HBs Ag-positive fulminant hepatitis underwent exchange transfusions and anti-HBs-rich plasma infusions. Circulating HBs Ag disappeared in 17 cases. Circulating anti-HBs detected by RIA was higher in cases with liver regeneration. There was no correlation between circulating anti-HBs level and the amount of anti-HBs-rich plasma administered. Recovery was observed in 36% of the cases and liver regeneration in 47%. As the beneficial effect of such a treatment is not yet evident, a controlled trial should require pairing of patients with respect to the number of exchange transfusions and amount of real or placebo anti-HBs.
Subject(s)
Antibodies , Hepatitis B Antibodies , Immunotherapy , Adolescent , Adult , Antibodies/administration & dosage , Clinical Trials as Topic , Exchange Transfusion, Whole Blood , Female , Hepatitis B Antibodies/administration & dosage , Hepatitis B Antibodies/analysis , Hepatitis B Antigens/analysis , Humans , Liver Function Tests , Liver Regeneration , Male , Middle AgedABSTRACT
The authors have achieved 5 complete recoveries from coma and two partial recoveries in 9 non-decerebrate patients in coma due to acute hepatic atrophy by using polyacrylonitrile membrane haemodialysis. Survival was not possible until sufficient hepatic regeneration had developed. On the other hand, repeated returns to consciousness were observed with prolonged survival lasting up to 40 days despite almost complete destruction of the liver. The different hypothesis relating to the mechanism of the encephalopathy and the usefulness of such a procedure are discussed: filtration of ammonia, free fatty-acids, role of amino-acids and possible polypeptides.