Document Detail


A 3-year experience with Molecular Adsorbent Recirculating System (MARS): our results on 63 patients with hepatic failure and color Doppler US evaluation of cerebral perfusion.
MedLine Citation:
PMID:  12950955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In our 3-year experience, we treated 63 patients with Molecular Adsorbent Recirculating System (MARS). The patients were divided as follows: 10 primary non-function (PNF) 16%, 10 delayed non-function (DNF) 16%, 16 Fulminant hepatitis (FH) 24%, 23 acute decompensation of chronic liver disease (ACLF) 38%, and 4 hepatic resection 6%. All patients who underwent MARS treatment had bilirubin >15 mg/dL, Glasgow Coma Score between 9 and 11, ammonium >160 microg/dL and non-coagulability. The determining factors taken into consideration for the continuation of MARS treatment were: an improvement in Glasgow Coma Score, and a decrease in ammonium and bilirubin. We also monitored hemodynamic parameters, acid-base equilibrium, and blood gas analysis before and after each treatment. In order to determine patients' neurological conditions, we not only took into account the Glasgow Coma Score, which does not give mathematically precise results but also took into account the fact that patients with hepatic coma had lower cerebral mean velocity in the cerebral arteries than patients without encephalopathy. For this reason, in the last 22 patients we monitored cerebral perfusion, determined by mean flow velocity (Vmean) in the middle cerebral artery. Our results were expressed as mean +/- SD and we analyzed the differences between mean values for each variable, before and after treatment by means of Student's t-test. At the end of treatment, we obtained significant P-values for bilirubin, ammonium, Glasgow Coma Score and creatinine. In 16/20 patients, we could demonstrate a clear correlation between the improvement in clinical conditions (especially neurological status) and improvement in cerebral perfusion, measured by color Doppler US.
Authors:
Gilnardo Novelli; Massimo Rossi; Renzo Pretagostini; Luigi Novelli; Luca Poli; Giancarlo Ferretti; Massimo Iappelli; Pasquale Berloco; Raffaello Cortesini
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Liver international : official journal of the International Association for the Study of the Liver     Volume:  23 Suppl 3     ISSN:  1478-3223     ISO Abbreviation:  Liver Int.     Publication Date:  2003  
Date Detail:
Created Date:  2003-09-02     Completed Date:  2004-02-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  101160857     Medline TA:  Liver Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  10-5     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Rome, Viale Regina Elena, Rome, Italy. novelligilnardo@virgilio.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Albumins
Ammonia / blood
Bilirubin / blood
Cerebrovascular Circulation
Female
Hepatic Encephalopathy / physiopathology,  therapy*,  ultrasonography*
Humans
Male
Renal Dialysis*
Sorption Detoxification*
Treatment Outcome
Ultrasonography, Doppler, Color
Chemical
Reg. No./Substance:
0/Albumins; 635-65-4/Bilirubin; 7664-41-7/Ammonia

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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