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BRANCHED CHAIN ~WRICHED AMINO ACID NUTRITION DOES NOT CHANGE THE OLWIL73ME OF HEPATIC COMA IN PATIENTS WITH CIRRHOSIS OF THE LIVER
337 H.Vilstrup, C.Gluud, F.Hardt, M.Kristensen, B.Mel~aard, O.K~hler, H.J.Sch~tten, J.J.Krintel, B.A.Hansen, A.Dejgaard, D.Bucher, Hvidovre Hospital, Bispebjerg Hospital, and Rigshospitalet, Copenhagen, Denmark
Sixty-four patients with cirrhosis and hepatic encephalopathy (HE), on the average grade III for 3 days, were randomized to infusion for up to 14 days with either I g/(kg-day) of a- mino acids with 40% branched chain amino acids (BCAA) or isocaloric glucose, supplemented with 50% glucose to 30 kcal/(kg-day) and lactulose. The mean plasma a-amino-N concentration was 4.5 nmol/l and increased to 5.4 mmol/l in both groups during the infusions, in the BCAA group partly due to increase in the BCAA concentration. The regimens were well tolerated. The patients spent on the average 5 days in the regimens. In both groups 16 patients woke up and 11 patients died. The rest of the patients were considered as treatment failures because of renal or respiratory failure. The neurological status, scored daily by the "Glasgow Coma Scale", deteriorated in 10 of the 11 glucose treated deaths, and in 3 of the 11 BCAA treated deaths (p<0.01). Thus BCAA do not change the outo0me of acute HE in cirrhotics, which pre- sumably depends on the degree of liver impairment, but may exert a cerebroprotective effect.
TERLIPRESSIN IN BLEEDING ESOPHAGEAL VARICES
338 S.Walker, A .St ieh l , R.Raedsch, B.Kommerell
Med. Univ. C l i n i c , D-6900 Heidelberg, FRG
A double b l ind placebo cont ro l led study was performed to establ ish whether the c l i n i c a l cource of var iceal hemorrhage can be improved by the addi t ion of t e r l i p r e s s i n (Na- t r ig lycy l -8-1ys ine-vasopress in) to standard therapy. F i f t y bleeding episodes from esophageal varices in 34 pat ients were randomized. Standard therapy with transfusions, f l u i d and e l e c t r o l y t e correct ion and laotu lose was performed in both groups. Balloon tamponade-was used in 20 bleeding episodes in the t e r l i p r e s s i n group and in 19 bleeding bleeding episodes in the control group. Sclerotherapy was performed in f i ve bleeding episodes in the t e r l i p r e s s i n group and in sev, en bleeding episodes in the placebo group. In the t e r l i p r e s s i n group, hemorrhage was cont ro l led in a l l bleeding episodes (25/25) whereas in the the placebo group only 20 of 25 bleeding episodes could be stopped within 36 hours (p=O.05). A l l 16 bleeding episodes treated with t e r l i p r e s s i n plus balloon tamponade but only 9 of 14 bleeding episodes treated with placebo plus bal loon tamponade could be stopped (p=O.01). The hos'pital mor ta l i t y rate was 12% (3/25) in the t e r l i p r e s s i n group and 32% (8/25) in the control group. Patients in the t e r l i p r e s s i n group required fewer transfusions, the balloon tamponade needed to be blocked for a shorter time and the duration of bleeding was shorter than in the contro l group. However these di f ferences were not s i g n i f l o a n t . We conclude that the .add i t ion of t e r l i p r e s s i n to standard therapy raises the rate of control of acute var iceal hemorrage.