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PubMed2005

Ascites from cirrhotic patients induces angiogenesis through the phosphoinositide 3-kinase/Akt signaling pathway.

BACKGROUND/AIMS: Ascites in patients with cirrhosis is associated with worsening of systemic hemodynamics. Thus, the aim of this study was to investigate the biological activity of ascites on endothelial cells. METHODS: Human umbilical vein endothelial cells (HUVECs) were used to investigate the angiogenic activity of ascites obtained from cirrhotic patients. RESULTS: Ascites-induced Akt activation, cell migration and tube formation in HUVECs. The pretreatment of HUVECs with the phosphatidylinositide 3-kinase (PI3-kinase) inhibitor LY294002, resulted in a decrease in chemotaxis and cell tube formation induced by ascites. Moreover, the inhibition of Akt activity in HUVECs by transduction of an inactive phosphorylation Akt mutant (AA-Akt), blocked tube formation. These angiogenic effects of ascites were also operative in vivo showing a PI3-kinase activation dependence in the angiogenesis induced by ascites. In addition, the preincubation of ascites with anti-fibronectin antibody led to a significant decrease in HUVECs migration, cell tube formation and in vivo angiogenesis. CONCLUSIONS: These results confirm the novel concept that ascites is a bioactive fluid which can modify vascular properties through the activation of the PI3-kinase/Akt pathway in endothelial cells. Furthermore, our results demonstrated that this ascites-induced mechanism is mediated, at least in part, by fibronectin.

Animals↗
PubMed2006

Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience.

PURPOSE: We determined the clinical presentation, risk factors and optimal treatment of chylous ascites that develop after retroperitoneal lymph node dissection in patients with testicular cancer. MATERIALS AND METHODS: We retrospectively reviewed the records of 329 patients who underwent post-chemotherapy retroperitoneal lymph node dissection at our institution, of whom 23 (7%) had chylous ascites postoperatively. Clinical and pathological parameters were entered into a database. RESULTS: Mean patient age at chylous ascites presentation was 32.1 years. On univariate and multivariate logistic regression analyses increasing amounts of preoperative chemotherapy (OR 1.24) and intraoperative blood loss (OR 1.33) were predictive of chylous ascites. The clinical presentation of chylous ascites consisted of abdominal fullness and distention in all patients. Initial treatment was paracentesis alone or combined with total parenteral nutrition in 77% of patients. An abdominal drain was used for persistent ascites in 10 patients. In patients treated conservatively the rate of resolution of chylous ascites was 77%. Only 23% of patients required peritoneovenous shunt placement. However, shunt use was associated with an 80% surgical revision rate. CONCLUSIONS: Conservative treatment resolves most cases of postoperative chylous ascites. An abdominal catheter drain should be considered for significant or recurring chylous ascites. When a peritoneovenous shunt is required, it may be needed for an extensive period for resolution and there are significant complications associated with its use. Increasing amounts of preoperative chemotherapy and operative blood loss raise the likelihood of chylous ascites.

Adult↗
PubMed1999

Endoscopic pancreatic duct stenting to treat pancreatic ascites.

BACKGROUND: Management of pancreatic ascites with conservative medical therapy or surgery has met with limited success. Decompression of the pancreatic ductal system through transpapillary stent placement, an alternative strategy, has been reported in only a handful of cases of pancreatic ascites. METHODS: We reviewed all cases from 1994 to 1997 in which patients with pancreatic ascites underwent an endoscopic retrograde pancreatogram documenting pancreatic duct disruption with subsequent placement of a transpapillary pancreatic duct stent. Clinical end points were resolution of ascites and need for surgery. RESULTS: There were 8 cases of pancreatic ascites in which a 5F or 7F transpapillary pancreatic duct stent was placed as the initial drainage procedure. Pancreatic ascites resolved in 7 of 8 patients (88%) within 6 weeks. Ascites resolved in the eighth patient, a poor candidate for surgery, following placement of a 5 mm expandable metallic pancreatic stent. No infections, alterations in ductal morphology, or other complications related to stent placement were noted. There was no recurrence of pancreatic ascites or duct disruption at a mean follow-up of 14 months. CONCLUSIONS: Our experience doubles the number of reported cases in which transpapillary pancreatic stent placement safely obviated the need for surgical intervention in the setting of pancreatic ascites. This therapeutic endoscopic intervention should be seriously considered in the initial management of patients with pancreatic ascites.

Adult↗
PubMed1989

Diagnostic value of ascites adenosine deaminase in tuberculous peritonitis.

The value of ascitic fluid adenosine deaminase activity in distinguishing tuberculosis from other causes of ascites was examined in a retrospective study of 41 patients with bacteriologically confirmed tuberculous peritonitis and 41 control patients, matched for age and sex, with ascites of other causes (12 alcoholic cirrhosis, 5 cryptogenic cirrhosis, 12 malignant disorders, 3 pancreatitis, and 9 miscellaneous causes). The mean ascites adenosine deaminase activity was 99.8 (SD 49.1) in tuberculous patients and 14.8 (8.4) U/l in control patients (p less than 0.0001). A cutoff of 32.3 U/l had a sensitivity of 95% and specificity of 98% in distinguishing between the two groups. In a subsequent prospective study of 64 patients with ascites, 11 were found to have tuberculosis. Of the others, 23 had cirrhosis (18 alcoholic, 5 cryptogenic), 17 malignant disorders, 3 pancreatitis, 5 cor pulmonale, 3 congestive cardiac failure, 1 systemic mastocytosis, and 1 renal failure and hypothyroidism. The mean ascites adenosine deaminase activity was 112.6 (45.0) U/l in the patients with tuberculous ascites and 16.3 (36.7) U/l (p less than 0.0001) in those with ascites of other causes. In this study, adenosine deaminase had a sensitivity of 100% and specificity of 96% in discriminating tuberculosis from other causes of ascites. These findings suggest that the ascitic fluid adenosine deaminase activity may be used to identify patients in whom the diagnosis of abdominal tuberculosis must be pursued.

Adenosine Deaminase↗
PubMed1992

Impaired functions of normal peripheral polymorphonuclear leukocytes in cirrhotic ascitic fluid.

The function of normal polymorphonuclear cells in the ascitic fluid of 32 patients with cirrhotic ascites and 17 patients with malignant ascites was studied independently of ascitic fluid heat-labile factors. Polymorphonuclear (PMN) function was assessed by a chemiluminescence method using preopsonized zymosan as stimuli. The chemiluminescence response was higher in malignant ascitic fluid than in cirrhotic ascitic fluid (0.84 and 0.15, respectively, p < 0.001). These results were confirmed by a microbiological assessment of phagocytosis. Suppressive factors were evidenced by making ascitic fluid dilutions and using cell-free chemiluminescence measurements. Addition of malignant ascitic fluid to cirrhotic ascitic fluid showed that there is also a deficiency in supportive factors other than C3. The impaired PMN production of oxidative metabolites we observed in cirrhotic ascitic fluid can partly explain the high susceptibility of cirrhotic patients to spontaneous bacterial peritonitis independently of C3 levels.

Adult↗
PubMed2005

Ascites induces modulation of alpha6beta1 integrin and urokinase plasminogen activator receptor expression and associated functions in ovarian carcinoma.

Interactions between cancer cells and the surrounding medium are not fully understood. In this study, we demonstrate that ascites induces selective changes in the expression of integrins and urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) in ovarian cancer cells. We hypothesise that this change of integrin and uPA/uPAR expression triggers signalling pathways responsible for modulating phenotype-dependent functional changes in ovarian cancer cells. Human ovarian surface epithelial (HOSE) cell lines and epithelial ovarian cancer cell lines were treated with ascites for 48 h. Ascites induced upregulation of alpha6 integrin, without any change in the expression of alphav, beta1 and beta4 integrin subunits. Out of the four ovarian cancer cell lines studied, ascites induced enhancement in the expression of uPA/uPAR in the more invasive OVCA 433 and HEY cell lines without any change in the noninvasive OVHS1 and moderately invasive PEO.36 cell lines. On the other hand, no change in the expression of alpha6 integrin or uPAR, in response to ascites, was observed in HOSE cells. In response to ascites, enhancement in proliferation and in adhesion was observed in all four ovarian cancer cell lines studied. In contrast, no significant increase in proliferation or adhesion by ascites was observed in HOSE cells. Ascites-induced expression of uPA/uPAR correlated with the increased invasiveness of HEY and OVCA 433 cell lines but was not seen in OVHS1, PEO.36 and HOSE cell lines. Upregulation of alpha6 integrin and uPA/uPAR correlated with the activation of Ras and downstream Erk pathways. Ascites-induced activation of Ras and downstream Erk can be inhibited by using inhibitory antibodies against alpha6 and beta1 integrin and uPAR, consistent with the inhibition of proliferation, adhesion and invasive functions of ovarian cancer cell lines. Based on these findings, we conclude that ascites can induce selective upregulation of integrin and uPA/uPAR in ovarian cancer cells and these changes may modulate the functions of ovarian carcinomas.

Ascites↗
PubMed1998

Is conversion of solid into more anoxic ascites tumors associated with p53 inactivation?

Most solid tumors are unable to grow in the ascites form, unless selected by prolonged serial transfer of peritoneal fluid (Klein, 1955). Established ascites tumor cells grow under highly crowded, virtually anoxic conditions (Warburg and Hiepler, 1953). Hypoxia was recently identified as a powerful inducer of p53 dependent apoptosis (Graeber et al., 1996). We wished to examine whether the conversion of relatively well-vascularized solid mouse tumors into freely growing ascitic cell variants favors cell with mutated or deleted p53. We have sequenced exons 4-9 of p53 cDNA from two serially transplanted methylcholanthrene induced sarcomas (MCIM and MSWBS) that were available in the original solid and the gradually converted ascites form. We have also examined five additional solid tumors, four carcinomas and one sarcoma and six additional ascites tumors, five carcinomas and one sarcoma. Sequence analysis showed that all solid tumors carried exclusively wild type p53. Among the eight ascites tumors, five carried mutant p53 and three had only the wild type gene. In one of the two isogenic pairs, the original solid tumor line had only wild type, whereas the derived ascites line had only mutant p53. In the second pair, the solid tumor was wild type whereas the ascitic variant was heterozygous. The naturally occurring alternatively spliced p53 (p53as) mRNA was detected in all solid tumors, but not in five of the eight ascites tumors. Our findings indicate that conversion of solid into ascites tumors favors the selection of cell variants with mutated p53 and of cells that lack the alternatively spliced form of p53.

Animals↗
PubMed2001

EUS in the detection of ascites and EUS-guided paracentesis.

BACKGROUND: The utility of EUS was evaluated for detection of ascites and EUS-guided FNA of ascites in patients undergoing EUS for diagnosis and staging of GI malignancies. METHODS: A series (from March 1994 to October 1997) of 571 consecutive patients who underwent upper EUS for various indications was retrospectively reviewed. Follow-up clinical information was obtained from referring physicians, subsequent CT, and telephone interviews. RESULTS: Eighty-five patients (15% of series) were found to have ascites by EUS. Six did not have CT before EUS. Pre-EUS CT identified ascites in only 14 (18%) of the 79 patients who had pre-EUS CT. Of the patients in whom CT was negative for abdominal fluid (n = 65) and who had clinical follow-up, 13 of 58 (22%) subsequently had ascites develop that were detected by CT or physical examination. Overall, 31 of the 85 patients underwent EUS-guided FNA paracentesis; the mean volume obtained was 7.9 mL (range 1-40 mL). In 5 patients, malignant ascites was diagnosed by EUS-guided FNA; in these patients surgery was avoided. CONCLUSIONS: EUS is more sensitive than CT in detecting small amounts of ascites. A significant number (22%) of patients who had ascites by EUS subsequently had ascites develop that was detectable by CT or physical examination. EUS-guided paracentesis appears to be safe and effective and can identify malignant ascites.

Ascites↗
PubMed2003

Haematological characteristics predicting susceptibility for ascites. 1. High carbon dioxide tensions in juvenile chickens.

1. Male broilers of two different genetic stocks, a pure broiler sire line (A) and commercially available Ross broilers (B), were used to study the effect of haematological characteristics in juvenile chickens on the development of clinical ascitic signs. Production performance (body weight gain (BWG), feed intake (FI), feed conversion ratio (FCR)) from 448 birds per stock was measured from 2 to 5 weeks of age. Mortality was recorded from 2 to 6 weeks of age. The birds were housed at a low ambient temperature to stimulate the incidence of ascites. 2. From each stock, 32 birds with the highest (high risk: HRc) and 32 birds with the lowest (low risk: LRc) carbon dioxide tensions (pCO2) in venous blood were selected at 11 d of age. These birds were marked for future blood sampling to determine changes in pCO2 with age to relate these values to ascites susceptibility. 3. At 2 weeks of age all birds (including HRc and LRc birds) were allotted to 32 floor pens (one HRc and one LRc in each pen) per stock. Venous blood samples were collected weekly from HRc and LRc birds for blood gas analysis and haematocrit, and at week 5 also for thyroid hormone (T3, T4) concentrations in plasma. At 5 weeks of age all HRc and LRc birds were examined post-mortem, relative heart, lung, and liver weights and arterial pressure index (API) values were recorded. 4. Birds from stock A showed a lower BWG and FCR and notably higher ascites mortality compared with stock B. An effect of pCO2 tensions at d 11 was found on the incidence of ascitic signs in selected birds of both stocks up to week 5. From the HRc groups 30% of the birds showed ascitic signs, whereas this was only 8% in the LRc group. LRc birds of stock B in particular showed constant low API values (20 +/- 3%) and none of these birds showed signs of ascites. 5. Our results suggest that the ascites problem in Ross birds can be eliminated by selection for low pCO2 tensions in venous blood. Stock effects on API, liver weight, lung weight, and plasma thyroid hormone independent of pCO2 showed a more complex picture of the ascitic signs in stock A compared with B. 6. We concluded that in this experiment a high pCO2 tension in venous blood measured at d 11 was a reliable predictor for ascites susceptibility observed at 5 weeks of age. A low pCO2 tension provides an appropriate criterion for genetic selection, whereas a high pCO2 tension emphasises the necessity for intensive management in poultry houses.

Animals↗
PubMed1993

Effect of murine ascites on the ability of hybridoma cells to produce antibody and proliferate in vitro.

Murine ascites has been shown to contain a variety of growth promoting activities. In this study, we examined the effects of ascites fluid on the efficiency of hybridoma production and cell growth. SP2/0 mouse myeloma cells were injected into peritoneal cavities of mice and ascitic fluid was collected. Lymphocytes from mice immunized with porcine growth hormone (pGH) were fused with myeloma cells in a standard hybridization procedure. These cells were then dispensed in 96-well plates in medium containing either 2.5% ascites or 20% fetal calf serum (FCS) and cultured for few days. Supernatants from these cultures were collected and analyzed for anti-pGH antibodies. It was demonstrated that ascites-supplemented medium increased the efficiency in generating specific antibody-secreting hybridomas by 4-fold over FCS-supplemented medium. Furthermore, hybridoma cells were cultured in microtiter plate and found to proliferate in response to ascites in a dose dependent manner. This effect was abolished by prior digestion of ascites with trypsin, indicating its protein nature. B-lymphocyte related cytokines seemed less likely involved because antibodies to IL-4 and IL-6 failed to alter the stimulatory effect of ascites. Ascites was fractionated by FPLC using Superose 12 column and the active moiety was found to be a small m.w. peptide (< 1,000 dalton). Therefore, murine ascites is capable of substituting for conventional FCS in culture medium in the area of hybridoma technology.

Animals↗
PubMed1983

Bactericidal and opsonic activity of ascitic fluid from cirrhotic and noncirrhotic patients.

Cirrhotic patients with ascites are highly susceptible to spontaneous bacterial peritonitis. Patients with ascites due to causes other than cirrhosis very seldom develop peritonitis. The antibacterial activity of these ascitic fluids is not known. The present study was undertaken to evaluate the bactericidal and opsonic activity in ascitic fluid from patients with and without cirrhosis and in normal (nonascitic) peritoneal fluid. Normal peritoneal fluids of 20 control subjects and ascitic fluids of 22 patients with noncirrhotic ascites all had normal bactericidal activity. The bactericidal activity of ascitic fluid was diminished in all 25 patients with cirrhosis (P less than 0.00005 by Fisher's exact test). Similar results were found when opsonic activity was evaluated. Complement and immunoglobulin concentrations in cirrhotic ascites were significantly lower than those in the other two groups. The present study demonstrates that noncirrhotic ascitic fluid has antibacterial activity similar to normal peritoneal fluid, whereas cirrhotic ascitic fluid has a marked reduction of both bactericidal and opsonic activities. These defects may explain the high incidence of peritonitis in cirrhotic patients.

Ascitic Fluid↗
PubMed2005

A new, accurate and conventional five-point method for quantitative evaluation of ascites using plain computed tomography in cancer patients.

BACKGROUND: To assess the exact response of the malignant ascites to the treatment, the objective measurement of the volume of ascites is essential. We have developed a simple method to measure the volume of ascites by using standard abdomino-pelvic computed tomography (CT). The aim of the study is to validate the accuracy of the measurements by comparing them with the standard volume calculation by using 3D-CT. METHODS: Twelve consecutive patients with cancer who had measurable ascites underwent 15 helical CT examinations. On conventional CT images, the thickness of ascites in centimeters was measured in three planes such as the bilateral subphrenic space (A and B), the bilateral paracolic space (C and D) and the pre-bladder space (E), and the average thickness: (A + B + C + D + E)/5 was then multiplied by the area of standard abdominal cavity in the anterior projection, that was assumed to be 1000 cm(2), to yield the volume of ascites: (A + B + C + D + E) x 200 (ml). The volume of ascites was compared with the exact volume, that was obtained from 3D-CT with the volume rendering method. RESULTS: The volume of ascites measured by the present method and the volume rendering method ranged from 140 to 4040 ml and from 86 to 4279 ml, respectively. The correlation was statistically significant with a correlation coefficient of 0.956 (P < 0.01) using the Spearman's rank correlation. In 13 examinations with the exact volume > or =300 ml, the average ratio of the absolute difference in the volume was 12.9 +/- 13.9% as compared with 62.8 and 162.0% in two examinations with the exact volume < 300 ml. CONCLUSION: The preliminary study indicated that the present five-point method using a conventional CT was accurate in patients with the volume of ascites > or =300 ml. Because this procedure is simple and easy to perform, it should be feasible in many hospitals for the follow-up of ascites after treatment.

Adult↗
PubMed2005

Differential expression of cardiac muscle mitochondrial matrix proteins in broilers from ascites-resistant and susceptible lines.

Ascites is a metabolic disorder of modern broilers that is distinguished by cardiopulmonary insufficiency in the face of intense oxygen demands of rapidly growing tissues. Broilers with ascites exhibit sustained elevation of pulmonary arterial pressure and right ventricular hypertrophy, the end result of which is heart failure. It has been shown that mitochondrial function is impaired in broilers with ascites. In the current study, mitochondrial matrix protein levels were compared between ascites-resistant line broilers and ascites-susceptible line broilers with and without ascites using two-dimensional (2-D) gel electrophoresis. One hundred seventy-two protein spots were detected on the gels, and 9 of the spots were present at different levels in the 4 groups of broilers. These 9 protein spots were selected for identification by mass spectrometry. Two of the spots were found to contain single mitochondrial matrix proteins. Both mitochondrial matrix proteins, the dihydrolipoamide succinyltransferase component of the 2-oxoglutarate dehydrogenase complex and the alpha-subunit of mitochondrial trifunctional enzyme, were present at higher levels in ascites-resistant line broilers with ascites in the present study. The elevated levels of 2 key proteins in aerobic metabolism in ascites-resistant line broilers with ascites observed in the present study suggests that the mitochondria of broilers with this disease may respond inappropriately to hypoxia.

Animals↗
PubMedDate not supplied

Peritoneovenous shunt function 2-6 years after insertion for cirrhotic ascites.

To test the hypothesis that prolonged freedom from clinically detectable ascites after peritoneovenous shunt insertion is the result of continued drainage of ascitic fluid through the shunt, the authors studied shunt patency and function in 26 of the 27 survivors of 59 alcoholic cirrhotic patients operated upon 2-6 years previously for massive ascites resistant to medical therapy. Twenty-three patients were without clinically detectable ascites (minimal ascites--Group A), and three had large ascites (Group B). In 20 Group A patients the shunts were patent and functioning. The other three Group A patients had completely occluded shunts without demonstrable ascitic fluid flow. In one Group B patient with a daily fluid intake of 5-6 L, the shunt was partially obstructed but flow was rapid; in the other two, shunts were completely occluded. One subject in Group B with a completely obstructed shunt was resistant to medical treatment after 6 years of freedom from ascites, whereas the other two were controlled medically. In the three in Group A who had nonfunctioning shunts and required no diuretics, the severity of the ascites had decreased so that artificial drainage was no longer necessary. Thus, freedom from clinically significant ascites does not always indicate that the shunt continues to function.

Ascites↗
PubMed2002

Preoperative staging of gastric cancer by endoscopic ultrasound: the prognostic usefulness of ascites detected by endoscopic ultrasound.

BACKGROUND: Endoscopic ultrasound (EUS) is the standard modality in local preoperative staging of gastric cancers and is reputedly able to detect ascites. However, the association between ascites detected by EUS and local tumor staging, peritoneal carcinomatosis, or survival after surgery is not well documented. GOALS: To assess the accuracy, sensitivity, and specificity of EUS in the preoperative staging and detection of ascites in gastric cancers. We also try to correlate ascites with histologic staging, tumor differentiation, and survival rate of gastric carcinoma after surgery. STUDY: The retrospective analysis was made in 57 consecutive patients with histologically confirmed gastric adenocarcinomas that underwent EUS before surgery. The accuracy of EUS was compared with the final surgical-pathologic findings. We estimated the prognostic usefulness by analyzing the clinicopathologic features of gastric adenocarcinomas and following up their survival rates. RESULTS: The overall T staging was 88% accurate by EUS. The accuracy for T staging was as follows: T1, 100%; T2, 33%; T3, 93%; and T4, 100%. About 50% of T2 cases were overstaged. The overall accuracy, sensitivity, and specificity of detecting lymph node metastasis by EUS were 79%, 79%, and 80%, respectively. One of the seven T1 cancers had regional lymph node metastasis, and it was missed by EUS, although the T classification was precisely staged based on finding submucosal invasion. A total of 22 patients (39%) had ascites detected by EUS; both the sensitivity and specificity of EUS in demonstrating ascites were 100% in our study. Ascites was significantly correlated with the depth of tumor invasion ( = 0.036), lymph node metastasis ( = 0.008), and poor cellular differentiation ( = 0.007), but it was not significantly correlated with macroscopic peritoneal carcinomatosis. The survival rate after surgical treatment was poor in those with gastric cancers with lymph node metastasis, ascites, or poorly differentiated tumors ( < 0.05). However, multivariate analysis showed that lymph node metastasis was the only significant prognostic predictor ( = 0.004). CONCLUSIONS: Endoscopic ultrasound is a valuable diagnostic tool in the local staging of gastric cancers and demonstration of ascites. Although the surgical treatment of gastric cancers with lymph node metastasis, ascites, or poor differentiation had poorer survival rate, only lymph node metastasis was proved to be a significant prognostic predictor in multivariate analysis.

Adenocarcinoma↗
PubMed1998

Nephrogenic ascites. Analysis of 16 cases and review of the literature.

Nephrogenic ascites is an entity that manifests as refractory ascites in patients with end-stage renal disease, where portal hypertensive, infectious, and malignant processes have been excluded. Most of these patients are undergoing hemodialysis. Hypoalbuminemia may predispose these uremic patients to ascites formation. The characteristics of the ascitic fluid suggest that the pathogenesis of the ascites is an alteration in peritoneal membrane permeability or impaired resorption due to peritoneal lymphatic channel obstruction. The ascitic fluid has a high protein content, low serum-ascites albumin gradient (SAAG), and low leukocyte count. Daily hemodialysis should be the initial therapy and is successful in one-third to three-fourths of patients within 3 weeks. Continuous ambulatory peritoneal dialysis or insertion of a peritoneovenous shunt are alternative treatments. Other therapies include instillation of intraperitoneal corticosteroids and binephrectomy, which have less predictable outcomes. Renal transplantation is the definitive treatment for nephrogenic ascites. Control of ascites reverses the progressive cachexia associated with uncontrolled disease, resulting in improved quality of life and survival approaching that of end-stage renal disease patients without ascites.

Adult↗
PubMed1989

Induction of endogenous cytokines in ascites of patients with ovarian cancer by OK-432, a streptococcal preparation.

To clarify the action mechanism of OK-432, OK-432 was intraperitoneally (i.p.) administered to 4 ovarian cancer patients with malignant ascites. In 2 of the 4 patients, 4 types of cytokines (tumor necrosis factor, interleukin 1 beta, interleukin 2, and interferon gamma) were induced in ascites after intraperitoneal injection of OK-432 (i.p. OK-432). In one of these patients, the ascitic supernatant after i.p. OK-432 significantly inhibited colony formation of autologous ascitic tumor cells; the amount of ascites decreased markedly, and the ascitic cytology became negative. In the other 2 patients, only interferon gamma was induced in ascites after i.p. OK-432. In these 2, ascitic supernatant did not inhibit colony formation of autologous ascitic tumor cells. These results indicated that i.p. OK-432 can induce various endogenous cytokines in malignant ascites and that these induced cytokines may contribute to the antitumor effect of i.p. OK-432.

Ascites↗
PubMed2000

Ascites and spontaneous bacterial peritonitis in fulminant hepatic failure.

OBJECTIVE: Although presence of ascites has been reported in patients with fulminant hepatic failure (FHF), spontaneous bacterial peritonitis (SBP) has not been studied in a large group of such patients. Hence, the present study was conducted to evaluate the prevalence and prognostic significance of ascites and SBP in FHF patients. METHODS: Two hundred ninety-eight consecutive patients (mean age 32.9+/-14.8 yr) with FHF were studied. There were 133 (44.6%) men and 165 (55.4%) women. Acute viral hepatitis accounted for 91.6% of the patients and were analyzed in the present study. RESULTS: Ascites was clinically detected in 79 (28.9%) patients. The patients with ascites were older (p = 0.005), had longer jaundice-encephalopathy interval (p<0.0000001), lesser grade of encephalopathy on admission (p = 0.0000043), and a lower incidence of raised intracranial pressure on admission (p = 0.0007). Patients with ascites had significantly lower serum albumin (p = 0.021), ALT (p = 0.0005), AST (p = 0.00017), and PT (p = 0.002) on admission than in patients without ascites. Multivariate logistic regression analysis showed that jaundice-encephalopathy interval (> or =14 days) and serum albumin (< or =2.5 g/dl) were the only independent predictors of ascites. SBP was detected in 14 (17.7%) patients (neutrocytic culture positive, 4; neutrocytic culture negative, 9; and monomicrobial bacterascites, 1). Escherichia coli was identified in three patients. Survival was no different between patients with and those without ascites and also between patients with and those without SBP. CONCLUSIONS: Ascites is a frequent accompaniment of FHF and is complicated by SBP. Jaundice-encephalopathy interval of 14 days or more and serum albumin (< or =2.5 g/dl) on admission predicts the development of ascites in these patients.

Adolescent↗