Hepatic encephalopathy in liver cirrhosis is due to several factors, including amino acid imbalance and hyperammonemia. Lactitol [correction of lactilol], a non adsorbable disaccharide, improves hepatic encephalopathy increasing bowel movements, modifying colonic bacteria and pH, and reducing blood ammonium. Ten patients with liver cirrhosis and longstanding stable hepatic encephalopathy were treated, after a period of drugs wash-out, with lactitol. A significant improvement of hepatic encephalopathy was observed, with a significant decrease of blood ammonium, related with the increase of stool frequency/day. Atrial natriuretic peptide decreased as well. Moreover, an increase of the ratio of plasma aliphatic amino acids (valine, leucine and isoleucine)/aromatic amino acid (tyrosine and phenylalanine) was observed. Lactitol is an effective drug in the treatment of chronic hepatic encephalopathy; its mechanism of action involves not only a decrease of blood ammonium but also modifications of the degree of plasma amino acid imbalance, and fluid and circulatory adjustments.

Adult↗

PubMedDate not supplied

[Experience with non-immunologic hydrops fetalis].

Non-immune hydrops fetalis (NHF) has become, with the decrease in frequency of rhesus-isoimmunization during the last years, an important aspect of modern obstetrics in consideration of the increased diagnostic and therapeutic means now available. Some cases of NHF with particular etiology (viral twin-twin transfusion syndrome, malformations) are reported and the necessity of a multidisciplinary specialistic approach for the resolution of diagnostic and prognostic problems of this serious complication of pregnancy is underlined.

Adult↗

PubMedDate not supplied

Body composition and long-term levo-carnitine supplementation.

PURPOSE: To evaluate the effect of long-term levocarnitine supplementation on nutritional state of patients in maintenance dialysis. PATIENTS AND METHODS: We studied by multifrequency-BIA (bioelectric impedance analysis) two groups of patients in maintenance bicarbonate hemodialysis for at least 4 years, comparable with respect to gender and age, and without liver disease, diabetes and malignancy. One group (25 patients) was treated with levocarnitine (1g/die) for three years or more; the control group (35 patients) never received this agent. RESULTS: Long-term levocarnitine supplementation was associated with higher serum levels of total protein and albumin in comparison to the control group. These effects were not associated with an increase in body fat mass and/or in total body water content, which are potentially detrimental conditions, especially considering the reported frequent association with circulatory and blood pressure alterations. CONCLUSIONS: Levocarnitine is able to improve the nutritional state, and this is associated with higher protein catabolism rate, i.e. with a higher protein intake, without detrimental effects on dialysis efficacy and adequacy.

Adult↗