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    The efficacy of flumazenil in subclinical to mild hepatic encephalopathic ambulatory patients - A prospective, randomised, double-blind, placebo-controlled study
    (E M H Swiss Medical Publishers Ltd, 2003) Dursun, M; Caliskan, M; Canoruc, F; Aluclu, U; Canoruc, N; Tuzcu, A; Yilmaz, S
    Objectives: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with fulminant hepatic failure and chronic liver disease. Its pathogenesis is unclear. One of the factors implicated is enhanced GABA-ergic tone, which is probably related to increased concentrations of cerebral benzodiazepine (BNZ). In the present study, we tested flumazenil, a cerebral BNZ antagonist, in cirrhosis patients with hepatic encephalopathy. Methods: Out of 47 patients, 7 were excluded prior to randomization for various reasons. Twenty patients were included in the flumazenil group and 20 in the placebo group in a prospective, randomized, double-blind, placebo-controlled study. Patients were given. flumazenil (1 mg/h, continuous IV infusion) or an equal volume of saline solution for 5 hours. Before and after treatment, portosystemic encephalopathy (PSE) stage and number connection test (NCT) scores were checked every half hour for 5 hours. EEG was recorded 15 minutes before and I hour after treatment. Results: While significant improvements were determined in PSE stage and NCT score in the flumazenil group, there were no such improvements in the placebo group. There was no statistically significant difference between pre- and post-treatment EEGs in either group. Conclusion: It was concluded that continuous IV infusion of flumazenil had beneficial and safe effects in the treatment of hepatic encephalopathy patients.
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    Intracranial multiple tuberculomas: 2 unusual cases
    (Elsevier Science Inc, 2005) Guzel, A; Tatli, M; Aluclu, U; Yalcin, K
    Background: Tuberculosis (TB) is still a major public health problem that continues to be an important cause of morbidity and mortality at worldwide level. Only 1% of patients with TB develop an intracranial tuberculoma (Tbm), usually as part of miliary TB. The radiological findings are often nonspecific, and they are difficult to diagnose without an increased index of suspicion. Cases Descriptions: In this report, we presented 2 unusual patients with intracranial multiple Tbms, one of whom is a 32-year-old woman who did not have pulmonary TB or other primary origin of TB. Her diagnosis was established histopathologically, and she was treated with antituberculous chemotherapy. The other patient is a 12-year-old girl who has pulmonary TB with portal hypertension together with liver cirrhosis. Her diagnosis was established with clinical, radiological, and laboratory findings, and she was treated with antituberculous chemotherapy for 18 months. Conclusions: Intracranial Tbms have become rare in developed countries, but TB is still a very common infectious disease at worldwide level. Therefore, diagnosis should be kept in mind when confronted with brain space-occupying lesions, especially in the immunocompromised or malnutritional hosts such as liver cirrhosis. When no other active extracranial tuberculous process is found, the diagnosis should be confirmed by a biopsy before beginning antituberculous treatment, which is rapidly effective. We have not encountered in the literature such a case of multiple intracranial Tbms associated with liver cirrhosis in an adult patient. (c) 2005 Elsevier Inc. All rights reserved.