Episodic Stupor Associated with an Eck Fistula in the Human with Particular Reference to the Metabolism of Ammoniaxs12
Year: 1954
Type: article
Abstract: The effect on animals of ligating the portal vein and diverting the blood from the portal system directly into the inferior vena cava through a surgically constructed fistula was first studied by Eck in 1877 (1).As a mark of respect for the ingenuity of these experiments, the eponym, "Eck fistula," has been perpetuated in medical writings.Animals so treated can be made to survive for long pe- riods of time in apparently good health and therefore the Eck fistula has been used extensively as a means of investigating the metabolic activities of the liver.Although dogs with an Eck fistula may remain in good clinical condition, it has been demonstrated that the liver undergoes a certain amount of atrophy; the production of plasma pro- teins, hemoglobin, and bile pigments is diminished; serum lipid levels are low despite adequate fat absorption; and the consumption and urinary output of water are increased (2-5).Perhaps the most interesting and controversial observation derived from these experiments has been the phenomenon of "meat intoxication," a neurological disorder consisting of stupor, ataxia, convulsions, and finally coma, which occurs in Eck fistula dogs either after the ingestion of meat, or spontaneously.This phenomenon has been studied extensively (6-10) and, while it has been suggested that vari- ous degradation products of protein metabolism are responsible, the pathogenesis actually remains obscure.Construction of an anastomosis between the portal vein and the inferior vena cava with or with- out interruption of the portal vein is frequently carried out in patients with portal hypertension for the treatment of esophageal varices.This anasto-
DOI: 10.1172/jci102862
Authors: William V. McDermott, Raymond D. Adams
Institutions: Harvard University, Massachusetts General Hospital
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2055041361