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PubMed2005

Laminin concentration in ascites of patients with hepatic cirrhosis and peritoneal carcinomatosis.

Laminin levels in ascitic fluid have been proposed as a marker for neoplastic ascites. We compared the concentration of laminin in serum and in ascitic fluid from patients with hepatic cirrhosis and peritoneal carcinomatosis and assessed the diagnostic value of serum laminin levels in differentiating neoplastic from benign ascites. Laminin concentrations were determined by ELISA with antibodies against laminin extracted from the human placenta, in patients with ascites due to peritoneal carcinomatosis (N = 20) and hepatic cirrhosis (N = 33). Patients with infected or hemorrhagic ascites were excluded. The receiver operating characteristic curve was used to determine the sensitivity and specificity of serum laminin for the diagnosis of neoplastic ascites. When compared to the group with cirrhosis, the carcinomatosis group presented significantly higher mean laminin levels in serum (3.3 +/- 0.5 vs 2.1 +/- 0.4 microg/ml, mean +/- SD, P < 0.05) and ascites (2.8 +/- 0.5 vs 1.6 +/- 0.4 microg/ml, P < 0.05). Although laminin concentration was higher in serum than in ascites, the laminin serum/ascites ratio and serum-ascites gradient did not differ between the studied groups. A significant correlation (r = 0.93, P < 0.0001) was observed between the serum and ascites laminin values. Serum laminin levels >2.25 microg/ml showed 100% sensitivity and 73% specificity for the diagnosis of neoplastic ascites. Serum concentration seems to be the main determinant of laminin levels in ascitic fluid and its values can be used as a diagnostic parameter in the study of neoplastic ascites.

Adolescent↗
PubMed1996

Serum/ascites albumin gradient: its value as a rational approach to the differential diagnosis of ascites.

BACKGROUND: The utility of differentiating ascites into 'transudate' and 'exudate' has recently been challenged. The aim of the present study was to compare the diagnostic accuracy of the serum/ascites albumin gradient, proposed as a new biochemical criterion for the differential diagnosis of ascites, with the markers traditionally used for the classification of peritoneal fluid into transudate and exudate. METHODS: Paired ascitic fluid and serum samples from 51 patients were examined with an established method for the diagnosis of the cause of ascitic fluid collection. Included in the study were 32 patients with ascites related to portal hypertension (cirrhosis, n = 28; 'cardiac' ascites, n = 2; Budd-Chiari, n = 2) and 19 patients with ascites not related to portal hypertension (peritoneal carcinomatosis, n = 17; tuberculous peritonitis, n = I; secondary bacterial peritonitis, n = 1). Specimens were collected during an episode of spontaneous bacterial peritonitis in 7 of 28 patients with cirrhosis. The serum/ascites albumin gradient was compared with ascitic fluid total protein, ascites/serum total protein ratio, ascites lactic dehydrogenase concentration, and ascites/serum lactic dehydrogenase ratio. RESULTS: The diagnostic accuracy was 98% for the serum/ascites albumin gradient compared with only 52%-80% for the four other markers tested. In patients with infected ascites, diagnostic accuracy was 89% for the albumin gradient and < or = 50% for the four other markers. CONCLUSIONS: The classification of ascites into transudate and exudate appears to be based on markers with low diagnostic accuracy. Differential diagnosis of ascites should be based on the serum/ascites albumin gradient, which is a reliable marker distinguishing ascites related to portal hypertension from all other causes of ascitic fluid collection, regardless of the presence of bacterial infection.

Ascites↗
PubMed2005

Patients with spontaneous bacterial peritonitis, and malignant and cirrhotic ascites.

BACKGROUND: Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases. METHOD AND PATIENTS: We studied tumor necrosis factor-alpha, tumor necrosis factor receptor and C-reactive protein levels in both ascitic fluid and serum in patients with spontaneous bacterial peritonitis (SBP) (n = 22), and in the malignant (n = 38) and cirrhotic (n = 32) ascites. RESULTS: C-reactive protein, tumor necrosis factor-alpha and tumor necrosis factor receptor levels in the ascitic fluid were found to be elevated in the SBP (p < 0.001) and malignant groups (p < 0.005) when compared with the sterile cirrhotic group. C-reactive protein levels in the serum were found to be elevated in the SBP group when compared with the sterile cirrhotic (p < 0.001) and malignant group (p < 0.005). Tumor necrosis factor-alpha in the serum was significantly elevated in the SBP when compared with the cirrhotic (p < 0.005) and malignant ascites (p < 0.001). Sensitivity and specificity of ascitic fluid CRP in discriminating malignant 84% and 67% and SBP from sterile ascites were 90% and 76%, respectively. Sensitivity and specificity of ascitic fluid TNF-alpha in discriminating malignant 77% and 60% and SBP from sterile ascites were 82% and 66%, respectively. Sensitivity and specificity of TNF-r p60 in discriminating malignant 74% and 70% and SBP from sterile ascites were 80% and 76%, respectively. CONCLUSION: The sensitivity and specificity of ascitic fluid CRP, TNF-alpha and TNF-r values were found to be similar. Ascitic fluid Creactive protein to differentiate SBP and malignant ascitic from cirrhotic ascites are cheap, practical and safe tests used in the differential diagnosis of ascites.

Adult↗
PubMed1990

Atrial natriuretic factor in cirrhotic patients with tense ascites. Effect of large-volume paracentesis.

The plasma levels of atrial natriuretic factor in liver cirrhosis can be affected by various factors, such as ascites, renal function, use of diuretics drugs and dietary sodium intake. Moreover, the influence of high intra-abdominal pressure on cardiac atrial natriuretic factor release in patients with tense ascites has not been investigated. The aim of the present study was to evaluate the circulating levels of atrial natriuretic factor and their relationships to plasma renin activity, aldosterone concentration, and urinary sodium excretion in 45 cirrhotic patients divided into 4 groups: (a) cirrhotics without ascites; (b) nonazotemic cirrhotics with ascites; (c) cirrhotics with ascites and functional renal failure; and (d) cirrhotics with ascites taking diuretics. In some patients with tense ascites, atrial natriuretic factor was also measured after rapid abdominal relaxation by large volume paracentesis. Plasma levels of atrial natriuretic factor obtained in 13 healthy control subjects after 5 days on a 40-50 mEq sodium daily intake were 22.8 +/- 3.3 pg/ml. Mean plasma atrial natriuretic factor levels were normal in patients without ascites (35.1 +/- 11.4 pg/ml) and in those with ascites taking diuretics (27 +/- 9.2 pg/ml), but elevated in patients with ascites not taking diuretics (59.6 +/- 12 pg/ml) and in those with ascites and functional renal failure (58.5 +/- 16.6 pg/ml). These data show that plasma atrial natriuretic factor levels are elevated only in cirrhotic patients who are ascitic and not taking diuretics. In these patients atrial natriuretic factor levels were directly correlated with urinary sodium excretion, even though sodium balance was positive. This could be the consequence of the contrasting effects of antinatriuretic factors, as suggested by the inverse relationships between atrial natriuretic factor and urinary sodium on the one hand and plasma renin activity and plasma aldosterone concentration on the other. Twenty-six patients with tense ascites (12 taking diuretics and 14 not) were treated with rapid large-volume paracentesis (6500 +/- 330 ml of ascitic fluid removed in 168 +/- 16 min). At the end of the procedure, plasma atrial natriuretic factor levels had increased in all patients (from 45.5 +/- 10.1 to 100 +/- 17 pg/ml), whereas plasma renin activity and plasma aldosterone concentration had decreased (from 10.3 +/- 1.6 to 7 +/- 1.3 ng/ml/h, and 1160 +/- 197 to 781 +/- 155 pg/ml, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Aldosterone↗
PubMed2006

EUS-guided paracentesis for the diagnosis of malignant ascites.

BACKGROUND: EUS and EUS-guided fine-needle aspiration (EUS-FNA) have well-defined roles in the diagnosis and staging of GI and pancreaticobiliary malignancy. Malignant ascites usually represents peritoneal carcinomatosis, increases disease stage, and portends a poor prognosis. There are limited data regarding the yield of EUS-guided paracentesis (EUS-P) for the diagnosis of malignant ascites. OBJECTIVE: To determine the usefulness of EUS-P for the diagnosis of malignant ascites. DESIGN: Prospective case series. SETTING: Tertiary referral academic center. PATIENTS: Those presenting for EUS examination for suspected or proven malignancy over a 16-month period were evaluated prospectively for the presence of ascites. INTERVENTIONS: EUS-P was performed via a transgastric or transduodenal approach if ascites was detected. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive predictive value, and negative predictive value of EUS-P for diagnosing malignant ascites. RESULTS: Six hundred twenty-nine patients were studied. Twenty-five patients with ascites who met inclusion criteria comprised the study cohort. The mean volume of ascites aspirated was 6.8 mL (range, 1-20 mL). Sixty-four percent (16 of 25) of EUS-P samples revealed malignant cytology. Of the group with negative ascitic cytology, 67% (6 of 9) had a proven malignancy. There was one false-negative cytology result. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-P for diagnosing malignant ascites was 94%, 100%, 100%, and 89%, respectively. The complication rate was 4%; 1 patient developed bacterial peritonitis after EUS-P. LIMITATIONS: The study did not address cost savings in patient care based on the diagnosis of malignant ascites. CONCLUSIONS: EUS-P is highly sensitive and specific for diagnosing malignant ascites. The finding of malignant ascites significantly alters patient management, so an active search for ascites and use of EUS-P should be incorporated into the diagnosis and staging of upper GI and pancreaticobiliary malignancy.

Aged↗
PubMed2002

Trace elements analysis of ascitic fluid in benign and malignant diseases.

OBJECTIVES: To evaluate differences in ascitic fluid trace element concentrations which might be useful in discrimination between benign and malignant ascites. DESIGN AND METHODS: The concentrations of copper, zinc, magnesium and iron in ascitic fluid and venous blood in 17 patients were investigated. The relationship between these trace elements and type of disease were examined. Investigations were carried out in a group of 5 males and 5 females aged 54 to 77 yr who had cirrhosis ascites and in a group of 7 females aged 41 to 76 yr with ascites due to gynecologic neoplasms. RESULTS: The mean ascitic fluid and serum concentrations of copper were significantly higher in neoplastic diseases compared to benign disease states (118,43 vs. 97,50, 91,14 vs. 26.90) (p < 0,05 and p < 0,01 respectively). The zinc levels in ascitic fluid and serum were significantly different between the groups (p < 0,01). Neoplastic patients had significantly higher ascitic fluid magnesium levels than the benign disease group (2,17 vs. 1,55, p < 0,001). The serum levels of iron were significantly lower in the neoplastic diseases group (92, 28 vs. 255, p < 0, 01). In benign diseases the concentration of zinc in ascitic fluid correlated positively with ascitic fluid copper concentrations. The concentrations of zinc and iron in malignant ascites correlate positively with the magnesium concentrations. Statistically significant negative correlations were found between ascites zinc and magnesium and magnesium and copper in cirrhotic patients and magnesium and copper in malignant diseases. CONCLUSIONS: The results showed that zinc, magnesium and iron levels were significantly different between cirrhotic and neoplastic illness. Analysis of serum and ascitic fluid trace element composition may be helpful in identifying and distinguishing the malignant and nonmalignant ascites and provides useful information on processes regulating passage of blood components into the peritoneal cavity.

Adult↗
PubMed1994

A European survey on the treatment of ascites in cirrhosis.

A questionnaire to assess the clinical choice of ascites treatment in cirrhosis was distributed to 1473 participants in an EASL meeting. The response rate (295, 20%) was considered satisfactory in view of the heterogeneity of the persons attending this event. Most participants (86.4%) in the survey were hepatologists and gastroenterologists. The following conclusions of the survey are noteworthy: (1) The objective of ascites therapy was to eliminate completely or almost completely the ascitic fluid for 49% of responders and to decrease ascites volume to an acceptable level of patient comfort for 48%; (2) The classical progressive therapeutic schedule of ascites is rarely used; (3) Following mobilisation of ascites, most (82%) maintain patients on diuretic therapy to avoid reaccumulation of ascites; (4) Only 5% of participants did not use paracentesis to manage ascites in cirrhosis. This was the therapeutic procedure most frequently used for patients with refractory ascites; (5) Although the most acceptable definition of refractory ascites was ascites which cannot be mobilized by maximal medical treatment, a significant proportion of participants also considered that intractable ascites due to diuretic-induced complications and recidivant ascites should be included in the definition; (6) The proportions of participants prescribing prophylactic therapy, mainly low sodium diet, to compensated patients with and without a past history of ascites were 68% and 16%, respectively.

Ascites↗
PubMed2005

Comparison of three lines of broiler breeders differing in ascites susceptibility or growth rate. 1. Relationship between acoustic resonance data and embryonic or hatching parameters.

Ascites is a prevalent cardiovascular disease among modern broilers with negative impacts on production and animal welfare. The peak of mortality due to ascites occurs at the end of the growing period, but the etiology of this problem may start during embryonic development. A few recent reports have demonstrated that the signs of ascites susceptibility are manifested during the late stages of incubation. In the current study, we used a nondestructive method based on egg acoustic resonance parameters [resonant frequency (RF) and damping] to establish a relationship between embryo physiological events during early development in broiler eggs and susceptibility to ascites. The hatching eggs of 3 broiler lines differing in ascites susceptibility were used for this study: ascites-resistant dam line (DAR), ascites-sensitive dam line (DAS), and ascites-sensitive sire line (SASL). These lines were selected on the basis of fast growth, high breast meat yield, and ascites induction at low temperatures such that the order of ascites susceptibility in terms of mortality was SASL >> DAS > DAR. Eggs were incubated under standard conditions in forced-draft incubators. We measured egg weights at setting, albumen pH, Haugh units (HU) at setting, and embryo weights at d 11 and 18, at internal pipping (IP), and at hatch. The durations of IP, external pipping (EP), and hatching were also determined. At 2 hourly periods during incubation, egg RF and damping were also measured. There were differences in egg weights between DAR and SASL vs. DAS, but albumen HU, albumen pH, and the ratio of yolk weight to egg weight were similar. There were differences in RF, damping, embryonic growth rates, and hatching events. Changes in resonant frequency and damping, which certainly suggest eggshell differences among lines, were not totally related to variations in physiological events during early and late embryonic development. A comparison between DAR and DAS, between DAS and SASL, or DAR and SASL indicates that sensitivity to ascites and selection for rapid growth rate in ascites-sensitive lines have different effects on embryonic parameters. We concluded that the sensitivity of broiler breeders to ascites does not influence egg internal quality, but the occurrence of ascites sensitivity in broilers could not be reliably predicted by early in ovo acoustic resonance parameters and hatching events.

Acoustics↗
PubMed1981

[Experimental studies on ascites tumor of human osteosarcoma in nude mice (author's transl)].

Six human osteosarcomas were transplanted subcutaneously in the back of nude mice and three of the six were found to be serially transplantable. Two of three transplantable solid tumors were called DOS tumor and KOS tumor. The 4th generation of DOS tumor and the 1st generation of KOS tumor grew to invade the peritoneum and tumor cells were spilt spontaneously into the abdominal cavity. These two cases were transformed to ascites tumor, called DOS-NM ascites tumor and KOS-NM ascites tumor. They were found to be serially transplantable by an intraperitoneal injection of free tumor cells (10-20 x 10(5) cells). DOS-NM and KOS-NM ascites tumor cells were analysed to have human karyotype and alkaline phosphatase activity. Ascites tumor cells were studied under light and electron microscopes. A large number of elongated and ballooned mitochondria were characteristically seen in the cytoplasm of two ascites tumor cells by electron microscope. Development of rough surfaced endoplasmic reticulum and Golgi's apparatus was poor, and no production of collagen fiber was seen in these materials. There is no report referring to ascites tumor of human osteosarcoma, therefore ascites tumor of osteosarcoma was made deliberately and the following results were obtained. 1) Several blocks of DOS tumor were implanted intraperitoneally into 5 nude mice, and only solid tumors grew in the abdominal cavity without ascites. 2) Minced DOS tumor was implanted subcutaneously close to the peritoneum and 2 out of 6 nude mice developed ascites tumor. 3) Cell suspension of DOS tumor was injected intraperitoneally and 3 out of 4 nude mice developed ascites tumors. As mentioned above, human osteosarcoma was successfully induced to ascites tumor (DOS-NM), which was established earlier compared with solid tumor (DOS). Characteristics of human osteosarcoma are easily examined with ascites tumor and in vivo screening test of anticancer drugs can be quantitatively done. Therefore ascites tumor is considered to be a valuable experimental model.

Adult↗
PubMed1997

Alpha feto-protein and albumin in ascitic fluid in hepatocellular carcinoma patients.

Alpha-feto-protein (AFP) is the most popular tumor marker for hepatocellular carcinoma (HCC). It is used in diagnosis and follow up of cases by estimating its rise in the serum. The aim of this work is to study the value of estimating AFP in ascitic fluid of HCC patients with ascites. This work is a case control study on 32 patients, including 22 cases with ascites and HCC and 10 control group with ascites due to liver cirrhosis without HCC. The level of AFP was estimated in serum and in ascitic fluid by Radio-immuno assay RIA. The serum ascites albumin gradient (SAAG) was assessed by measuring albumin in all samples using bromocresole green dye binding. Guided aspiration liver biopsy and ascitic fluid cytology was done, stained with H & E. It was found that, AFP level in serum was elevated in 72.7% of HCC patients, and in ascitic fluid was elevated 63.6% HCC patients. Also, there was a highly significant, direct positive correlation between elevation of AFP in serum and in ascitic fluid (r = 0.778). No elevation of AFP in serum and in ascitic fluid was detected in control group. Ascitic fluid cytology showed malignant cells in one case only. SAAG was significantly lower in the HCC group 0.83 gm/dl than the control group 2.43 gm/dl (p-value < 0.001). Elevation of AFP in ascitic fluid is of high importance in evaluation of HCC, and is as significant as serum and runs parallel to it. Estimation of AFP in ascitic fluid is much more significant in evaluation of HCC cases than ascitic fluid cytology.

Ascitic Fluid↗
PubMed1994

Diuretics vs. paracentesis followed by diuretics in cirrhosis: effect on ascites opsonic activity and immunoglobulin and complement concentrations.

Ascitic fluid opsonic activity and ascitic fluid C3 concentrations are important protective factors against spontaneous bacterial peritonitis. This randomized controlled study was performed to compare the effect of diuretic administration alone vs. single large-volume therapeutic paracentesis followed by administration of diuretics on ascitic fluid opsonic activity and on ascites and serum immunoglobulin and complement concentrations in patients with alcoholic cirrhosis and tense ascites. Twenty-one patients were randomly allocated to two groups: group 1 included 11 patients who were treated with diuretics alone, and group 2 included 10 patients who were treated with single large-volume therapeutic paracentesis (5 to 6 L of ascites removed) followed by diuretics. Ascitic fluid opsonic activity and serum and ascites immunoglobulin and complement concentrations were measured at the beginning and at the end of treatment. The ascitic fluid opsonic activity increased significantly in patients treated with diuretics alone (p < 0.05), whereas in the group of patients treated with therapeutic paracentesis followed by diuretics, the ascites opsonic activity remained stable. Although ascitic fluid IgG, IgA and C3 concentrations increased significantly in patients treated with diuretics alone (p < 0.05), ascitic fluid C3 concentration significantly decreased in patients from group 2 (p < 0.05), whereas IgG and IgA concentrations remained unchanged. However, in both groups of patients serum immunoglobulin and complement concentrations remained unchanged. This study suggests that in cirrhotic patients with tense ascites, treatment with diuretics alone may have the potential advantage over single large-volume therapeutic paracentesis followed by the administration of diuretics of providing better protection from spontaneous bacterial peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Laboratory chemical analysis in ascites].

Chemical analysis of ascitic fluid may be helpful in determining the underlying disease. We discuss the diagnostic accuracy of the common and newer chemical parameters (protein, LDH, lactate, glucose, cholesterol, triglycerides, phospholipids, fibronectin, albumin gradient [value of serum minus value of ascites], ferritin, tumor markers, immunomodulators, leukocytes, bacterial and cytologic examinations). We also review the pathogenesis and clinical findings of the most frequent ascites forms (benign hepatic, infective, malignant ascites, ascites associated with liver metastases or hepatocellular carcinoma, cardiac and pancreatic ascites) and the most important diagnosis criteria. In the malignant ascites a high cholesterol, a narrow albumin gradient or a high ferritin value have high diagnostic accuracy, but diagnosis is by the finding of malignant cells. For the diagnosis of infective ascites, bacteriology is mandatory even though the results are negative in most cases, particularly in spontaneous bacterial peritonitis where diagnosis has to be established clinically, by a low pH or by a high leukocyte count. Benign hepatic ascites is diagnosed by demonstrating an underlying chronic liver disease and laboratory examinations of the peritoneal fluid to exclude other causes. The laboratory tests in ascites associated with liver metastases or with hepatocellular carcinoma were similar to those in benign hepatic ascites and the two ascites forms must be separated by other clinical and technical findings. Pancreatic ascites can easily be distinguished from the other forms by the high amylase and lipase content.

Ascites↗
PubMedDate not supplied

White count, pH and lactate in ascites in the diagnosis of spontaneous bacterial peritonitis.

In order to evaluate the diagnostic accuracy of ascitic pH and lactate for early confirmation of spontaneous bacterial peritonitis (SBP), 109 consecutive patients with ascites were studied. The mean ascitic leukocyte [white blood cell (WBC)] and polymorphonuclear cell (PMN) counts, pH and lactate levels in 42 patients with sterile "normal" ascites were 124 +/- 157 per mm3, 41 +/- 77 per mm3, 7.502 +/- 0.097 and 11.1 +/- 7.9 mg per dl, respectively. Mean ascitic WBC and PMN counts were significantly increased in 10 patients with SBP (10,452 +/- 8,091 and 9,522 +/- 7,470 per mm3), in 10 patients with bloody ascites (2,591 +/- 4,284 and 1,057 +/- 1,494 per mm3) and in 11 patients with cytology positive malignant ascites (1,529 +/- 2,071 and 868 +/- 1,601 per mm3) (p less than 0.001). Mean ascitic pH was significantly reduced in SBP (7.335 +/- 0.048), in bloody ascites (7.384 +/- 0.037) and in cytology positive malignant ascites (7.355 +/- 0.167) (p less than 0.001). Mean ascitic lactate was also significantly elevated in these three groups of patients (36.8 +/- 17.0, 42.8 +/- 35.8 and 24.0 +/- 17.5 mg per dl, respectively; p less than 0.001) as well as in patients with bacteremia (51.6 +/- 78.0 mg per dl, p less than 0.005). However, ascitic pH less than 7.31, ascitic lactate greater than 33 mg per dl were observed only in three of the patients with SBP.(ABSTRACT TRUNCATED AT 250 WORDS)

Ascitic Fluid↗
PubMed1992

High concentrations of soluble tumor necrosis factor receptors in ascites.

Ascites and plasma concentrations of soluble tumor necrosis factor receptors p55 and p75 were measured in a prospective study in 34 patients (35 occasions of ascites) with hepatic (5 infected and 21 uninfected) and malignancy-related (9) ascites. All patients had high concentrations of both soluble tumor necrosis factor receptors in ascites and plasma; these were about 500 times higher than the corresponding tumor necrosis factor-alpha concentrations. Ascites levels of soluble tumor necrosis factor receptors p55 and soluble tumor necrosis factor receptors p75 were significantly elevated in patients with malignancy-related (p55: 26.0 +/- 8.6 ng/ml; p75: 20.5 +/- 17.4 ng/ml; mean +/- S.D.) and infected ascites (p55: 25.1 +/- 10.9 ng/ml, p75: 22.6 +/- 11.0 ng/ml) compared with patients with uncomplicated hepatic ascites (p55: 10.1 +/- 4.4 ng/ml; p75: 6.0 +/- 2.6 ng/ml). Patients with infected or malignancy-related ascites also showed higher soluble tumor necrosis factor receptor concentrations in plasma than did patients with plain hepatic ascites. Successful antibiotic treatment of peritonitis reduced soluble tumor necrosis factor receptor p55 and p75 ascites levels in three patients from 24.2 +/- 15.2 ng/ml to 10.7 +/- 1.9 ng/ml and from 20.2 +/- 14.4 ng/ml to 7.5 +/- 1.8 ng/ml, respectively. Soluble tumor necrosis factor receptors p55 and p75 at cutoff levels of 16.5 ng/ml and 9.5 ng/ml, respectively, differentiated between infected or malignant and plain hepatic ascites with diagnostic accuracies of 94% and 89%, respectively. They did not differentiate between infected and malignant ascites. The concentrations of soluble tumor necrosis factor receptor p55 were usually higher in ascites than in plasma in all subgroups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Reduction of renal cortical blood flow assessed by Doppler in cirrhotic patients with refractory ascites.

The usefulness in cirrhotic patients of hemodynamic measurements by Doppler ultrasonography (US) is still not defined. We investigated the relationships between Doppler measurements and the severity of ascites. Portal blood flow velocity and volume, and hepatic and renal arterial resistance indexes (RI) were measured in 57 cirrhotic patients (19 without ascites, 28 with responsive ascites, and 10 with refractory ascites) and 15 healthy controls. The renal arterial RI were obtained for the main renal artery, interlobar vessels, and cortical vessels. Cirrhotic patients had decreased portal blood flow and an increased congestion index (CI). Only the CI was correlated to the severity of ascites, showing that it is also a reliable measure of the severity of portal hypertension in patients with ascites. The hepatic and renal artery RI were increased in cirrhotic patients, and the two values were correlated (r = .68; P = .00001). The RI of renal interlobar and cortical vessels were higher in patients with refractory ascites than in patients without ascites (P < .02 and P < .009), and correlated with sodium excretion rate (r = -.45; P < .003), the renin-aldosterone system, and creatinine clearance (r = -.62; P < .0002). The RI decreased from the hilum of the kidney to the outer parenchyma in healthy subjects and patients with responsive ascites, but this difference disappeared in patients with refractory ascites. This indicates that the degree of renal vasoconstriction varies in different areas according to the severity of the ascites. Cortical vessels are involved mainly in patients with refractory ascites, suggesting that the intrarenal blood flow distribution in cirrhosis tends to preserve the cortical area and that severe cortical ischemia is a feature of refractory ascites.

Adult↗
PubMed1986

Development of intractable ascites following upper abdominal surgery in patients with cirrhosis.

Recently, two patients with cirrhosis in whom ascites intractable to medical therapy had developed were referred to Medical Center Hospital and Audie L. Murphy Memorial Veterans Administration Hospital. Ascites had developed in both following upper abdominal surgery. To better characterize postoperative ascites, the records of all patients with cirrhosis who had upper abdominal operations at these hospitals during a five-year period were reviewed. Patients with portacaval shunts or pre-existing ascites were excluded. Of the 31 patients meeting the study requirements, ascites developed in 12 in the immediate postoperative period. In 10, the ascites resolved with medical management. As a group, these 10 patients had more severe liver disease than the group in whom ascites did not develop. The remaining two patients had ascites intractable to medical therapy. The ascitic fluid protein level was high in these two patients as well as in the two referred patients with a mean value of 4.5 +/- 1.6 g/dl. One patient with intractable ascites died and the other three required operative management. No clinical or laboratory features distinguished the patients in whom intractable ascites developed from the patients in whom postoperative ascites did not develop. It is suggested that intraoperative injury to vessels draining hepatic lymph was the cause of the intractable ascites.

Abdomen↗
PubMed2001

Association between weight gain, blood parameters, and thyroid hormones and the development of ascites syndrome in broiler chickens.

The present study examined the association between thyroid hormones and the development of ascites on one hand and the ability to predict ascites from growth rate and hematocrit on the other hand. Ascites syndrome was induced in broiler chickens in two trials by exposing the chicks to low ambient temperature (Ta) and by supplying a pellet form of diet. Weight gain, hematocrit, hemoglobin, and plasma thyroxin (T4) and triiodothyronine (T3) concentrations were measured weekly for each bird, and comparisons were made between birds that eventually died from ascites and those that did not. Mortality from ascites amounted to 24.3 and 24.2% in Trials 1 and 2, respectively. Weight gain did not differ between ascitic and healthy chickens up to approximately 2 wk before death but was significantly lower in the ascitic broilers 1 to 2 wk before death. Hematocrit was significantly higher in broilers with ascites with the exception of ascitic broilers that died at the age of 7 wk (Trial 1). In ascitic broilers, T4 and T3 concentrations declined significantly during the week of death. The present findings raise the question of whether the association between low levels of thyroid hormones and the development of ascites is one of the physiological responses in the syndrome cascade, or whether the failure to maintain thyroid hormones concentration is one of the triggers of the syndrome initiation. This question requires further investigation. It can be concluded that a high rate of weight gain is not always a good predictor of ascites development. Hematocrit and thyroid hormones can provide a good indication but only during the last week of life, and not in all cases. None of these parameters, however, can predict the development of ascites at an early age.

Animals↗
PubMed2005

Selection strategies for body weight and reduced ascites susceptibility in broilers.

Ascites syndrome is a metabolic disorder in broilers. Mortality due to ascites results in significant economic losses and has a negative impact on animal welfare. It has been shown that genetic factors play a considerable role in susceptibility of birds to ascites, which offers perspectives for selection against this syndrome. The aim of the present study was to evaluate the consequences of alternative selection strategies for BW and resistance to ascites syndrome using deterministic simulation. In addition to the consequences of current selection (i.e., selection for increased BW only) alternative selection strategies including information on different ascites-related traits measured under normal or cold conditions and the consequences of having information on the underlying genes (i.e., MAS) were quantified. Five different breeding schemes were compared based on the selection response for BW, ascites susceptibility, and the rate of inbreeding. Traits investigated in the index as indicators for ascites were hematocrit value (HCT) and ratio of right ventricle to the total ventricular weight of the heart (RV:TV). The results indicated that by ignoring ascites susceptibility in the breeding goal, the gain for BW is 130 g and the birds will become more susceptible to ascites. Testing 50% of the birds under cold temperature conditions and including information of ascites related traits (HCT and RV:TV) measured under normal and cold conditions makes it possible to achieve a relatively high gain for BW (111.4 g) while controlling the genetic level for ascites susceptibility (selection response was 0). The results of scenarios including QTL information of ascites susceptibility showed that QTL information could be used very effectively in controlling ascites susceptibility.

Animals↗