Hepatic Encephalopathy in Chronic Liver Failure

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. Front Matter....Pages i-xi Introduction....Pages 1-2 Front Matter....Pages 3-3 Ammonia: The Old and the New....Pages 5-14 Role of Synergism in the Pathogenesis of Hepatic Encephalopathy....Pages 15-23 γ-Aminobutyric Acid Receptors in Experimental Hepatic Encephalopathy....Pages 25-40 A Possible Role for Excitatory Neurotoxic Amino Acids in the Pathogenesis of Hepatic Encephalopathy....Pages 41-51 The Development of the False Neurotransmitter Concept of Hepatic Encephalopathy....Pages 53-60 Studies Relating to a Theoretical Understanding of Altered Blood-Brain Barrier Transport in Liver Disease....Pages 61-69 Amino Acid Transport in Isolated Brain Capillaries....Pages 71-85 Cerebro-Spinal Fluid Amino Acid Pattern in Hepatic Encephalopathy....Pages 87-94 Alterations of Plasma and Brain Tryptophan in Hepatic Encephalopathy: A Study in Humans and in Experimental Animals....Pages 95-106 New Methods for the Determination of Serum and Breath Mercaptans and Its Application in Liver Cirrhosis and Hepatic Encephalopathy....Pages 107-113 Plasma Influence on the Altered Blood-Brain Barrier to Amino Acids after Portacaval Shunt: Preliminary Results....Pages 115-120 Hepatic Encephalopathy is Associated with Decreased Numbers of Receptors for Excitatory Aminoacid Neurotransmitters....Pages 121-125 Brain Gamma Amino-Butyric Acid in Acute Hepatic Encephalopathy in Dogs Following Hepatectomy with or without Abdominal Evisceration....Pages 127-134 Front Matter....Pages 135-135 Carbohydrate Metabolism in Liver Disease....Pages 137-148 Proteins and Amino Acids in Liver Failure....Pages 149-159 The Metabolic Fate of Branched-Chain Amino Acids....Pages 161-181 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 Porto-Caval Anastomosis....Pages 183-192 Muscle Biopsy Studies on Malnutrition in Patients with Liver Cirrhosis....Pages 193-208 The Role of Muscle Protein Catabolism in the Plasma Amino Acid Profile of Cirrhotics....Pages 209-211 Front Matter....Pages 135-135 Plasma Prolactin in Liver Cirrhosis....Pages 213-219 Short-Term Branched Chain Amino Acid Parenteral Nutrition in Liver Cirrhosis: A Dose-Related Effect on Plasma Amino Acids and Nitrogen Balance....Pages 221-228 Nutritional Effects of Branched-Chain Ketoanalogues in Chronic Hepatic and Renal Failure: A Preliminary Report....Pages 229-235 Front Matter....Pages 237-237 Summary of the Contributions: Assessment and Evaluation of Hepatic Encephalopathy....Pages 239-244 Visual Evoked Potentials in the Quantitative Assessment of Portal-Systemic Encephalopathy and Its Preclinical Stage....Pages 245-251 Front Matter....Pages 253-253 Bromocriptine in the Treatment of Chronic Hepatic Encephalopathy....Pages 255-265 Bromocriptine to Treat Portal Systemic Encephalopathy....Pages 267-274 Lactitol, a Potential Second Generation Disaccharide Drug for the Treatment of Portal-Systemic Encephalopathy....Pages 275-278 Lactose to Treat Acute and Chronic Portal Systemic Encephalopathy....Pages 279-285 Do Branched-Chain Amino Acids Have a Role in the Treatment of Hepatic Encephalopathy?....Pages 287-299 Treatment of Hepatic Encephalopathy by Infusion of a Modified Amino Acid Solution: Results of a Controlled Study in 47 Cirrhotic Patients....Pages 301-310 Efficacy of Branched-Chain Amino Acids in the Treatment of Hepatic Encephalopathy....Pages 311-321 Branched Chain Amino Acid Enriched Solutions in the Treatment of Hepatic Encephalopathy: A Controlled Trial....Pages 323-333 Branched-Chain Amino Acids in the Treatment of Severe Hepatic Encephalopathy....Pages 335-344 Prophylaxis of Hepatic Encephalopathy after Porta-Caval Anastomosis using Branched Chain Amino Acid Mixtures....Pages 345-350 Effective Treatment of Latent Porto-Systemic Encephalopathy with Oral Branched Chain Amino Acids....Pages 351-357 Effect of Vegan and Meat Protein Diets in Mild Chronic Portal-Systemic Encephalopathy....Pages 359-367 [ 14 C]-L-Valine Binding to Post Mortem Frontal Cortex Homogenates in Hepatic Encephalopathy....Pages 369-373 Regional Analysis of Norepinephrine, Dopamine and Amino Acids in the Brain 18 Hours after Hepatectomy and Infusion of Branched-Chain Amino Acids....Pages 375-380 Comment to Oral BCAA Trials....Pages 381-383 Back Matter....Pages 385-398 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