Oral l-ornithine-l-aspartate in minimal hepatic encephalopathy: A randomized, double-blind, placebo-controlled trial.

AIM: Evaluate efficacy/safety of oral l-ornithine-l-aspartate (LOLA) in controlling minimal hepatic encephalopathy (MHE). METHODS: Consecutive cirrhotic outpatients with MHE (defined by psychometric number connection tests A/B [NCT-A/B] and digit symbol substitution test [DSST] score of >2 standard deviations) were randomized to a 60-day oral LOLA (5 g t.i.d) or placebo group. Critical flicker frequency test (CFF), quantitative electroencephalogram (qEEG), arterial ammonia (NH3), Beck's anxiety-depression forms and liver disease quality of life (LD-QOL) were assessed. Patients were followed for 6 months after the end of the study to assess LOLA prophylactic role on overt hepatic encephalopathy (OHE). RESULTS: Sixty-four patients were included, 63 (98.4%) with MHE. In six of these patients, CFT was less than 39 Hz (9.52%); NH3 was increased in 32 (50.8%); 25% had abnormal qEEG. Age, sex, scholarship, Child-Pugh (CP), Model for End-Stage Liver Disease, NCT-A/B, DSST, CFF and NH3 were similar in both groups at the baseline. LOLA led to a significant improvement in NCT-B age-controlled z-score (3.4 ± 3.4 vs 1.5 ± 2.3, P = 0.01) and CFF (42.2 ± 5.8 vs 45.2 ± 5.8, P = 0.02), comparing the first and the last visit, but there were no differences between LOLA and placebo regarding the whole psychometric battery, CFF, LD-QOL and Beck's forms. No serious adverse effects occurred. Patients taking LOLA had less episodes of OHE at 6 months (5% vs 37.9%, P = 0.016), as they have significant improvement on liver function assessed by CP (P < 0.001). CONCLUSION: A 60-day oral LOLA course was not better than placebo in treating MHE, but was useful in preventing further episodes of OHE.

[Primary connus medullaris glioblastoma: case report]. / Glioblastoma primário de cone medula: relato de caso.

Glioblastomas are the most common type of brain tumors; astrocytic in their origin, they are anaplastic tumors, and are located mainly in the cerebral hemispheres. Primary growth in the conus medullaris is very rare, and the assessment and prognosis of this kind of tumor are distinct and unique. We present here the case of a 39 years-old man with an intramedullary tumor of the spinal cord, with an histo pathological diagnosis of glioblastoma, along with some therapeutic considerations.

Glioblastoma primário de cone medula: relato de caso / Primary connus medullaris glioblastoma: case report

O glioblastoma, um tumor anaplásico de linhagem astrocitária, é o mais freqüente tumor cerebral. Localiza-se preferencialmente nos hemisférios cerebrais; seu crescimento primário no cone medular é muito raro, e o manejo e prognóstico deste tipo de lesão são distintos dos outros tumores observados nesta localização. Apresentamos o caso de um homem de 39 anos com tumor intramedular com diagnóstico histo-patológico de glioblastoma.