Prospective study of portasystemic encephalopathy after emergency portacaval shunt for bleeding varices

Prospective Randomized Trial of Emergency Portacaval Shunt and Emergency Medical Therapy in Unselected Cirrhotic Patients With Bleeding Varices

“…It is noteworthy that EPCS resulted in significantly higher survival rates of patients in each of Child's risk classes than did EMT, and the differences between the two groups were particularly striking in patients in class B and class C. In patients with alcoholic cirrhosis, two major factors that determine prolonged survival and quality of life are alcoholism and PSE (18,25). These factors are often interrelated.…”

“…In patients with alcoholic cirrhosis, two major factors that determine prolonged survival and quality of life are alcoholism and PSE (18,25). These factors are often interrelated.…”

Portal-Systemic Encephalopathy in Emergency Treatment of Cirrhosis and Bleeding Esophageal Varices

“…The question is, can cirrhotic patients tolerate an operation of this magnitude when it is performed as an emergency in the face of bleeding? To answer this question, we have conducted prospective studies of emergency PCS (EPCS) over the past 47 years, as follows: (1) an unrandomized study of 400 unselected patients who underwent EPCS; (2) a RCT of EPCS versus emergency medical therapy involving 43 patients at our Veterans Administration Hospital; (3) an unrandomized study of 94 unselected, consecutive patients with Child's class C cirrhosis; (4) a RCT of portacaval shunt versus endoscopic sclerotherapy in 518 unselected patients bleeding from gastric varices; (5) a n u n r a n d o m i z e d s t u d y i n 1 2 p a t i e n t s w i t h u n c o n t r o l l a b l e b l e e d i n g f r o m p o r t a l hypertensive gastropathy; (6) a NIH grant supported RCT of EPCS versus emergency endoscopic sclerotherapy (EST) that enrolled 211 patients who have had more than 10 years of follow-up or until death; and (7) a NIH grant supported RCT of TIPS versus EPCS that enrolled 154 patients who have been followed up for 5-10 years (Orloff, 1967;Orloff et al, 1980;Orloff et al, 1992;Orloff et al, 1994;Orloff et al, 1995a;Orloff et al, 2009a;Orloff et al, 2009b;Orloff et al, 2011a;Orloff et al, 2011b;Orloff et al, 2010;Orloff et al, 2011c;Orloff et al, 2011d;Orloff et al, 2011e;Orloff et al, 2011f;Orloff et al, 2011g;Orloff et al, 2011h;Orloff et al, 2011i;Orloff & Bell, 1983;Bell, et al, 1981;Orloff, 1968;Orloff, 1969;Orloff et al, 1974;Orloff et al, 1975;Orloff & Bell, 1986;Orloff et al, 1995b;Orloff et al, 1997) . The unique features of our studies that, together, make them different from other reported investigations are as follows: (1) EPCS was undertaken within 24 h of initial contact of the patient with our institution in one study and within 8 h in the other six studies; (2) the patients were unselected, which means that all patients with bleeding varices, regardless of their condition ("all comers"), were entered in the studies and treated; (3) the studies were prospective, which means that the p...…”

Miscellanea on Encephalopathies

“…To answer this question, we have conducted prospective studies of emergency PCS (EPCS) over the past 47 years, as follows: ( 1 7) a NIH grant supported RCT of TIPS versus EPCS that enrolled 154 patients who have been followed up for 5-10 years (Orloff, 1967;Orloff et al, 1980;Orloff et al, 1992;Orloff et al, 1994;Orloff et al, 1995a;Orloff et al, 2009a;Orloff et al, 2009b;Orloff et al, 2011a;Orloff et al, 2011b;Orloff et al, 2010;Orloff et al, 2011c;Orloff et al, 2011d;Orloff et al, 2011e;Orloff et al, 2011f;Orloff et al, 2011g;Orloff et al, 2011h;Orloff et al, 2011i;Orloff & Bell, 1983;Bell, et al, 1981;Orloff, 1968;Orloff, 1969;Orloff et al, 1974;Orloff et al, 1975;Orloff & Bell, 1986;Orloff et al, 1995b;Orloff et al, 1997) . The unique features of our studies that, together, make them different from other reported investigations are as follows: ( 1) EPCS was undertaken within 24 h of initial contact of the patient with our institution in one study and within 8 h in the other six studies; (2) the patients were unselected, which means that all patients with bleeding varices, regardless of their condition ("all comers"), were entered in the studies and treated;…”