Acute Hepatic Encephalopathy: Pathophysiology and Diagnosis
p. 21
Pathophysiology
p. 21
Cerebral Edema and Related Effects
p. 23
Other Mechanisms
p. 27
Diagnosis
p. 29
Summary
p. 31
Acute Hepatic Encephalopathy: Treatment
p. 35
Standard Treatment
p. 35
Experimental Treatments
p. 37
Summary
p. 42
Medical Management of Acute Liver Failure
p. 45
Patient Environment and Monitoring
p. 45
Fluids, Electrolytes and Nutrition
p. 46
Hepatic Encephalopathy and Cerebral Edema
p. 48
Renal Impairment
p. 50
Pulmonary Disease
p. 51
Infection
p. 51
Coagulation and Hemorrhage
p. 52
Surgical Management of Acute Liver Failure
p. 55
Definitions and Patient Selection
p. 55
Transplant Evaluation
p. 59
Anesthetic Considerations
p. 61
Surgical Technique
p. 62
Results
p. 66
Summary
p. 68
Liver Support System Development
p. 73
Historical Perspective
p. 73
The Challenge
p. 74
Past Accomplishments: Laboratory Studies
p. 74
Past Accomplishments: Clinical Studies
p. 78
Current Status of Liver Support
p. 79
Clinical Experience with a Bioartificial Liver
p. 97
Methods
p. 97
Results
p. 100
Discussion
p. 104
Clinical Use of a Bioartificial Liver to Treat Acetaminophen-Induced Fulminant Hepatic Failure
p. 107
Methods
p. 107
Results
p. 109
Discussion
p. 110
Development of a Strategy for Management of Severe Acute Liver Failure: The Liver Support Unit
p. 113
Defining the Clinical Need
p. 113
Liver Support Unit Logistics
p. 113
Critical Clinical Care Issues
p. 114
Other Experimental Therapeutic Strategies: Liver Gene Therapy
p. 117
Transplantation of Genetically-Altered Cells
p. 117
Direct Gene Delivery
p. 120
Other Experimental Therapeutic Strategies: Hepatocyte Transplantation
p. 129
Correction of Specific Genetic Defects
p. 130
Treatment of Acute Liver Insufficiency
p. 130
Other Considerations
p. 131
Modulation of Transplanted Cell Antigenicity
p. 136
Human Hepatocyte Studies
p. 136
Optimal Technique
p. 137
Other Cell Transplantation
p. 148
Index
p. 151
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