7, 29, 30 It also lends support to the hypotheses that ammonia and inflammatory cytokines may act synergistically31 and that they might induce astrocyte swelling/dysfunction as a common pathogenic endpoint.32 The observation that patients with alcohol-related cirrhosis are more likely to exhibit neuropsychiatric abnormalities than their counterparts with non–alcohol-related cirrhosis is not entirely novel and most likely due to the direct damage that alcohol misuse causes to the brain, regardless Ridaforolimus order of the degree of hepatic involvement.1, 33, 34 In addition, the enhanced activation of the inflammatory cascade observed in patients with alcohol-related cirrhosis

may also play a role. The findings of this study have several direct and indirect implications: First, the discrepancies between EEG and psychometric abnormalities often observed in patients with cirrhosis depend, at least to some extent, on the different pathways leading

to such abnormalities. Second, PHES and EEG analysis are both useful for an optimal HE evaluation in that they reflect different aspects of the pathogenesis of HE and they independently predict the subsequent occurrence of severe overt HE and death. Third, ITF2357 manufacturer for the same reasons, and for purposes of differential diagnosis, the results of a comprehensive neuropsychiatric examination should probably be included in the decision process leading to selection for hepatic transplantation. Finally, it Ergoloid is possible to hypothesize that the effects of ammonia/indole-lowering therapeutic strategies are more likely to be measured by neurophysiological rather than psychometric tools. In contrast, the effects of new drugs aimed at modulating the inflammatory cascade are probably best assessed by psychometry. In conclusion, PHES and EEG abnormalities

in patients with cirrhosis have partially different biochemical correlates and independently predict outcome. If confirmed, these results suggest that, despite the demands of routine hepatology practice for simple tools for the evaluation of neuropsychiatric status, meaningful and prognostically useful results can be obtained only with protocols including both psychometry and neurophysiology and, where possible, measurement of venous ammonia/indole and an inflammatory marker. This will be even more important within research and clinical trial settings. The authors are grateful to Dr. Antonietta Sticca for technical assistance. “
“Cysts in the liver can be classified in several different ways. Congenital cystic disease includes autosomal dominant polycystic kidney disease (ADPKD), simple cysts of the liver, polycystic liver disease (PLD), and the spectrum of diseases that includes autosomal recessive polycystic kidney disease (ARPKD), congenital hepatic fibrosis, and Caroli disease. Acquired cysts include hydatid disease, cystadenoma, and cystadenocarcinoma.