Hepatic Encephalopathy in Chronic Liver Failure de Livio Capocaccia

Hepatic Encephalopathy in Chronic Liver Failure

Livio Capocaccia

The meeting which took place in Rome on November 19th and 20th of 1982 is easily the best meeting on hepatic coma that I have ever attended, and I have attended many. It was an exceedingly we- planned meeting with prolonged opportunity for discussion, and there was genuine interplay and exchange of ideas (not the usual picture of a rushed meeting with investigators presenting their own point of view and talking past each other without a meaningful ex change) which took place in Rome. My co-editors and I hope that the published transcript, which of course can only reflect what transpired in Rome on those two days, does justice to a very intellectually exciting and gratifying ex change of ideas. L. Capocaccia, J. E. Fischer and F. Rossi-Fanelli v CONTENTS Introduction 1 SECTION 1: PATHOGENETIC PROBLEMS IN HEPATIC ENCEPHALOPATHY Ammonia: The old and the new • • . • • • . • . • • • . • . • 5 L. Zieve Role of synergism in the pathogenesis of hepatic encephalopathy • • • • . • • . . . . • 15 L. Zieve y-Aminobutyric acid receptors in experimental hepatic encephalopathy •. •. • • 25 M. L. Zeneroli, ~. Baraldi,and E. Ventura A possible role for excitatory neurotoxic amino acids in the pathogenesis of hepatic en 41 cephalopathy • • • • • • • • • • • • • • • F. Moroni, G. Lombardi, G. Moneti, D. Pellegrini and C.

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Section 1: Pathogenetic Problems in Hepatic Encephalopathy.- Ammonia: The old and the new.- Role of synergism in the pathogenesis of hepatic encephalopathy.- ?-Aminobutyric acid receptors in experimental hepatic encephalopathy.- A possible role for excitatory neurotoxic amino acids in the pathogenesis of hepatic encephalopathy.- LThe development of the false neurotransmitter concept of hepatic encephalopathy.- Studies relating to a theoretical understanding of altered blood-brain barrier transport in liver disease.- Amino acid transport in isolated brain capillaries.- Cerebro-spinal fluid amino acid pattern in hepatic encephalopathy.- Alterations of plasma and brain tryptophan in hepatic encephalopathy: a study in humans and in experimental animals.- New methods for the determination of serum and breath mercaptans and its application in liver cirrhosis and hepatic encephalopathy.- Plasma influence on the altered blood-brain barrier to amino acids after portacaval shunt: Preliminary results.- Hepatic encephalopathy is associated with decreased numbers of receptors for excitatory aminoacid neurotransmitters.- Brain gamma amino-butyric acid in acute hepatic encephalopathy in dogs following hepatectomy with or without abdominal evisceration.- Section 2: Metabolic and Prophylactic Aspects of Hepatic Encephalopathy.- Carbohydrate metabolism in liver disease.- Proteins and amino acids in liver failure.- The metabolic fate of branched chain amino acids.- Long term dietary supplement with branched chain amino acids: a new approach in the prevention of hepatic encephalopathy: Results of a controlled study in cirrhotics with portocavai anastomosis.- Muscle biopsy studies on malnutrition in patients with liver cirrhosis: Preliminary results of long-term treatment with abranched-chain amino acid enriched diet.- The role of muscle protein catabolism in the plasma amino acid profile of cirrhotics.- Plasma prolactin in liver cirrhosis.- Short-term branched chain amino acid parenteral nutrition in liver cirrhosis: A dose-related effect on plasma amino acids and nitrogen balance.- Nutritional effects of branched-chain ketoanalogues in chronic hepatic and renal failure: A preliminary report.- Section 3: Assessment and Evaluation of Hepatic Encephalopathy.- Summary of the contributions.- Visual evoked potentials in the quantitative assessment of portal-systemic encephalopathy and its preclinical stage.- Section 4: Therapeutic Aspects of Hepatic Encephalopathy.- Bromocriptine in the treatment of chronic hepatic encephalopathy.- Bromocriptine to treat portal systemic encephalopathy.- Lactitol, a potential second generation disaccharide drug for the treatment of portal-systemic encephalopathy.- Lactose to treat acute and chronic portal systemic encephalopathy.- Do branched-chain amino acids have a role in the treatment of hepatic encephalopathy?.- Treatment of hepatic encephalopathy by infusion of a modified amino acid solution: Results of a controlled study in 47 cirrhotic patients.- Efficacy of branched-chain amino acids in the treatment of hepatic encephalopathy.- Branched chain amino acid enriched solutions in the treatment of hepatic encephalopathy: A controlled trial.- Branched-chain amino acids in the treatment of severe hepatic encephalopathy.- Prophylaxis of hepatic encephalopathy after portacaval anastomosis using branched chain amino acid mixtures.- Effective treatment of latent porto-systemic encephalopathy with oral branched chain amino acids.- Effect of vegan and meat protein diets in mild chronic portal-systemic encephalopathy.-14C] -L-Valine binding to post mortem frontal cortex homogenates in hepatic encephalopathy.- Regional analysis of norepinephrine, dopamine and amino acids in the brain 18 hours after hepatectomy and infusion of branched-chain amino acids.- Comment to oral BCAA trials.- Contributors.