***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A r and omized double blind clinical comparison of neomycin and lactulose was performed in 33 cirrhotic patients with chronic portal-systemic encephalopathy ( PSE ) at seven cooperating hospitals . In order to maintain double blindness , sorbitol syrup was used as a control solution along with neomycin and was compared with lactulose syrup and placebo tablets in a double drug protocol . Twenty-nine patients were studied in a crossover investigation in which each received both therapeutic regimens preceded and followed by control periods . Four additional patients received one or the other agent , but did not receive both . Serial , semiquantitative assessment s were made in all patients of mental status , asterixis , and the trailmaking test ( TMT ) and electroencephalograms ( EEG ) and arterial ammonia levels . Both neomycin-sorbitol and lactulose were effective in the majority of patients ( 83 and 90 % , respectively ) . Each of these parameters ( mental state , asterixis , TMT , EEG , and NH3 ) was improved significantly by neomycin-sorbitol and lactulose . The post-treatment levels for each of these measures were similar in the neomycin and lactulose-treated groups . Mean stool pH was reduced by neomycinsorbitol to 6.1 and by lactulose to 5.5 . This difference was highly significant statistically . Bowel activity was similar in the two groups . Both drugs were free of toxicity . These investigations demonstrate that both lactulose and neomycin-sorbitol are effective in the treatment of chronic portal-systemic encephalopathy Six patients with cirrhosis and severe chronic hepatic encephalopathy were treated with bromocriptine . All showed significant overall improvement clinical ly and in 3 , the electroencephalogram became normal . The cerebral blood flow increased significantly from 32.7 + /- 2.4 ( mean + /- 1 SE ) to 40.5 + /- 1.5 ml/100 g brain/min ( P less than 0.05 ) . Similarly , there were significant improvements in the cerebral oxygen consumption from 2.2 + /- 0.4 to 3.3 + /- 0.4 ml/100 g brain/min ( P less than 0.02 ) and in cerebral glucose consumption from 2.1 + /- 0.6 to 6.6 + /- 1.6 mg/100 g brain/min ( P less than 0.02 ) . Cross-over to placebo produced overall deterioration , more marked in the patients who had received the active drug for the shorter time period . No serious side effects were seen ; the drug was well tolerated in doses of up to 15 mg daily and is a useful treatment for chronic hepatic encephalopathy when the response to conventional therapy has been poor Three of six patients with chronic hepatic encephalopathy treated with levodopa showed a significant improvement . One patient was probably improved whilst the remaining two patients failed to show any benefit . Serial electroencephalography did not demonstrate significant changes . Treatment with levodopa was associated with an improvement in ` speed-based ' tasks as assessed by computerized psychometry . A significant rise in cerebral oxygen consumption was found during levodopa therapy . Gastrointestinal side effects were dose limiting . It is concluded that a therapeutic trial of levodopa in patients with chronic hepatic encephalopathy is indicated when the response to conventional therapy has been poor 
    Output:
    
The treatment response was not significantly different with regard to the type of hepatic encephalopathy or dopaminergic agonist , but the analyses had very low power to detect potential differences .
REVIEW ERS ' CONCLUSIONS This review does not provide evidence that dopaminergic agonists are of benefit to patients with acute or chronic hepatic encephalopathy , or fulminant hepatic failure .