[Encephalopathy in acute hepatic atrophy. Effect of the purification of middle molecules. Preliminary results]

The authors have achieved 5 complete recoveries from coma and two partial recoveries in 9 non-decerebrate patients in coma due to acute hepatic atrophy by using polyacrylonitrile membrane haemodialysis. Survival was not possible until sufficient hepatic regeneration had developed. On the other hand, repeated returns to consciousness were observed with prolonged survival lasting up to 40 days despite almost complete destruction of the liver. The different hypothesis relating to the mechanism of the encephalopathy and the usefulness of such a procedure are discussed: filtration of ammonia, free fatty-acids, role of amino-acids and possible polypeptides.