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An overview is given of diagnostic determinations to be carried out on ascites fluid, and on the medical therapy as based on our knowledge of the pathophysiology. Paracentesis has become more frequently used. It is slightly more effective than therapy with high doses of diuretics and carries less side effects. Longterm studies are needed to investigate whether albumin can be safely substituted by dextran-70 or haemaccel.
A group of 235 patients were treated between 1981 and 1993 for primary spontaneous pneumothorax. Immediate recovery was obtained in 150 (75%) out of 8 in whom drainage had been applied, and in a total of 79 who had been operated. Fifty of the remaining 52 patients with the first episode of pneumothorax, had repeated paracentesis with no complete lung expansion prior to operation, and 2 were referred to pleural cavity drainage. Three out of 79 operated patients, required re-thoracotomy (2 on the second day, and 1 on the eighth day following operation) because of hemothorax. In 3 patients an infection developed, thereupon a prolonged drainage of pleural cavity was used with good result.
Out of 235 patients discharged from the Department of Thoracic Surgery, Silesian Medical Academy, after treatment of primary spontaneous pneumothorax between 1981 and 1993, 232 (98.7%) answered our questionnaire and so were included in the study. Mean follow-up time was 10.4 years. No recurrence of the disease was reported by any of 79 patients who had been treated by surgical procedure/thoracotomy plus pleurectomy/, but 21 (14.3%) out of 147 treated by paracentesis reported a recurrence of pneumothorax. In 17 patients the recurrence was the first-time case, in 3 the second-time, in 1 the third-time. Out of 232 patients, 10 (4.3%) had a recurrence of pneumothorax on the opposite side. Achieving expansion of the lung, 80% of the patients reported no problems at all. Only 6 (2.6%) of the whole group stated they could no longer work in their profession because of the pneumothorax they had suffered in the past.
A patient with acute pancreatitis developed subcutaneous fat necrosis of the anterior abdominal wall secondary to leakage of pancreatic enzymes through a rent in the peritoneum following paracentesis. The same patient also had another subcutaneous complication of pancreatitis, namely, nodular liquifying panniculitis of the lower extremities. The diagnosis was made by the typical histological findings of subcutaneous fat necrosis, foci of necrotic cells with a "ghost-like" appearance, and basophilic-staining calcium soaps deposited around the necrotic cells.
The prostaglandin-inhibiting effect of Indomethacin (IN) was studied in rabbits, using paracentesis as a stimulus and rise in aqueous protein and fluorescein concentration after intravenous fluorescein injection as parameters. In eye pre-treated with IN eyedrops the rise in fluorescein and protein concentration in the secondary aqueous was less than the control eyes; the rise in the control eyes was less than in the eye of rabbits not treated with IN. There was good correlation between the rise in protein and the rise in fluorescein concentration in the secondary aqueous. The four different 0.5% IN suspensions used showed different PG-inhibiting activity, attributed to the difference in physiochemical composition.
There is in the ciliary epithelium a barrier which prevents the passage of plasma proteins into the posterior chamber of the eye. The anatomical site of this blood-aqueous barrier is at the zonulae occludentes (tight junctions) located between the lateral plasma-membranes of the nonpigmented epithelial cells. Using the freeze-fracture technique we have studied these junctions in the pars plicata. As in many epithelia, they are formed by an anastomosing network of ridges on the fracture PF face and by a complementary set of furrows on the fracture EF face of plasma membranes. Features of these junctions are the presence of frequent parallel and closely associated double or triple ridges, and a few small gap junctions, associated with tight junctional elements of the zonulae occludentes. We also show that the number of junctional strands (ridges and furrows from apex to base) varies from a few strands to about 15, according to their position around the nonpigmented epithelial cells. These observations suggest that the rabbit's ciliary epithelium is to be classified among the 'tight' or 'very tight' epithelia (Claude and Goodenough, 1973). After paracentesis, we observed no breakdown of the zonulae occludentes. This supports the hypothesis that the site of leakage of the plasma proteins is elsewhere than ciliary epithelium.
Coagulation disorders and obesity might complicate transabdominal paracentesis. In a woman with severe thrombocytopenia we used the vaginal approach guided by vaginosonography to obtain ascitic fluid for analysis.
A 34-year-old man with a three-month history of intraocular inflammation after ocular trauma with a fir branch, had an acute unilateral fulminant iridocyclitis. The iris had a thick, gray, cheesy membrane composed of nodular lepromata. The patient denied a history of Hansen's disease, despite the dermatologic and facial features that suggested the diagnosis. Anterior chamber paracentesis and scleral nodule biopsy demonstrated Mycobacterium lepra. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin.
A simplified method of diagnostic abdominal paracentesis and lavage is described. Liberal application of this method as part of the initial physical examination of blunt trauma patients resulted in identification at first examination of 94 per cent (61 of 65) of those who were to have laparotomy. No case in the series was brought to laparotomy as the result of findings at arteriography, radionuclide imaging, or sonarography, and no intraabdominal problem was missed because of failure to use one of these organimaging technics. The very limited role of these imaging procedures in early management of blunt abdominal trauma is discussed.
Abdominal paracentesis is a well-tolerated therapeutic alternative to relieve the severe pulmonary compromise caused by severe ascites and pleural effusion in the ovarian hyperstimulation syndrome. An improvement in renal function may be another benefit that deserves further investigation.
A study to evaluate peritoneal fluid as an index of intestinal gangrene in infants with necrotizing entercolitis (NEC) was begun in 1974. Twenty samples of peritoneal fluid were obtained by paracentesis or lavage from 15 infants with nonperforated NEC. A brown color in the peritoneal fluid was noted in all 8 patients found to have intestinal gangrene at subsequent operation. Gram stain showed bacteria in 6 of these 8 patients and bacterial cultures were confimatory in all but one. In 12 samples of peritoneal fluid in patients without intestinal gangrene, the fluid was straw-colored or pink and Gram stain showed no bacteria. The decision to operate on an infant with intestinal gangrene and impending perforation may be aided by analysis of the peritoneal fluid.
Author designed an ophthalmochirurgical instrument for deep foreign bodies of cornea, calculi infarcts, cyst punction, especially for paracentesis, too. The essential is standardized Luer-conus, which permits to put up any hypodermic needle of Luer-system.
Abdominal paracentesis is a useful and safe technique in the evaluation of ascites. The withdrawn ascitic fluid should be routinely analyzed for appearance, blood cell count, and amylase and total protein concentrations; examined cytologically; and cultured. Results should either substantiate the clinical diagnosis or alert the clinician to the presence of previously unsuspected disease.
Hepatobiliary scintigraphy has been recognized as a useful diagnostic tool in detecting the presence and site of bile leaks. The authors report a case of bile ascites secondary to a postsurgical biliary leak, the scintigraphic findings in bile ascites, and the potential use of paracentesis, in combination with hepatobiliary scintigraphy, in confirming the presence of bile ascites and a bile leak.
Forty patients with cirrhosis of the liver and tense ascites were randomized to receive either aldactone 400 mg/day and furosemide 80 mg/day (n = 20) or repeated large volume paracentesis (LVP) and infusion of low molecular weight dextran (n = 20). Both treatment groups were similar in clinical and laboratory parameters. Complete mobilization of the ascitic fluid was achieved in all receiving LVP and dextran therapy within 1 week of the treatment, in contrast to the minimal mobilization of the ascitic fluid in patients receiving diuretics even after 2 weeks of therapy. Renal function, the clinical parameters of systemic hemodynamics, serum electrolytes, and hepatic function remained stable in patients receiving LVP and dextran and were similar to those in the diuretic-treated patients. We found no deterioration of these functions in the nonedematous patients treated by LVP and dextran even though the protective effect of edema against LVP was lacking in them. Plasma volume estimation in six nonedematous cirrhotic patients treated by LVP and dextran did not reveal any hypovolemia after complete mobilization of ascites. The frequency of complications and death were similar in the two groups. Dextran infusion is a safe, effective, and low-cost replacement therapy in patients with cirrhotic ascites treated by LVP.
Ascites is a common complication of cirrhosis and has a major clinical impact on the patient's general well-being. Approximately 10% of patients with cirrhosis can develop diuretic-resistant, tense ascites that requires other therapeutic interventions. In recent years, there has been a renewed interest in large-volume paracentesis (LVP) as a safe, simple, and inexpensive method to substitute for other more complicated and costly therapeutic interventions for refractory ascites. In this article, we review the latest literature supporting the use of LVP for the treatment of refractory, tense ascites. We also address the role of intravascular volume expansion after LVP, note that usually no postparacentesis volume expansion is necessary, and compare, when used, the different plasma volume expanders in terms of efficacy, safety, and cost.
A case of non-immunological hydrops fetalis with gross ascites is reported. Following definitive ultrasonic diagnosis, a fetal abdominal paracentesis was performed under ultrasonic control with a view to minimising fetal trauma during delivery.
Chronic expanding intrapericardial hematoma (CEIH) is rare. A thorough search of literature revealed a few cases after open heart surgery, chest trauma, or epicardial injury. We report the case of a 72-year-old man presenting with a large CEIH and constrictive pericarditis, who had no past history of the above conditions but had undergone pericardiocentesis four years earlier. The cause of the initial hemorrhage of the hematoma might be due to a scratch by a needle during pericardial paracentesis. The hematoma had expanded during a course of four years. The hematoma was removed surgically, and there has been no sign of recurrence 17 months after the operation.