Number-connection test

Testa etal. 50 Paromomycin (open) 5 days Antibacterial assays in vitro, NH3, number connection test E Rif > Par T Rif = Par... 

Loguercio et al. 61 Rif + sorbitol Rif + lactitol Lactitol (double-blind) 14 consecutive days each month for 3 months Mental status, asterixis, blood NH3, number connection test E Rif + Lat = Rif + Sor >Lat T Rif + Lat = Rif + Sor = Lat... 

Mas et al. 62 Lactitol (double-blind) 5-10 days HE index, mental status, asterixis, NH3, number connection test, EEG E Rif >Lat T Rif = Lat... 

Number-connection test (part A of trail-making test, fourfold variations)... 

Tab. 10.8 Assessment criteria for the handwriting-specimen test 3.2.2 Number-connection test...

The trail-making test (R.M. Reitan, 1955) originated from the army individual test (1945) and the test results of s.G. Armitag (1946). It Comprises two parts the number-connection test (NCT) with numbers from 1-25 (part A) and the number and letter combination test (NLCT) with numbers from 1-13 and the letters A-L (part B). (32, 33) (s. fig. 10.2)... 

Fig. 10.2 Number-connection test (NCT part A) and number-letter-connection test (NLCT part B) (R.M. Reitan, 1955 H.O. Conn, 1977)...

Tab. 10.9 Assessment criteria for the number-connection test (NCT part A)...

Conn, H.O. Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Dig. Dis. 1977 ... 

Saxena, N., Bhatia, M., Joshi, Y.K., Garg, P.K., Tandon, R.K. Auditory P 300 event-related potentials and number connection test for subclinical hepatic encephalopathy in patients with cirrhosis of the liver a follow-up study. J. Gastroenterol. Hepatol. 2001 16 322—327... 

Yen, C.-L., Liaw, Yi-F. Somatosensory evoked potentials and number connection test in the detection of subchnical hepatic encephalopathy. Hepato-Gastroenterol. 1990 37 332-334... 

Favourable effect of E. faecium M-74 emiched with organic selenium on chronic hepatic encephalopathy was also demonstrated (Boca et al. 2004). The blood ammonia levels as well as the results from the number-connecting test after 8-9 weeks significantly approached the normal pattern. EEG results were improved and they were often normalised. In another clinical study, the administration of E. faecium M-74 probiotic strain was associated with reduction of serum cholesterol concentrations by 12% after 56 weeks of oral administration (HUvak et al. 2005). 

Ammonia metabolism within the muscle may be improved by the administration of L-omithine-L- aspartate (LOLA). Controlled trials suggest that enteral and parenteral formulations of ornithine aspartate significantly reduce blood ammonia levels and have useful therapeutic effects in patients with cirrhosis and encephalopathy (Kircheis et al., 1997 Stauch et al., 1998). Poo et al. (2006) recently showed in a randomized, lactulose-controlled study of oral ornithine-aspartate in 20 patients with clinically overt HE that LOLA in contrast to lactulose significantly improved parameters of mental status, number connection test scores, asterixis scores and EEG. Both lactulose and LOLA reduced serum ammonia levels and improved quaUty of life scores. Since only 20 patients were included in this study the results cannot be considered proof for the superiority of LOLA compared to lactulose, while the data underscore the effect of both agents. Ornithine aspartate is well tolerated in general. From a theoretical point of view the combination of disaccharides and ornithine aspartate may be useful in patients with insufficient efficacy of only one of the two drugs. 

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