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PubMed1989

[Effect of prior psychopharmacotherapy on the development, clinical course and therapeutic effect of insulin coma in patients with schizophrenia].

In 123 patients the peculiarities of formation and effectiveness of insulin coma (IC) were studied under drug therapy as compared with 49 drug-free patients. Pharmacotherapy preceding the ICs produced uneven effect on its course. Artefact course of IC was most frequently observed after mageptil, chlorpromazine melipramine treatment, and to a lesser extent--after haloperidol, triphtazin, amitriptyline. It was virtually absent after benzodiazepines. The autonomic manifestations in IC and the harmony if its development and clinical picture, markedly changing under drug treatment, were exposed as predictors of the efficiency of IC therapy.

Adult↗
PubMed1986

[The place of atropine coma therapy in the complex treatment of hypochondriacal schizophrenia (non-delusional hypochondriasis)].

In order to expand the possibilities of the treatment of resistant hypochondriac schizophrenia, the author developed a new method of multiple modality therapy which is based on the use of the rebound effectiveness of atropine comas. It consists of a course of atropine comatose therapy and a subsequent intensive medicamentous therapy in the form of intravenous instillation of psychotropic agents. This treatment was given to 36 patients with slowly progressive hypochondriac schizophrenia, whose clinical manifestations were restricted to a picture of non-delirious hypochondria. In most cases (82%) the treatment yielded a positive effect. The method was the most effective in patients with syndromes of obsessive and hysterical hypochondria as well as in those with cenesthopathic conditions. The use of therapy in rigid hypochondria proved poorly effective.

Adolescent↗
PubMed1978

Brain energy metabolism and alterations of transmitter profiles in acute hepatic coma.

Brain energy reserve, tricarboxylic cycle intermediate and some putative neurotransmitters were measured in a devascularisation model with portacaval shunt and hepatic artery ligation done in two interventions. Conditions were standardized in that physiologic parameters, i.e. body temperature, systemic arterial pressure, PO2, PCO2 and pH, were kept constant and brain tissue was obtained with the "freeze-blowing" technique designed for deep freezing brain substance in less than one second. 1. Measured values indicative of the brain energy reserve (glucose, glycogen, ATP and phosphocreatin) were not found to differ from those of sham-operated animals. 2. Of the stimulating neurotransmitters, norepinephrine, dopamine, glutamic acid and aspartic acids were reduced with the exception of acetylcholine among the inhibitory neurotransmitters GABA and cAMP were unchanged, while all others including serotonin, octopamine, and phenylethanolamine were increased. 3. The results of these experiments suggest that an inbalance of amino acids with resultant changes in neurotransmitter profiles rather than an energy deficit constitutes the factor underlying hepatic coma.

Adenosine Diphosphate↗
PubMed1987

Coma and the etiology of violence, Part 2.

Coma and the etiology of violence are explored by the author through a review of the literature. Animal studies, post-traumatic psychic disorder studies, post-traumatic anger and violence studies, tumor and lesion of the limbic system studies, temporal lobe epilepsy studies, episodic dyscontrol syndrome studies, and minimal brain dysfunction studies were reviewed in Part 1, which was published in the December 1986 issue of the Journal. Part 2 concludes the review with clinical surveys on violent individuals and studies on clinical treatment of violence.These studies reveal the etiologic significance of central nervous system dysfunction in the production of violent behavior. Because central nervous system factors are involved in some instances of violent behavior, physicians clearly have a role in the early identification of potentially violent subjects and in the intervention or treatment of individuals who have been violent toward others. Studies have consistently found that lower socioeconomic groups are more predisposed to brain injury from trauma, and several studies have indicated that this is true for segments of the black community. Therefore, investigations in the relationship between central nervous system injury and violence should be a major goal of the black community. Black physicians should assume a lead role in these inquiries and in the prevention and treatment of violence, specifically black-on-black number.

Adolescent↗
PubMed1986

[The place of insulin coma therapy among the current methods of treating patients with paroxysmal schizophrenia].

The efficacy of intensive insulin coma therapy (IICT) and individually adjusted psychopharmacotherapy (IAT) was studied in schizophrenics in a month after the treatment initiation. Comparison of the efficacy of these 2 methods showed that the insulin treatment led to a sharper differentiation between patients with favourable and unfavourable therapeutic effect. The duration of schizophrenia did not affect the results of IICT. This method was more effective in schizoaffective syndromes in the framework of periodic schizophrenia, as well as in paroxysmal schizophrenia when it closely resembled the former. IICT was poorly effective in neurosis-like and hallucination-paranoid syndromes in the framework of the continuous course of schizophrenia. The rate of disappearance of psychotic symptomatology in the insulin therapy correlated with the degree of the course therapeutic effect.

Adult↗
PubMed1986

[Postoperative coma caused by liver failure].

Reported are 135 cases of hepatectomy. Eight patients died, including seven who died of coma due to liver failure. Preoperative misjudgement of the functional reserve of the liver is, admittedly, an unsolved problem. A two-session approach, following chemotherapeutic tumour reduction, might be an alternative, when it comes to large liver tumours with reduced liver function.

Female↗
PubMed1986

Adequate diet prevents hepatic coma in dogs with Eck fistulas.

The conventional animal model of human portal systemic encephalopathy is the dog with Eck fistula. Dogs fed standard dog chow after Eck fistula manifest anorexia, weight loss, hepatic atrophy and encephalopathy. This study was done to determine the natural history of dogs undergoing Eck fistulas when adequate nutrition is maintained with a palatable diet. Twenty-four mongrel dogs were divided into four groups--Eck fistula fed standard dry dog chow (EF-SC) (n equals nine); sham operated fed standard chow (SO-SC) (n equals five); Eck fistula fed a liquid (Isocal) diet (EF-LD), LD), and sham operated fed a liquid diet (SO-LD) (n equals five). Dogs were sacrificed when they had clinical signs of encephalopathy or up to 120 days after operation. EF-SC dogs had a daily caloric intake approximately 40 per cent of that of the other groups. Two EF-SC dogs died of sepsis within two weeks of the operation, the other seven became encephalopathic between 46 and 91 days (a mean of 63.6 +/- 15.6). No other dogs had signs of neurologic deterioration. EF-SC dogs lost 19 +/- 9 per cent body weight and the serum albumin level decreased 14.5 per cent while the other groups maintained body weight and serum albumin levels. Both EF-SC and EF-LD groups had decreased liver weight to body weight ratios (LW X 100/BW) compared with sham operated upon dogs reflecting hepatic atrophy (1.97 +/- 0.7 and 2.2 +/- 0.23 versus 3.04 +/- 0.85 and 3.48 +/- 0.44). Results of histologic examination of the liver revealed hepatocyte atrophy, deglycogenation and lipid accumulation in EF dogs. We conclude from these data that providing dogs with Eck fistula a palatable diet prevents weight loss and malnutrition, but not hepatic atrophy. The lack of neurologic signs in well nourished dogs suggests to us that data concerning hepatic coma from the standard Eck fistula model should be interpreted with extreme caution.

Animals↗
PubMed1985

The 1984 COMA report--a new approach?

This paper argues that the 1984 COMA report marks a new departure in recommending dietary changes to individuals rather than to the population en masse. The consequences of this approach include the necessity of providing members of the public with accurate and intelligible information on foods and a reliable means of assessing their dietary intake of fat.

Adult↗
PubMed1979

Comparative value of different dialysis membranes, including a carbon coated membrane for removal of noxious substances in hepatic coma.

Three dialysis membranes, including a polyacrilonitrile membrane, a polycarbonate membrane and a cuprophan membrane coated with charcoal, have been compared with cuprophan in order to assess their ability to clear from aqueous solution and plasma, substances thought to be of pathogenetic importance in hepatic coma (ammonia, short chain fatty acids and mercaptans), some protein bound (glycocholate and bromsulphthalein) and some middle molecular weight molecules (ethylenediaminetetracetic acid, cyanocobalamin and inulin). High clearance of ammonia, short chain fatty acids and mercaptans were found with membrane tested but dialysis was relatively ineffective for removal of protein bound molecules. Cyanocobalamin, glycocholate and ethanethiol were removed best by the carbon coated membrane and by combining dialysis with adsorption, this membrane may offer advantages over other treatments for liver failure.

Absorption↗
PubMed1982

Coma vigil masquerading as psychiatric illness.

A patient is described who had the hyperpathic variety of akinetic mutism (coma vigil), which was mistaken for a dissociative state. The case discussion emphasizes the importance of differentiating neuropsychiatric syndromes from those which are purely psychiatric in nature in order that appropriate treatment may be given.

Adult↗
PubMed1982

[Concomitant pancreatitis in hepatic coma].

Increased levels of serum amylase were found in 14 out of 34 patients (41%) with coma due to acute liver failure, in 8 out of 55 patients (14%) with hepatic encephalopathy, and in 5 out of 10 patients with a mixed pathogenesis. In 4 patients of the first group (11.7%) and 4 of the second group (7%) pancreatitis was diagnosed at post mortem. The pathogenesis of pancreatitis concomitant with liver failure is unclear. Virus infection and intoxication may do damage to both organs; hemodynamic factors, coagulation defects, and derangements of metabolism may play a role as well.

Acute Disease↗
PubMed1984

Effects of methanethiol on erythrocyte membrane stabilization and on Na+,K+-adenosine triphosphatase: relevance to hepatic coma.

Methanethiol (CH3SH) has been implicated in the pathogenesis of hepatic coma. Studies are presented to identify the possible biochemical basis of anesthesia-like effects of methanethiol and those features which distinguish such effects from common anesthetics and may represent the basis of its toxicity. CH3SH was found to stabilize erythrocyte membranes against hypotonic hemolysis at relatively low concentrations. At 37 degrees C the AH25 value for human erythrocyte antihemolysis was observed at a concentration of 0.34 mumol of CH3SH bound per mg of erythrocyte protein. Similar results were obtained with rat erythrocytes. This property of CH3SH is in common with other anesthetic agents. Anesthetic agents also inhibit the membrane-associated Na+,K+-adenosine triphosphatase (ATPase); however, for effective and nontoxic agents of this type the inhibition of ATPase activity is elicited at concentrations which are at least an order of magnitude higher than those which influence the membrane stability characterized by the antihemolysis effect (P. Seeman, Pharmacol. Rev. 24: 583-655, 1972). CH3SH was also found to inhibit the membrane Na+,K+-ATPase activity. The I25 value for the inhibition of human erythrocyte ATPase activity was obtained at CH3SH concentration of 0.12 mM which corresponded to 0.3 mumol of CH3SH bound per mg of erythrocyte membrane protein. Rat erythrocyte membrane ATPase was somewhat more sensitive to CH3SH. In all cases the binding of CH3SH to erythrocytes occurred primarily on the membrane. These results indicate that no differential exists with respect to the dose-response of these two activities associated with human erythrocyte membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

[Severe neurological toxicity (coma, convulsions, distal motor neuropathy) secondary to the association of accidental poisoning by isoniazid and a protocol containing high doses of vincristine].

Authors report the case of a 19 year old metastatic Ewing's sarcoma, prophylactically treated for suspected tuberculosis by Rifampicin and INH. Hepatic failure was induced by accidental overdose of INH. A high dose containing VCR protocol associated, lead to a coma with convulsions and severe motor peripheral neuropathy partially regressive. Neurological incidents of VCR, INH and their association are reviewed.

Adult↗
PubMed1984

Amino acid disturbances in experimental hepatic coma rats.

In our previous paper (1), we discussed the in-vitro adsorption spectrum of plasma amino acids by coated charcoal hemoperfusion. We now describe the general amino acid disturbances in plasma, CSF and cerebrum in the galactosamine induced hepatic coma model in rats. All aromatic amino acids (AAA) increased significantly in the three compartments studied. Branched chain amino acids (BCAA) were either elevated to a much lesser extent or remained unchanged. The molar ratio of BCAA:AAA was consequently reduced. This is similar to findings in fulminant hepatic failure in human and other animal models. Most of the 20 amino acids analyzed were increased significantly in the plasma. Increases of amino acids were minimal in the brain tissue studied, i.e. the cerebrum.

Amino Acids↗
PubMedDate not supplied

[Case of hepatic coma with lateral conjugate deviation of gaze].

The forced horizontal deviation of gaze, persisting more then 48 hours, has been observed during a rapidly developing hepatic coma in a patient whose post mortem examination did not reveal any structural lesion involving the central nervous system.

Central Nervous System↗
PubMed1984

[Hepatic coma in fulminating viral hepatitis--treatment results in 1981 in a district hospital].

n the basis of clinical case reports on liver disintegration comata in foudroyant virus hepatitis the coma therapy was explained which was performed in the clinic for infectious and tropic diseases of the County Hospital St. Georg Leipzig in 1981 and this therapy was compared with the possibilities mentioned in literature. The aim of the article was to determine the present position of a county hospital in the great number of forms of therapy proposed. The basic therapy aimed at the reduction of neurotoxic protein metabolites and the application of intensive-medical therapeutic methods in interdisciplinary cooperation of internal specialist, specialist in dialysis and haemostaseologist are valuated as successful. The combined haemoperfusion/haemodialysis--two out of three patients treated survived--as a constituent of the present concept of therapy is assessed positively.

Adult↗
PubMed1982

[Pulmonary complications in hepatic coma].

Incidence and extent of pulmonary complications were evaluated retrospectively in 101 patients with hepatic coma (34 patients with acute liver failure, 57 patients with hepatic encephalopathy and 10 patients with mixed forms). 76 patients (73.3%) had pulmonary complications (pulmonary edema 57 cases, pneumonia 20 cases, tracheobronchitis 30 cases). Lethality of the group with pulmonary complications was 97% as compared to 16% in the group without pulmonary complications. Pathogenesis of pulmonary complications is not completely clear; different mechanisms are being discussed like central mechanisms, vascular lesions caused by metabolic or toxic factors, cardiac failure, and increased susceptibility to infection. In 9 out of 59 cases (15.3%) with respiratory failure no morphological changes could be observed in the lungs; in these cases intrapulmonary shunts might have been the cause for the pulmonary complications. The incidence of pulmonary complications increased by a factor of 2.4 during intensive care unit treatment of the patients; this increase shows, that intensive care unit treatment still has to be improved.

Adult↗
PubMed1982

[Extracorporeal liver perfusion in the treatment of hepatic coma].

Four patients with fulminant hepatic failure had extracorporal hemoperfusion. In selecting the patients, the following criteria were applied: Potential reversibility of the liver disease, prothrombin time under 10%, neurological coma stage III-IV. In total 11 treatments (9 treatments using baboon and 2 treatments using human livers) were performed lasting from 3 to 60 hours. One patient improved immediately after perfusion. 3 patients died; at post mortem severe oedema of the brain and acute yellow atrophy of the liver without tendency to regeneration was observed in these patients.

Adult↗