A prospective randomized double-blind study was conducted to evaluate the efficacy of sodium benzoate in the treatment of acute portal-systemic encephalopathy. Seventy-four consecutive patients with cirrhosis or surgical portasystemic anastomosis and hepatic encephalopathy of less than 7 days duration were randomized to receive lactulose (dose adjusted for 2 or 3 semiformed stools/day) or sodium benzoate (5 gm twice daily). Assessment of response included mental status, asterixis, arterial ammonia level, electroencephalogram and number-connection test. Each was given a score between 0 and 4+. A portal-systemic encephalopathy index was calculated with these scores. Visual, auditory and somatosensory evoked potentials and a battery of psychometric tests for intelligence and memory were also performed to assess improvement. Thirty-eight patients received sodium benzoate; 36 took lactulose. Thirty patients (80%) receiving sodium benzoate and 29 (81%) receiving lactulose recovered; the remaining patients died. Improvement in portal-systemic encephalopathy parameters occurred in both treatment groups and was similar (p greater than 0.1). Electroencephalogram and evoked potentials were not as helpful as mental status in assessing of recovery. Psychometric test scores remained abnormal after recovery of mental status (21 to 42 days) and were probably too sensitive for monitoring of these patients. The incidence of side effects was similar in the two treatment groups. The cost of lactulose for one course of therapy was 30 times that of sodium benzoate. We conclude that sodium benzoate is a safe and effective alternative to lactulose in the treatment of acute portasystemic encephalopathy.

rum bilirubin, and prothrombin time prolongation over The profiles of patients with fulminant hepatic failure controls at admission were related to survival (P õ . 01). (FHF) from developing countries have not been reportedThe rapidity of onset of encephalopathy and cause of earlier. The current study was conducted prospectively, FHF did not influence the outcome. Cox's proportional at a single tertiary care center in India, to document the hazard regression showed age ¢40 years, presence of demographic and clinical characteristics, natural cerebral edema, serum bilirubin ¢15 mg/dL, and procourse, and causative profile of patients with FHF as thrombin time prolongation of 25 seconds or more over well as to define simple prognostic markers in these pacontrols were independent predictors of outcome. tients. Four hundred twenty-three consecutive patients Ninety-three percent of the patients with three or more with FHF admitted from January 1987 to June 1993 were of the above prognostic markers died. The sensitivity, included in the study. Each patient's serum was tested specificity, positive predictive value, and the negative for various hepatotropic viruses. Univariate Cox's repredictive value of the presence of three or more of these gression for 28 variables, multivariate Cox's proporprognostic factors for mortality was 93%, 80%, 86%, and tional hazard regression, stepwise logistic regression, 89.5%, respectively, with a diagnostic accuracy of 87.3%. and Kaplan-Meier survival analysis were done to idenWe conclude that most of our patients with FHF might tify independent predictors of outcome at admission. Most reports on fulminant hepatic failure (FHF)from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be have been predominantly from the West, 1-9 and particuimplicated as the causative agent, and isolated HCV larly from three countries: the United Kingdom, 1,2 Ja-RNA could be detected in 7 (19%). Two hundred eighty-pan, 3,4 and France. 5 Based on these geographically limeight (66%) patients died. Approximately 75% of those ited observations, a new classification of this disease who died did so within 72 hours of hospitalisation. One entity into hyperacute, acute, and subacute liver failquarter of the female patients with FHF were pregnant. ure has been suggested.2 These authors also suggested Mortality among pregnant females, nonpregnant fe-the adoption of this classification universally for a unimales, and male patients with FHF was similar (P ú .1). form terminology. The latter study has not been able The cause and rapidity of the onset of hepatic enceph-

Background:There is paucity of methodologically sound published studies on intracerebral hemorrhage (ICH) from India, on pub med/embase search.Aims:To explore etiology of ICH and correlate the causes, location, and size of hemorrhage to clinical outcome.Materials and Methods:A hospital-based descriptive study from South Indian eastern coastal town of Puducherry; 60 consecutive subjects aged > 12 years, predominantly of inbred Tamil population, with head CT evidence of intracerebral hemorrhage not associated with trauma and brain tumors, were recruited. Outcome at three months was measured using Glasgow Outcome scale, NIHSS and mortality. SPSS v 19 was used for statistical analysis.Results:Commonest etiological factor was hypertension, followed by bleeding diathesis, thrombolysis for myocardial infarction, and cortical vein thrombosis. Most frequent locations of hematoma were basal ganglia, thalamus, internal capsule, and cerebral and cerebellar parenchyma. Hematoma volume correlated significantly with systolic and mean arterial pressure but not with diastolic blood pressure. Poor outcome was correlated to size (P < 0.05) and intraventricular extension of hematoma (P < 0.05), and to systolic, diastolic and mean arterial pressure, but not to age, gender, smoking, alcoholism, ischemic heart disease, and blood sugar level. Among diabetic patients with ICH, the size of hematoma (P = 0.04) and severity of coma (P = 0.01) at admission were significantly worse compared to the non-diabetic, but not the outcome at three months [Glasgow outcome scale or mortality (P = 0.94 and 0.14)].Conclusions:The location of hemorrhage and correlation with outcome agreed with the patterns described for the non-white races in prior reports. Independence of outcome to diabetic status despite a more severe initial presentation may indicate importance of good care, even in high risk groups.

Systemic reactions to contact with a caterpillar are rare in children. A 3-month-old infant presented to the emergency department with acute onset of rash, severe respiratory distress and shock. Her mother volunteered that the infant had been exposed to a tree processionary caterpillar. The infant responded to systemic corticosteroids and antihistamines although the rash persisted for more than 5 days.