EXTRACORPOREAL PIG-LIVER PERFUSION IN TREATMENT OF HEPATIC COMA DUE TO FULMINANT HEPATITIS
| Autor: | Jean Kennedy, S. P. Parbhoo, A. B. Ajdukiewicz, Sheila Sherlock, I. M. James, P.J Brock, C Xanalatos, L. J. Chalstrey, Pauline Sayer |
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| Rok vydání: | 1971 |
| Předmět: |
Adult
Blood Glucose Blood Platelets Extracorporeal Circulation medicine.medical_specialty Swine medicine.medical_treatment Exchange transfusion Phosphates Acute fatty liver of pregnancy Hemoglobins Oxygen Consumption Animals Humans Urea Medicine Aspartate Aminotransferases Fulminant hepatitis Serum Albumin medicine.diagnostic_test business.industry Fatty liver Bilirubin Electroencephalography Organ Size General Medicine Hepatitis A Alkaline Phosphatase medicine.disease Surgery Bicarbonates Glucose Liver Respiratory failure Regional Blood Flow Cerebrovascular Circulation Hepatic Encephalopathy Anesthesia Liver biopsy Potassium Pancreatitis Calcium Female business Viral hepatitis |
| Zdroj: | The Lancet. 297:659-665 |
| ISSN: | 0140-6736 |
| DOI: | 10.1016/s0140-6736(71)92678-x |
| Popis: | Five patients in deep hepatic coma due to fulminant hepatitis were treated with 6 extracorporeal pig-liver perfusions. In three patients the acute hepatic necrosis was due to viral hepatitis, in one to an overdose of paracetamol, and in one patient liver failure was due to acute fatty liver of pregnancy. Corticosteroids and exchange transfusion were not used. All patients showed severe electroencephalographic changes and one patient who recovered showed virtually no cerebral activity. Perfusion lasted for 3.5-5.5 hours, during which a 48-94 litre exchange from pig liver to patient was effected. Improvement in the level of consciousness and in the electroencephalogram was noted in all patients. Serum-bilirubin levels fell significantly. Detailed studies of cerebral metabolism in one patient showed a striking improvement in the cerebral oxygen consumption and in the oxygen/glucose index. Complications during and after perfusion included bleeding, renal and respiratory failure, hypoglycaemia, hypokalaemia, hypocalcaemia, psychosis, and pancreatitis. Two patients regained full consciousness and are leading a normal life 13 and 8 months after pig-liver perfusion. Liver biopsy shows recovery of normal hepatic structure. Three patients died 2 hours to 10 days after liver perfusion. One patient died from massive gastrointestinal haemorrhage associated with fatty liver of pregnancy; in the second patient necropsy showed a shrunken liver with no evidence of regeneration; the third patient had a severe acute haemorrhagic pancreatitis from which he died although the level of consciousness was improving. These results are encouraging, but this treatment must be reserved for patients in acute liver failure who have the potential for complete recovery. |
| Databáze: | OpenAIRE |
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