Hepatorenal syndrome, hepatopulmonary syndrome, and now, hepatospinal syndrome?

Abstract

Background & Aims: Hepatic myelopathy is a rare complication of chronic liver disease, causing progressive spastic paraparesis. Today, no therapy of this disorder has been established. Commonly used therapeutic strategies for hepatic encephalopathy aiming at the reduction of plasma ammonia levels such as protein restriction, oral neomycin, lactulose, or ornithine aspartate fail to improve the symptoms of hepatic myelopathy. The aim of this study was to find out whether orthotopic liver transplantation (OLT) may improve hepatic myelopathy. Methods:

Effects of amoxicillin repeated administration on the hemogram and biogram of sheep

“…24 ALT, another hepatic leakage enzyme, did not show significant change, because its activity is not high in ruminants' hepatocytes. 23,24 In addition to that, a significant increase in ALP monitored in the treated group was not associated with an increase in bilirubin. It is obvious that ALP is a cholestatic marker and its synthesis and release increases in association with impaired bile flow, 23,24 and the TB in the treated group was within normal range, accordingly, this increase in ALP may be considered non-specific and attributed to its wide and fluctuating reference intervals in ruminants.…”

“…5,8,21,22 A significant increase in the level of AST and cholesterol in the amoxicillin-treated group may indicate hepatic impairment, as AST is a hepatic leakage enzyme that increases in association with the liver and muscular diseases. 23 This increase, although statistically significant, is not considered conclusive, as the level of AST remained within the lower normal range for ovines. 24 ALT, another hepatic leakage enzyme, did not show significant change, because its activity is not high in ruminants' hepatocytes.…”

“…It is obvious that ALP is a cholestatic marker and its synthesis and release increases in association with impaired bile flow, 23,24 and the TB in the treated group was within normal range, accordingly, this increase in ALP may be considered non-specific and attributed to its wide and fluctuating reference intervals in ruminants. 23 Supporting to this, GGT the specific cholestatic enzyme in large animals showed no significant changes in amoxicillin-treated group.…”

Hepatic Myelopathy: Case Report and Review of the Literature

“…To date, there were only 15 cases undergone OLT in the English literature, altogether 11 cases showed quite impressive improvement, 18,21,[24][25][26] mostly recovered to be ambulatory.…”

“…32 It can be ignored because walking difficulty can be all too easy to attribute this to a multitude of other problems commonly seen in this group of patients, including peripheral edema, malnutrition, and electrolyte disturbances. 24 Most commonly, symptoms will develop after several bouts of HE, although rarely myelopathy may be the presenting manifestation of liver failure. The signs of corticospinal tract damage appear to accumulate with each episode, although other neurologic signs resolve completely.…”