Lege Artis Medicinae

[RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY - A MULTICENTRIC STUDY]

SZALAY Ferenc, TELEGDY László, SZELI Dóra, CSÁK Tímea, FOLHOFFER Anikó, HORVÁTH Andrea, ABONYI Margit, SZABÓ Olga, RÉDEI Csaba, NEMESÁNSZKY Elemér

MAY 20, 2004

Lege Artis Medicinae - 2004;14(05)

[INTRODUCTION - Hepatic encephalopathy is a well-known neuropsychiatric syndrome occurring in patients with either acute or chronic liver diseases. Rifaximin, a non-absorbable antibiotic is accepted for the treatment of hepatic encehalopathy. Our aim was to investigate the efficacy and the safety of rifaximin in cirrhotic patients with hepatic encephalopathy in Hungary. PATIENTS AND METHODS - 49 patients (25 male and 24 female) with hepatic encephalopathy stage I., II. and III. were involved into the study. Patients were treated with rifaximin for seven days. The daily dose was 3x400 mg in tablets. The severity of hepatic encephalopathy was characterised by hepatic encephalopathy index (HEi) calculated as a score of five parameters; mental state, asterixis, ammonia level, number connection test and critical flicker frequency. Pretreatment and postreatment HEi were compared. RESULTS - The study was completed in 46 patients. The treatment was suspended in 2 patients who died in liver failure and in one because of oesophageal variceal bleeding. The plasma ammonia level decreased from 103.7 ± 46.4 μmol/L to 67.7 ± 32.3 μmol/L (p=0,007) during the treatment. The hepatic encephalopathy index improved in 39 (85%) patients, worsened in 4 (9%) and no change was observed in 3 cases (6%). Improvement was observed in patients both with Child B and Child C stages. Loose stool in two patients and nausea in one patient were the only registered side effects. No severe adverse event related to the study medication was observed. CONCLUSIONS - Rifaximin is an effective and safe medicine for the treatment of hepatic encephalopathy.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[16th National Conference of the Supervisors of General Practitioners]

KRAMER Imre

Lege Artis Medicinae

[9th Debrecen Cardiology Days]

PÁLVÖLGYI Nóra, MOHÁCSI Attila

Lege Artis Medicinae

[NEUROFIBROMATOSIS, MALIGNANT MELANOMA AND HYPERTHYREOIDISM IN A HCV POSITIVE PATIENT]

FOLHOFFER Anikó, HORVÁTH Andrea, CSÁK Tímea, NÉBENFÜHRER László, TELKES Márta, IVÁNYI András, SZALAY Ferenc

[INTRODUCTION - Similar occirrence of neurofibromatosis and malignant melanoma is rare. We report a patient with neurofibromatosis, cutaneous melanoma, hyperthyreoidism and HCV positivity. CASE REPORT - A 43-year-old woman has been under care for neurofibromatosis for 16 years when she presented with increased serum ?- glutamyltransferase, alkaline phosphatase activity and anti-HCV antibody positivity at regular checkup. A pigmented lesion removed from her back histologically proved to be cutan melanoma. Interferon treatment was applied. She lost 8 kilograms in half a year which was caused not by the tumor progression, but hyperthyreoidism. A rapid clinical and laboratory improvement was observed for thyreostatic treatment and she regained her bodyweight. One year later she presented with a cough caused by pulmonary tumor. The tumor was surgically removed and histologically diagnosed as metastasis of melanoma. Cytostatic treatment was applied and she became asymptomatic. Four years after the diagnosis of melanoma she died of apoplexy. During the autopsy there was no sign of either melanoma or liver disease. CONCLUSIONS - The careful investigation of skin should be emphasised even in case of long established neurofibromatosis. The presented case shows an association of malignant melanoma and neurofibromatosis. In the background of loss of bodyweight even in a patient with history of malignant disease other causes should also be searched such as hyperthyreoidism especially during interferon therapy.]

Lege Artis Medicinae

[CALM]

MATOS Lajos

Lege Artis Medicinae

[CURRENT STATUS OF THE DIAGNOSTICS AND THERAPY OF UROLOGICAL TUMOURS]

ROMICS Imre

[Significant amount of urological patients have malignant disease. Prostate cancer is the second most frequent cancer in males associated with high mortality and decreased quality of life. Hence the importance of early diagnosis. Furthermore, diagnostical protocols, operative and conservative therapeutic modalities are summarised. Hematuria is the most frequent sign of bladder cancer. Diagnostical, surgical and adjuvant therapeutical differencies of the superficial and muscle invasive bladder cancers are discussed. The urinary deviation after cystectomy could be associated with complications therefore regular follow up of patients is necessary. The standard therapy of renal cancer is surgical. Unfortunately its mortality has not change during past years. Testicular cancer is the disease of young males. If diagnosed early, most cases are curable. Therapy is complex, involving surgical, chemoand radiation therapy as well. Penis cancer is a rare disease, but highly malignant. In advanced stage patients are incurable.]

All articles in the issue

Related contents

Clinical Neuroscience

Neurological disorders in liver transplantation

YUKSEL Hatice , AYDIN Osman, ARI Derya , OTER Volkan , AKDOGAN Meral , BIROL BOSTANCI Erdal

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation.

Lege Artis Medicinae

[Diabetes mellitus and the liver]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past years, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. Its unfavourable effects on the liver have been forgotten: the accelerated progression of the liver diseaeses and the increased risk of hepatocellular carcinoma. The multimetabolic syndrome leads to non-alcoholic fatty liver diseases (steatosis, steatohepatitis, cirrhosis). On he other hand some types of liver cirrhosis (for example the common alcoholic form) are worsening the insulin resistance, so they may due to a hepatogenous diabetes mellitus, that’s treatment is different and needs more regard, than type 2 diabetes.]

Lege Artis Medicinae

[Prevention and treatment of hepatic encephalopathy]

HUNYADY Béla

[As acute or chronic liver diseases progress, liver failure and related hepatic encephalopathy may develop. The latter occurs in more than 70% of patients with hepatic cirrhosis. Because of declining cognitive functions, sleep disturbances, memory problems and impaired motion coordination, this condition can - even in mild form - limit the patient's self-sufficiency and activity and can lead to a decreased quality of life and ability to work. Its most advanced stage, hepatic coma is one of the leading causes of liver-related mortality. These conditions generate a substantial healthcare costs. Treatment of hepatic encephalopathy involves dietary restrictions, prevention and treatment of precipitating factors, inhibition of the production and absorption of toxic substances (especially ammonia) and restoration of the amino acid balance. In addition to the traditionally used treatment with disaccharids (lactulose, lactitol), evidence has been accumulating regarding the efficacy and safety of a nonabsorbable antibiotic compound, rifaximin, which targets enteral pathogen bacteria, both in treatment and in prevention of hepatic encephalopathy. Artificial liver support therapies have been also introduced in Hungary. This review summarises the experience regarding treatment of hepatic encephalography for physicians involved in the management of patients with hepatic diseases.]

Journal of Nursing Theory and Practice

[Trends in antibiotic use in ventilator-associated pneumonia in context of using closed suction system]

PETHŐNÉ Tóth Ibolya, AHMANN Mercédesz, SHAHOOD Hadel, BÁLINT Csaba, PAKAI Annamária

[The aim of this study was to investigate the incidence of VAP in open and closed suction techniques and to determine whether closed suction techniques had altered the duration of combination antibiotic use. Quantitative, retrospective study was performed at the Central Anes­thesiology and Intensive Care Unit. A non-randomized, targeted expert study is aimed at patients in intensive care units with evidence of respiratory-related pneumonia. Data were collected from hospital records, the hospital pharmacy IT system, the NNSR system. Descriptive and mathematical statistical methods(p<0,05) were used to evaluate the results. Mean of ventilated days was 9.95±3.35. VAP was reported at an average of 4.95±2.29 days and antibiotic treatment lasted for 8.00±2.66 days. The suction technique showed with the number of intensive care days, the number of ventilation days, the average number of VAPs, and the treatment with antibiotics. The introduction of a closed suction alone did not reduce the incidence of VAP and the use of antibiotics. APN plays an important role in uncovering the risk factors for VAP and preventing its development, which ultimately leads to a reduction in mortality.]

Lege Artis Medicinae

[MANAGEMENT OF LIFE-THREATENING ENDOSCOPIC THERAPY-RESISTENT OESOPHAGUS VARICEAL BLEEDING]

ERŐSS Bálint Mihály, SZÉKELY György, SIKET Ferenc, LÁZÁR István

[INTRODUCTION - Liver cirrhosis has two serious consequences: hepatic failure and portal hypertension. Portal hypertension has two important clinical appearances: variceal bleeding and therapy resistant ascites. Variceal bleeding can be recurrent and resistant to endoscopic treatment. These complications can be prevented by implantation of Transjugular Intrahepatic Portosystemic Shunt (TIPS). CLINICAL CASE - A 59 year old male with cirrhosis due to hepatitis C, was hospitalized in our department in April 2004 with variceal bleeding. We tried to control the bleeding twice by band ligation, once by sclerotherapy and with the use of Sengstaken-Blakemore tube, but bleeding continued for three weeks despite the endoscopic treatment. The patient needed intensive care therapy and was treated with more than forty units of packed red cells and plasma. At that point we decided to implant a TIPS, which was carried out succesfully. After TIPS implantation no rebleeding occured and the shunt had good patency. Moderate hepatic encephalopathy was observed, which is a well known phenomenon, but it could be treated with pharmacologic therapy. CONCLUSIONS - In case of portal hypertension TIPS implantation can prevent from variceal rebleedings and may caus significant improvement in the quality of life.]