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Seventy-five cirrhotic patients with hyperammonemia in ing number of patients with compensated or noncompenthe past or at the time of the study were randomly divided sated cirrhosis are managed in outpatient clinics over a long into two groups (treated with lactulose or nontreated) in 14 period. In these patients, prevention of the above complicahospitals in Japan. Thirty-six cirrhotic patients were diag-tions is necessary in long-term home care to improve the nosed as having subclinical hepatic encephalopathy (SHE), quality of life (QOL). and 39 were diagnosed as non-SHE. SHE was diagnosedIn hepatic encephalopathy, psychoneurological symptoms when the results of all three of the quantitative psychometric are clinically absent before the onset and during the interval tests used (number connection test, and symbol digit and period of encephalopathic episodes. However, subclinical heblock design tests of the Wechsler adult intelligence scale patic encephalopathy (SHE), in which behavior abnormali-[revised]) were abnormal as compared with age-matched ties and impairment in cognitive functions can be shown by normal values. The mean number of abnormal psychometric quantitative psychometric (neuropsychologic) tests, has been test results and the prevalence of SHE were used for a quanti-reported recently in cirrhotic patients who have no history tative evaluation of the efficacy of the lactulose treatment. of encephalopathy, and clinically appear to be free of encephTwenty-two of the SHE patients were treated with lactulose alopathy.1,2 Moreover, recent imaging analysis of the brain (45 mL/d) for 8 weeks, and the other 14 SHE patients did in cirrhotic patients with and without encephalopathy has not receive lactulose. In the SHE patients administered lactu-shown brain atrophy on computed tomography, 3 abnormal lose, the results of the quantitative psychometric evaluation regional cerebral blood flow on single photon emission comwere significantly improved at 4 and 8 weeks after the begin-puted tomography, 4 and high signals in the basal ganglia on ning of the lactulose administration. The SHE had disap-T1-weighted magnetic resonance imaging. Therefore, it is important for the long-term management it persisted in 11 (85%) of the untreated 13 patients. We of cirrhotic patients to understand the presence of these morconcluded that lactulose treatment in cirrhotic patients with phological changes and functional impairments of the brain, SHE is effective with respect to psychometric tests. (HEPA-and to pay attention to changes in daily behavior and sleep. TOLOGY 1997;26:1410-1414.)This approach would be useful for maintaining the compensated stage of cirrhosis over a long period and for reversing Because the treatment for complications of cirrhosis such as hepatic encephalopathy, jaundice, ascites, and gastrointes-the noncompensated cirrhosis to compensated cirrhosis. tinal bleeding has improved, the survival period of cirrhotic Lactulose has been used worldwide for the treatment of patients has been markedly prolonged. Th...

The Nx rats exhibited lower excretion of urine UA and over-expression of ABCG2 in the ileum. The fact that serum UA did not increase despite the decrease in UA excretion suggests that an excretory pathway other than the kidney, probably the intestine, may operate in a complementary role that corroborates the increase in ABCG2 expression in the ileum.

We evaluated the efficacy and safety of stereotactic body radiation therapy (SBRT) for patients with head and neck tumors. From April 2005 through April 2008, 34 patients with head and neck tumors were treated with CyberKnife SBRT. Twenty-one of them had prior radiotherapy. Treatment sites were orbit (n = 7), cervical lymph nodes (n = 6), nasopharynx (n = 5), oropharynx (n = 4) and others (n = 12). The prescribed dose ranged from 19.5 to 42 Gy (median, 30 Gy) in 3-8 fractions for consecutive days. The target volume ranged from 0.7 to 78.1 cm(3) (median, 11.6 cm(3)). The median follow-up was 16 months. Treatment was well tolerated without significant acute complications in any cases. Complete response rate and partial response rate were 32.4% and 38.6%, respectively. The overall survival rates were 70.6% and 58.3% at 12 and 24 months, respectively. The overall survival was better in patients without prior radiotherapy within the previous 24 months or in case of smaller target volume. Six patients suffered severe late complications. All these patients had prior radiotherapy, and 2 of them developed massive hemorrhage in the pharynx and both died of this complication 5 and 28 months, respectively, after SBRT. Our preliminary results suggest that SBRT is an effective treatment modality for head and neck tumors. However, re-irradiation has significant risk of severe and even fatal late complications in the form of necrosis and hemorrhage in re-irradiated areas.

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