The meeting which took place in Rome on November 19th and 20th of 1982 is easily the best meeting on hepatic coma that I have ever attended, and I have attended many. It was an exceedingly we- planned meeting with prolonged opportunity for discussion, and there was genuine interplay and exchange of ideas (not the usual picture of a rushed meeting with investigators presenting their own point of view and talking past each other without a meaningful ex­ change) which took place in Rome. My co-editors and I hope that the published transcript, which of course can only reflect what transpired in Rome on those two days, does justice to a very intellectually exciting and gratifying ex­ change of ideas. L. Capocaccia, J. E. Fischer and F. Rossi-Fanelli v CONTENTS Introduction 1 SECTION 1: PATHOGENETIC PROBLEMS IN HEPATIC ENCEPHALOPATHY Ammonia: The old and the new ¿ ¿ . ¿ ¿ ¿ . ¿ . ¿ ¿ ¿ . ¿ . ¿ 5 L. Zieve Role of synergism in the pathogenesis of hepatic encephalopathy ¿ ¿ ¿ ¿ . ¿ ¿ . . . . ¿ 15 L. Zieve y-Aminobutyric acid receptors in experimental hepatic encephalopathy ¿. ¿. ¿ ¿ 25 M. L. Zeneroli, ~. Baraldi,and E. Ventura A possible role for excitatory neurotoxic amino acids in the pathogenesis of hepatic en­ 41 cephalopathy ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ ¿ F. Moroni, G. Lombardi, G. Moneti, D. Pellegrini and C.

Section 1: Pathogenetic Problems in Hepatic Encephalopathy.- Ammonia: The old and the new.- Role of synergism in the pathogenesis of hepatic encephalopathy.- ?-Aminobutyric acid receptors in experimental hepatic encephalopathy.- A possible role for excitatory neurotoxic amino acids in the pathogenesis of hepatic encephalopathy.- LThe development of the false neurotransmitter concept of hepatic encephalopathy.- Studies relating to a theoretical understanding of altered blood-brain barrier transport in liver disease.- Amino acid transport in isolated brain capillaries.- Cerebro-spinal fluid amino acid pattern in hepatic encephalopathy.- Alterations of plasma and brain tryptophan in hepatic encephalopathy: a study in humans and in experimental animals.- New methods for the determination of serum and breath mercaptans and its application in liver cirrhosis and hepatic encephalopathy.- Plasma influence on the altered blood-brain barrier to amino acids after portacaval shunt: Preliminary results.- Hepatic encephalopathy is associated with decreased numbers of receptors for excitatory aminoacid neurotransmitters.- Brain gamma amino-butyric acid in acute hepatic encephalopathy in dogs following hepatectomy with or without abdominal evisceration.- Section 2: Metabolic and Prophylactic Aspects of Hepatic Encephalopathy.- Carbohydrate metabolism in liver disease.- Proteins and amino acids in liver failure.- The metabolic fate of branched chain amino acids.- Long term dietary supplement with branched chain amino acids: a new approach in the prevention of hepatic encephalopathy: Results of a controlled study in cirrhotics with portocavai anastomosis.- Muscle biopsy studies on malnutrition in patients with liver cirrhosis: Preliminary results of long-term treatment with abranched-chain amino acid enriched diet.- The role of muscle protein catabolism in the plasma amino acid profile of cirrhotics.- Plasma prolactin in liver cirrhosis.- Short-term branched chain amino acid parenteral nutrition in liver cirrhosis: A dose-related effect on plasma amino acids and nitrogen balance.- Nutritional effects of branched-chain ketoanalogues in chronic hepatic and renal failure: A preliminary report.- Section 3: Assessment and Evaluation of Hepatic Encephalopathy.- Summary of the contributions.- Visual evoked potentials in the quantitative assessment of portal-systemic encephalopathy and its preclinical stage.- Section 4: Therapeutic Aspects of Hepatic Encephalopathy.- Bromocriptine in the treatment of chronic hepatic encephalopathy.- Bromocriptine to treat portal systemic encephalopathy.- Lactitol, a potential second generation disaccharide drug for the treatment of portal-systemic encephalopathy.- Lactose to treat acute and chronic portal systemic encephalopathy.- Do branched-chain amino acids have a role in the treatment of hepatic encephalopathy?.- Treatment of hepatic encephalopathy by infusion of a modified amino acid solution: Results of a controlled study in 47 cirrhotic patients.- Efficacy of branched-chain amino acids in the treatment of hepatic encephalopathy.- Branched chain amino acid enriched solutions in the treatment of hepatic encephalopathy: A controlled trial.- Branched-chain amino acids in the treatment of severe hepatic encephalopathy.- Prophylaxis of hepatic encephalopathy after portacaval anastomosis using branched chain amino acid mixtures.- Effective treatment of latent porto-systemic encephalopathy with oral branched chain amino acids.- Effect of vegan and meat protein diets in mild chronic portal-systemic encephalopathy.-14C] -L-Valine binding to post mortem frontal cortex homogenates in hepatic encephalopathy.- Regional analysis of norepinephrine, dopamine and amino acids in the brain 18 hours after hepatectomy and infusion of branched-chain amino acids.- Comment to oral BCAA trials.- Contributors.