• Title, Summary, Keyword: hepatic encephalopathy

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The High Expressed Serum Soluble Neural Cell Adhesion Molecule, a High Risk Factor Indicating Hepatic Encephalopathy in Hepatocelular Carcinoma Patients

  • Liu, Tian-Hua;Guo, Kun;Liu, Ri-Qiang;Zhang, Shu;Huang, Zhuo-Hui;Liu, Yin-Kun
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.8
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    • pp.3131-3135
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    • 2015
  • Objective: To investigate whether the expression of serum soluble neural cell adhesion molecule (sNCAM) is associated with hepatic encephalopathy (HE) in hepatocelular carcinoma (HCC) patients. Materials and Methods: The Oncomine Cancer Microarray database was used to determine the clinical relevance of NCAM expression in different kinds of human cancers. Sera from 75 HCC cases enrolled in this study were assessed for expression of sNCAM by enzyme linked immunosorbent assay (ELISA). Results: Dependent on the Oncomine Cancer Microarray database analysis, NCAM was down regulated in 10 different kinds of cancer, like bladder cancer, brain and central nervous system cancer, while up-regulated in lung cancer, uterine corpus leiomyoma and sarcoma, compared to normal groups. Puzzlingly, NCAM expression demonstrated no significant difference between normal and HCC groups. However, we found by quantitative ELISA that the level of sNCAM in sera from HCC patients with HE ($347.4{\pm}151.9ng/ml$) was significantly more up-regulated than that in HCC patients without HE ($260.3{\pm}104.2ng/ml$), the p-value being 0.008. sNCAM may be an important risk factor of HE in HCC patients, the correlation coefficients was 0.278 (P<0.05) on rank correlation analysis. Conclusions: This study highlights that up-regulated level of serum sNCAM is associated with HE in HCC patients and suggests that the high expression can be used as an indicator.

Diagnosis and Management of Acute Liver Failure in Children (소아에서 급성 간부전의 진단과 치료)

  • Shim, Jung Ok
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.sup2
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    • pp.50-58
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    • 2008
  • Acute liver failure is a devastating disease in children. Most cases of acute liver failure in children are indeterminate; however, metabolic liver disease is one of the main causes in the pediatric age group. Though a major symptom of acute liver failure is hepatic encephalopathy, this is very difficult to diagnose, particularly in younger children. Liver transplantation has improved the chances of survival dramatically; however, it is not known which patients are ideal candidates for liver transplantation. Because patients may deteriorate rapidly, arranging care in a center with expertise will secure the best possible outcomes.

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Electroencephalogram Power Spectra in Thioacetamide-induced Hepatic Encephalopathy (Thioacetamide 유발 간성뇌장애에서 뇌파 Power Spectra)

  • Lee, Chi-Hui;Choi, Won-Jin;Park, Jung-Sook;Lee, Hyang-Yi;Ha, Jeoung-Hee;Lee, Maan-Gee
    • The Korean Journal of Pharmacology
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    • v.32 no.3
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    • pp.293-300
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    • 1996
  • During the development of hepatic encephalopathy after thioacetamide (TAA) injection to rat, EEG was recorded at two different states: without or with tactile stimulation of tail at regular intervals. Calculations based on the spectral and band analysis were used. The changes in the power spectra and bands were examined in 3 different behavioral stages: normal, mild ataxia and severe ataxia. In normal rats, the stimulation produced the increase in the power of the theta $(3.5{\sim}8\;Hz)$ and the gamma $(30{\sim}50\;Hz)$ bands. These changes could not be produced in rats with the mild and severe ataxia. The changes in the power of the theta band occurred earlier than those of the beta3 and the gamma bands in the stimulated state. Gradual decreases in the spectral power of the beta3 $(21{\sim}30\;Hz)$ and the gamma bands were correlated with the progress of the stages from normal condition to mild to severe ataxia in both unstimulated and stimulated states. The results indicate that the spectral and band analysis used in this study can quantify the severity of the neurological malfunction during HE.

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Validation of a Paper and Pencil Test Battery for the Diagnosis of Minimal Hepatic Encephalopathy in Korea

  • Jeong, Jae Yoon;Jun, Dae Won;Bai, Daiseg;Kim, Ji Yean;Sohn, Joo Hyun;Ahn, Sang Bong;Kim, Sang Gyune;Kim, Tae Yeob;Kim, Hyoung Su;Jeong, Soung Won;Cho, Yong Kyun;Song, Do Seon;Kim, Hee Yeon;Jung, Young Kul;Yoon, Eileen L.
    • Journal of Korean Medical Science
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    • v.32 no.9
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    • pp.1484-1490
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    • 2017
  • The aim of this study was to validate a new paper and pencil test battery to diagnose minimal hepatic encephalopathy (MHE) in Korea. A new paper and pencil test battery was composed of number connection test-A (NCT-A), number connection test-B (NCT-B), digit span test (DST), and symbol digit modality test (SDMT). The norm of the new test was based on 315 healthy individuals between the ages of 20 and 70 years old. Another 63 healthy subjects (n = 31) and cirrhosis patients (n = 32) were included as a validation cohort. All participants completed the new paper and pencil test, a critical flicker frequency (CFF) test and computerized cognitive function test (visual continuous performance test [CPT]). The scores on the NCT-A and NCT-B increased but those of DST and SDMT decreased according to age. Twelve of the cirrhotic patients (37.5%) were diagnosed with MHE based on the new paper and pencil test battery. The total score of the paper and pencil test battery showed good positive correlation with the CFF (r = 0.551, P < 0.001) and computerized cognitive function test. Also, this score was lower in patients with MHE compared to those without MHE (P < 0.001). Scores on the CFF (32.0 vs. 28.7 Hz, P = 0.028) and the computer base cognitive test decreased significantly in patients with MHE compared to those without MHE. Test-retest reliability was comparable. In conclusion, the new paper and pencil test battery including NCT-A, NCT-B, DST, and SDMT showed good correlation with neuropsychological tests. This new paper and pencil test battery could help to discriminate patients with impaired cognitive function in cirrhosis (registered at Clinical Research Information Service [CRIS], https://cris.nih.go.kr/cris, KCT0000955).

Acquired Portosystemic Shunts Secondary to Hepatic Microvascular Dysplasia in a Young Dog

  • Hwang, Taesung;An, Soyon;Kim, Ahreum;Han, Changhee;Huh, Chan;Lee, Hee Chun
    • Journal of Veterinary Clinics
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    • v.37 no.2
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    • pp.88-90
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    • 2020
  • A one year old spayed female Bichon Frise dog presented with gait abnormalities and seizure. Serum biochemical results showed elevated levels of alkaline phosphatase, alanine aminotransferase, and ammonia. Serum bile acid level was also increased to be over 30 μmol/L on preprandial. Urinalysis identified the presence of ammonium urate crystal. Abdominal ultrasonography and CT revealed aberrant, tortuous, and multiple small vessels connected to the caudal vena cava between left kidney and caudal vena cava. Macroscopic specific findings associated with extrahepatic congenital portosystemic shunts (PSS) or other liver diseases were not identified. Liver biopsy was performed. Histopathologic evaluation revealed hepatic lobular hypoplasia with portal arterial duplication and vascular shunts. Based on these finding, this case was diagnosed as multiple acquired PSS secondary to hepatic microvascular dysplasia (HMD) and hepatic encephalopathy. A liver biopsy is recommended to differentiate HMD from other liver diseases and to confirm HMD when a young dog has multiple acquired PSS.

Intrahepatic portosystemic shunt with a second degree atrioventricular block fixed by transvenous coil embolization in a dog

  • Lee, Seung-Gon;Nam, So-Jeong;Kim, Hyun-Wook;Hyun, Changbaig
    • Korean Journal of Veterinary Research
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    • v.48 no.4
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    • pp.493-500
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    • 2008
  • A 2-year-old female Pekingese dog was presented with primary complaints including exercise intolerance and neurological sign associated with hepatic encephalopathy. The major findings in clinical examination included an intermittent seizure, a slow heart rate with pulse deficit, leukocytosis and anemia in hemogram, elevated pre- and post-prandial serum bile acid and hepatic enzymes, hypoproteinemia, coagulopathy, ammonium urate crystaluria and bilirubinuria. Diagnostic tests revealed an intrahepatic portosystemic shunt complicated with a second degree atrioventricular block and QT prolongation. The case was successfully treated with a transvenous coil embolization. Clinical signs were gradually improved and cardiac bradyarrhythmia disappeared. This case is a rare case of intrahepatic portosystemic shunts complicated with a cardiac bradyarrhythmia in a small breed dog fixed by a transvenous coil embolization.

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

  • Kim, Jeong Han;Choe, Won Hyeok;Kwon, So Young;Yoo, Byung-chul
    • Journal of Korean Medical Science
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    • v.33 no.52
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    • pp.335.1-335.17
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    • 2018
  • Background: Spontaneous bacterial peritonitis (SBP) is a serious infectious complication in patients with liver cirrhosis. However, information about prognosis of SBP in hepatocellular carcinoma (HCC) patients is limited. We investigated the clinical course of SBP in HCC patients. Methods: This study enrolled patients diagnosed with SBP between 2005 and 2017. Medical records of patients were reviewed and clinical course was compared between the non-HCC and HCC groups. Results: In total, 123 SBP cases including 49 HCC cases were enrolled. Men were predominant (48/74, 64.9% vs. 34/49, 69.4%; P = 0.697); median age was 58 years in both non-HCC and HCC groups (P = 0.887). The most common etiology was alcohol (32/74, 43.2%) in non-HCC group and hepatitis B (30/49, 61.2%) in HCC group (P = 0.009). Antibiotic resistance rate was higher in non-HCC than in HCC group (29.7% vs. 12.2%; P = 0.028); in-hospital mortality did not differ between the groups (25/74, 33.8% vs. 13/49, 26.5%; P = 0.431). Development rate of hepatorenal syndrome did not differ between non-HCC and HCC group (14/74, 18.9% vs. 10/49, 20.4%; P = 1.000), but hepatic encephalopathy was less common in HCC group (26/74, 35.2% vs. 9/49, 18.3%; P = 0.008). The most important predictor of in-hospital mortality in patients with HCC was white blood cell count above $11,570cells/mm^3$ (odds ratio, 6.629; 95% confidence interval, 1.652-26.590; P = 0.008). Conclusion: Prognosis of SBP in HCC patients is relatively less severe. This result may be related with reduced antibiotics resistance and lower development rates of other complications, such as hepatic encephalopathy. Degree of systemic inflammation may be the most important factor for in-hospital mortality.

Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices

  • Kim, Seung Kwon;Lee, Kristen A.;Sauk, Steven;Korenblat, Kevin
    • Korean Journal of Radiology
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    • v.18 no.2
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    • pp.345-354
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    • 2017
  • Objective: Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. Materials and Methods: We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. Results: There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. Conclusion: BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.

Clinical Features of Delirium in Liver Transplantation in a General Hospital in Korea-Retrospective Study (일병원에서 나타난 간이식 환자들의 섬망 양상-후향적 연구)

  • Choi, Soon-Ho;Son, Jung-In;Kim, Sang-Eok;Han, Oh-Su
    • Korean Journal of Psychosomatic Medicine
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    • v.15 no.2
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    • pp.93-99
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    • 2007
  • Object : This study aimed to investigate the characteristics of delirium in liver transplanted patients in a hospital in Korea. Method : We reviewed the medical records of 29 liver transplanted patients who were confirmed as delirium by psychiatrists with DSM-IV-TR diagnostic criteria. We estimated the correlation between delirium and clinical conditions of liver transplantations. Result : Post-operative delirium duration was significantly correlated with frequency of hepatic encephalopathy, pre-operative mental status, and stay of intensive care unit. Conclusion : Although there were many limitations of this study, it seemed that pre-operative hepatic encephalopathy affected post liver transplantation delirium.

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A Case of Congenital Extra Hepatic Portocaval Shunt (Abernethy Malformation Type 2) with a very Large Liver Mass and an Atrial Septal Defect (거대 간 종괴와 심방 중격 결손을 동반한 Abernethy 기형 2형 1예)

  • Lee, Hae-Jeong;Lee, Jee-Hyun;Huh, June;Kang, I-Seok;Lee, Heung-Jae;Suh, Yeon-Lim;Yoo, So-Young;Choe, Yon-Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.1
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    • pp.56-59
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    • 2008
  • Extrahepatic portosystemic shunts, known as Abernethy malformations, were first reported by John Abernethy in 1793. They are classified into two types: Type I refers to a congenital absence of the portal vein and Type II refers to a shunt involving a side-to-side anastomosis with reduced portal blood flow into the liver parenchyma. This malformation is so rare that less than 100 cases have been reported in the medical literature. We report the case of a 13-month-old boy who had a congenital extrahepatic portocaval shunt with a hypoplastic portal vein. This case was complicated with an atrial septal defect and a large hyperplastic nodule in the liver. The patient was diagnosed with a Type II Abernethy malformation. We planned on surgical occlusion of the extrahepatic portocaval shunt. However, six months later, the patient had a sudden onset of a fever of unknown origin and developed hepatic encephalopathy. Although he underwent a liver transplantation, he died of acute hepatic failure.

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