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Titolo:
FLUMAZENIL IN CIRRHOTIC-PATIENTS IN HEPATIC-COMA - A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CROSSOVER TRIAL
Autore:
POMIERLAYRARGUES G; GIGUERE JF; LAVOIE J; PERNEY P; GAGNON S; DAMOUR M; WELLS J; BUTTERWORTH RF;
Indirizzi:
UNIV MONTREAL,HOP ST LUC,ANDRE VIALLET CLIN RES CTR,LIVER UNIT,264 RENE LEVESQUE E MONTREAL H2X 1P1 PQ CANADA UNIV MONTREAL,HOP ST LUC,NEUROSCI RES UNIT MONTREAL H2X 1P1 PQ CANADA NO REG FORENS LAB SAULT ST MARIE P6A 6V3 ON CANADA
Titolo Testata:
Hepatology
fascicolo: 1, volume: 19, anno: 1994,
pagine: 32 - 37
SICI:
0270-9139(1994)19:1<32:FICIH->2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
BENZODIAZEPINE ANTAGONIST FLUMAZENIL; GAMMA-AMINOBUTYRIC ACID; RECEPTOR LIGANDS; ENCEPHALOPATHY; FAILURE; RO-15-1788; GABA; REVERSAL; BINDING; COMPLEX;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
35
Recensione:
Indirizzi per estratti:
Citazione:
G. Pomierlayrargues et al., "FLUMAZENIL IN CIRRHOTIC-PATIENTS IN HEPATIC-COMA - A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CROSSOVER TRIAL", Hepatology, 19(1), 1994, pp. 32-37

Abstract

Previous reports have suggested that ''endogenous'' benzodiazepines could contribute to neural inhibition in hepatic encephalopathy. RO 15-1788 (flumazenil), a specific antagonist of brain benzodiazepine receptors, could thus reverse the neurological symptoms of hepatic encephalopathy. To test this possibility, we conducted a double-blind, placebo-controlled crossover trial of the efficacy of flumazenil in cirrhoticpatients in hepatic coma. Seventy-seven cirrhotic patients in hepaticcoma were evaluated. Fifty-six were excluded from the trial because of multiorgan failure or because coma was precipitated by prior use of benzodiazepines, and 21 patients were randomly assigned to the flumazenil group (11 patients) or the placebo group (10 patients). Treatment was administered intravenously as a 20-ml solution (placebo or 2 mg flumazenil); seven patients were crossed over. Clinical status was assessed blindly by two observers, using a modified Glasgow scale, every 15min for 6 hr. Electroencephalogram tracings obtained before and afterdrug administration were evaluated blindly by two independent observers. Serum concentrations of benzodiazepines before treatment were measured by means of a fluorescence polarization immunoassay. Improvement in neurological symptoms was observed in six patients treated with flumazenil, whereas none in the placebo group showed improvement (p < 0.05; Fisher's exact test). Improvements in electroencephalogram tracingswere demonstrated in four patients treated with flumazenil, compared with two patients in the placebo group (p = NS). Benzodiazepines were found in the serum of four patients treated with flumazenil (two responders and two nonresponders); all of these patients had received pharmaceutical benzodiazepines 4 to 6 days before the trial. We conclude that flumazenil is effective in a subset of highly selected cirrhotic patients with severe hepatic encephalopathy and that this beneficial effect is not related to the presence of benzodiazepines in the blood.

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Documento generato il 01/06/20 alle ore 02:28:33