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PubMed1986

Effects of topical diclofenac sodium in a rabbit model of ocular inflammation and leukotaxis.

A useful model that combines paracentesis with administration of a leukotactic factor was developed in order to study the effects of topical diclofenac sodium on various aspects of ocular inflammation. The increases in intraocular pressure (IOP) and secondary aqueous humor protein concentration induced in rabbits by anterior chamber paracentesis, as well as leukocyte accumulation in the anterior chamber induced by formyl-methionyl-leucyl-phenylalanine, were significantly reduced by topical application of diclofenac sodium at concentrations of 2 mM (0.064%, w/v) and higher. Lower doses consistently affected only IOP and secondary protein concentrations. A slight paracentesis-induced miosis was refractory to diclofenac sodium. That this potent inhibitor of prostaglandin synthesis can reduce important signs of ocular inflammation is well supported in this model.

Administration, Topical↗
PubMed1988

Manipulation of ascitic fluid pressure in cirrhotics to optimize hemodynamic and renal function.

Intra-abdominal pressure (IAP), measured via a transurethral catheter, hemodynamic, and renal functions were evaluated in 25 cirrhotic patients admitted to ICU with variceal bleeding, tense ascites, and peripheral edema. In patients with an IAP greater than 25 cm H2O, a paracentesis was performed to decrease the IAP by 10 cm H2O. After paracentesis, a decrease in the IAP from 33.47 to 19.06 cm H2O (p less than 0.001) resulted in a decrease in total peripheral resistance (TPR) (p less than 0.01) and a significant increase in cardiac index (CI) (p less than 0.001), stroke index (p less than 0.001), left ventricular stroke work (LVSW) (p less than 0.01), and right ventricular stroke work (p less than 0.01). The therapeutic effects of paracentesis on renal function were: a decrease in BUN and serum creatinine (p less than 0.001) and an increase in the creatinine clearance (Ccr) (p less than 0.001), urine volume (p less than 0.001), osmolar clearance (Cosm) (p less than 0.001), and urine creatinine (p less than 0.001) values. The IAP correlated directly with the TPR (r = +0.35, p less than 0.01) and inversely with the CI (r = -0.39, p less than 0.001) and LVSW (r = -0.37, p less than 0.001) in the 126 studies of IAP performed with the 25 patients. IAP also correlated directly with BUN (r = 0.40, p less than 0.001), serum creatinine (r = 0.28, p less than 0.01), and free water clearance (CH2O) (r = 0.3, p less than 0.001); IAP correlated negatively with Ccr (r = -0.54, p less than 0.001) and Cosm (r = -0.43, p less than 0.001). In critically ill cirrhotic patients, IAP, when measured noninvasively via a bladder catheter, is an accurate and useful method to follow manipulation of ascitic fluid pressure quantitatively in order to optimize hemodynamic and renal function.

Abdomen↗
PubMed1994

The role of ultrasonography in blunt abdominal trauma: results in 250 consecutive cases.

The accuracy of ultrasonography (US) in detecting abdominal lesions and free fluid collections in patients with blunt abdominal trauma was evaluated in 250 patients. Particular attention was paid to the role of associated US-guided paracentesis in doubtful cases and in those referred for nonsurgical therapy. The overall sensitivity of US in detecting free fluid collection was 98% (51 of 52 cases) with a specificity of 99% and a positive predictive value of 100%. The overall sensitivity was 93% in spleen injuries, 80% in liver injuries, and 100% in kidney lesions with a positive predictive value of 93%, 100%, and 100%, and a specificity of 99%, 100%, and 100%, respectively. Three stable patients underwent celiotomy on the basis of the results of US-guided paracentesis. The versatility, sensitivity and, repeatability of US, along with its feasibility at bedside and the possibility of performing a guided paracentesis represent the main characteristics that make US the first diagnostic approach to patients with blunt abdominal trauma.

Abdominal Injuries↗
PubMed1998

Influence of transjugular intrahepatic portosystemic shunts (TIPS) on tissue oxygenation in patients with cirrhosis.

UNLABELLED: AIMS/BACKGROUNDS: The aim of this prospective study was to evaluate the influence of transjugular portosystemic intrahepatic shunts (TIPS) on tissue oxygenation in patients with cirrhosis and refractory ascites. METHODS: Five shunted patients were included in the study. The blood and tissue oxygenation values were analyzed 12 days and 4 months after TIPS procedure. The results were compared with those observed in patients treated by paracentesis. RESULTS: Unlike patients treated by paracentesis, PaO2 values remained unchanged throughout follow-up in shunted patients. After the TIPS procedure, there was a transient increase in systemic O2 transport and O2 uptake and a transient decrease in O2 saturation of hepatic oxyhemoglobin. After 4 months, TIPS resulted in an increase in PCO2 values and bicarbonate concentrations. CONCLUSIONS: The TIPS procedure seems to prevent the decrease in PaO2 observed in patients treated by paracentesis and may improve the respiratory alkalosis of cirrhosis.

Adult↗
PubMed1975

Pathways for the response of the eye to injury.

The role of a neural pathway in the disruption of the blood-aqueous barrier of the rabbit after two irritating stimuli, topical nitrogen mustard, and paracentesis, was studied. Retrobulbar anesthesia or section of the ophthalmic division of the trigeminal nerve decreased the breakdown of the blood-aqueous barrier, as measured by protein in the aqueous humor, after topical nitrogen mustard. Sensory denervation, accomplished with retrobulbar alcohol, virtually prevented the protein rise in the aqueous humor. Disruption of the blood-aqueous barrier after paracentesis, however, was not affected by retrobulbar anesthesia or alcohol denervation. Therefore, the increased protein in the aqueous humor after an irritative stimulus appears to be mediated by at least two pathways. The response to a stimulus such as nitrogen mustard depends on sensory innervation and is not mediated by prostaglandins to any important degree. The response to paracentesis does not require sensory innervation and appears to be mediated, at least in part, by prostaglandins.

Animals↗
PubMed1991

Cancer antigen 125 in serum and ascitic fluid of patients with liver diseases.

Serum concentrations of cancer antigen 125 (CA 125) were determined for 373 patients with various liver diseases: 57 with acute hepatitis, 57 with chronic hepatitis, 244 with liver cirrhosis (86 compensated and 158 decompensated), and 15 with primary liver cancer. The antigen was measured simultaneously in the serum and ascitic fluid of 46 of the patients with liver cirrhosis and sequentially in the serum and ascitic fluid of another 25 cirrhotics treated with paracentesis and (or) diuretics. Abnormal results for CA 125 were detected in sera from 4% of the patients with acute or chronic hepatitis, 60% of the patients with liver cirrhosis, and 67% of the patients with primary liver cancer. The main factor associated with abnormal serum concentrations of this antigen was the presence of ascites, with pathological CA 125 values in 94% of patients with ascites without jaundice (mean 566 +/- 528 arb. units/mL), compared with only 40% of patients with jaundice and without ascites (mean 40.1 +/- 28.5 arb. units/mL) (P less than 0.001). High concentrations of CA 125 were mainly associated with spontaneous bacterial peritonitis. The serum concentration of CA 125 decreased after treatment with paracentesis, but increased in patients treated with diuretics rather than paracentesis. The release of this antigen in liver cirrhosis appears to be independent of the liver disorder and, rather, results from peritoneal synthesis of this antigen.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1987

Prevention of surgically induced miosis by diclofenac eye drops.

In this investigation, a rabbit model was used to study the effectiveness of topical diclofenac sodium in the prevention of miosis induced by manipulation of the ocular structures. In untreated rabbit eyes, paracentesis of the anterior chamber induced a 25% narrowing of the pupil. In atropine-treated rabbit eyes, the absolute pupil diameters were larger, but the pupil still contracted, resulting in a postoperative diameter of 6.5 mm. Pretreatment with diclofenac 0.1% eye drops effectively inhibited paracentesis-induced miosis; the postoperative pupil narrowing amounted to only 9% of the original diameter in both untreated and atropine-treated eyes. With a combined topical application of atropine and diclofenac, the mean pupil diameters after paracentesis were as large as 8.7 mm. Diclofenac seems to be a promising drug for the maintenance of mydriasis during eye surgery.

Animals↗
PubMed1977

[Medulloblastoma with intractable ascites treated by carboquone--a complication of a ventriculoperitoneal shunt (author's transl)].

Although complication occasionally occur in the use of ventriculoperitoneal shunts (VP-shunt), the occurrence of intractable ascites and extracranial metastasis through the shunt are uncommon. Recently intractable ascites occurred in a two years old girl in whom a left VP-shunt had been placed before four month for obstructive hydrocephalus secondary to medulloblastoma. Paracentesis was performed with recovery of clear, straw-colored fluid with a specific gravity of 1012, a protein content of 0.3 gm/L and many of mononuclear cell on microscopic examination. Liver-scan and enzyme profile gave normal results. During 3 weeks, 6 times paracentesis were performed and total volumes of ascites were 3850 ml. At 5 and 6 times paracentesis, Carboquone 1 mg was injected into peritoneal cavity and 0.1 mg into ventricle cavity through flashing device. After these injection, intractable ascites were cured, no metastasis can be seen in peritoneal cavity when died 4 month later. No precise explanation can be offered for occurrence of this intractable ascites. It is said that chronic irritation of the visceral and parietal peritoneum or sub-clinical peritonitis may cause peritoneal malabsorption. In our case, antitumor agent was very effective, so this treatment will be recommended to try for intractable ascites.

Ascites↗
PubMedDate not supplied

[Reliability of bioelectric impedance analysis as a method of nutritional monitoring in cirrhosis with ascites].

Bioelectric impedance analysis (BIA) was carried out in 55 cirrhotic patients (32 with and 23 without ascites) and 20 healthy controls with the aim of evaluating its usefulness in cirrhosis. Furthermore, in 13 of the ascitic patients BIA was performed immediately before and 24 hours after paracentesis. No differences were observed among the three groups in either resistance or the values of total body water (TBW), lean body mass (LBM) and fatty body mass (FBM) estimated by BIA. On the other hand, reactance and the phase angle were lower in cirrhotic patients. Likewise, the percentage of body cell mass (BCM) was lower in ascitic patients than in the non ascitic patients and the controls (37.7 +/- 1.2 vs 42.3 +/- 1.2 vs 45.5 +/- 1.6%; p = 0.0003). Mid-arm muscle circumference was correlated with TBW and LBM in all the groups and with only BCM in the controls and those without ascites. In general, the precision of the regression lines was lower in the ascitic patients than in the non ascitic patients and controls. TBW decreased following paracentesis (28.3 +/- 1.7 vs 30.3 +/- 2.0 kg; p = 0.008) but this decrease did not correspond with the volume of ascitic fluid obtained in any case. The mean BCM did not change with paracentesis although individual differences ranged between -8.0 and +11.2% (CI 95%). It is concluded that BIA is not a reliable method for nutrition evaluation in cirrhotic patients with ascites in clinical practice and that the anthropometric parameters are still preferable in these cases.

Ascites↗
PubMed1995

[Justification of routine puncture of ascites in cirrhotic patients admitted to emergency hospital units].

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent, serious, recurrent complication, occurring in 10 to 30% of cirrhotic patients hospitalized with ascites. The key to diagnosis of SBP is ascites paracentesis and polymorphonuclear count in ascitic fluid. The purpose of our study was to evaluate sensitivity and specificity of clinical and biological criteria in diagnosis of 5 BP. METHODS: We prospectively reviewed 30 adult cirrhotic patients admitted in our emergency department with ascites. Ascites paracentesis was performed in each patient, and SBP diagnosis was based on either positive bacteriological culture or polymorphonuclear count above 250/mm3 in ascitic fluid. Classical criteria for SBP were recorded: blood pressure under 90 mm of Hg, abdominal pain, temperature above 38.5 or under 36.5, jaundice, encephalopathy, increased serum bilirubin or creatinine, leukocyte blood count about 12 G/l. We evaluated sensitivity and specificity of those criteria in SBP, and compared their frequency in patients with SBP or sterile ascitic fluid. RESULTS: Thirty patients were included in our series, and in 14 of them a SBP was diagnosed. A significant difference was observed between spontaneous bacterial peritonitis and sterile ascitic fluid for abdominal pain and temperature abnormalities, but specificity and sensitivity of these criteria were very low. Moreover, SBP was asymptomatic in 7%. CONCLUSION: Due to the high rate of mortality in patients with SBP we recommend diagnostic procedures for this frequent complication as soon as patient is admitted in emergency department. This diagnosis must be based on ascitic fluid paracentesis, which has to be performed, in the emergency department, in every cirrhotic patient admitted with ascites. Indeed, SBP is often asymptomatic, and no clinical or bacteriological criteria can be considered as completely reliable for the diagnosis of spontaneous bacterial peritonitis.

Ascites↗
PubMed1994

[Treatment of ascites in liver cirrhosis].

The treatment of severe cirrhotic ascites is still a major clinical problem. On the basis of the current recommendations for treatment in the textbooks we have reviewed the randomized clinical trials comparing the existing different options of treatment. It is concluded that paracentesis is marked by several advantages compared to diuretics. Paracentesis has to be followed by an intravenous infusion of a volume expander to avert hypovolaemic complications and can then be performed as total paracentesis. The effect has to be maintained by diuretics. Synthetic products of low cost may substitute albumin. Intravenous reinfusion of ascites fluid constitutes a viable alternative. Under diuretic treatment spironolactone (in doses up to 400 mg daily) should be preferred to furosemide. Combinations of diuretics offer no advantages. The value of sodium restriction although rational is not documented in randomized trials. Sodium restriction is difficult to comply with and is not crucial for the therapeutic effect when diuretics are being administered at the same time. The advantages of a peritoneovenous shunt are outweighed by the very frequent incidence of shunt occlusion, for which reason the application should be restricted.

Ascites↗
PubMed1994

Autologous protein reinfusion in severe ovary hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications of ovulation induction by exogenous gonadotropins. The pathophysiologic factors of this syndrome are not well known. Increased capillary permeability causes third space fluid shift, which is responsible for ascites, pleural fluid, and edemas. Severe OHSS may result in renal failure, hypovolemic shock, thromboembolic disease, respiratory distress, and may cause death. It has been observed that paracentesis is efficacious, provided that care is taken to reinfuse protein lost in the peritoneal exudate. For this reason, in three patients with severe OHSS we have used a dialytic technique of reinfusion of concentrated ascitic fluid. STUDY DESIGN: We treated three patients with severe OHSS (grade 6). Through sonography-guided paracentesis, the ascitic fluid was concentrated by ultrafiltration and reinfused. This treatment was instituted and performed once only. Ultrafiltration was obtained with a common high-flow dialyzer (polyacrylonitryle membrane). The concentrated fluid was returned to the patient in a peripheral vein. We have limited further treatment to restoration of fluid and electrolyte balance, avoiding in particular potentially teratogenic drugs. RESULTS: In all three patients, a progressive increase of diuresis was evident during treatment and subjective improvement was almost immediate. Fifteen days after treatment, hematologic and biochemical parameters had returned within normal limits. CONCLUSIONS: In treating severe OHSS, we have used the technique of reinfusion of concentrated ascitic fluid to avoid protein depletion induced by paracentesis. We have been able to successfully restore to normal the hematologic and biochemical imbalance with one treatment. Use of the technique described herein should be limited to carefully selected instances and treatment should be performed in an intensive care unit.

Adult↗
PubMed1994

Role of routine estimation of creatinine clearance in patients with liver cirrhosis.

BACKGROUND: Frequent occurrence of renal dysfunction without azotemia in patients with decompensated cirrhosis, and its prognostic and therapeutic importance, are not well appreciated. METHODS: Creatinine clearance (CrCl), 24-hour urinary sodium excretion, fractional excretion of sodium, and urine flow were estimated in 68 non-azotemic uncomplicated cirrhosis patients; all these patients were followed up for a period of 6 months. Eighteen patients with ascites and edema were treated with large volume paracentesis without colloid replacement and renal function was evaluated before, and 48 hours and 7 days later. Eight patients with abnormal CrCl were treated with 10 mg of enalapril daily and CrCl estimated at the end of 7 days. RESULTS: Of 68 patients, 22 had CrCl > 80 mL/min (Group I), 21 had CrCl of 50-80 mL/min (Group II) and 25 had CrCl < 50 mL/min (Group III). Renal dysfunction correlated with Child's class. During a mean follow up period of 180 days, patients in Groups II and III had higher mortality rates than those in Group I (23.8% and 36.0% vs 9.1%; p < 0.001). Following large volume paracentesis, CrCl decreased at 48 h and continued to be low at the end of 7 days even though blood urea nitrogen and serum creatinine remained normal. CrCl improved with 10 mg enalapril at 7 days (46.5 +/- 15.4 to 73.2 +/- 19.7 mL/min; p < 0.05). CONCLUSION: More than two-thirds of patients with advanced cirrhosis have abnormal CrCl despite normal blood urea nitrogen and serum creatinine; they also have a higher mortality as compared with patients with normal CrCl. CrCl decreases after large volume paracentesis even though blood urea nitrogen and serum creatinine remain unchanged. Enalapril improves CrCl in patients with liver cirrhosis but its exact clinical utility needs further evaluation.

Adult↗
PubMed1996

Home ascites drainage using a permanent Tenckhoff catheter.

Management of refractory ascites (RA) can be accomplished in many ways. Rapid recurrence will be a problem even with repeated paracentesis. We studied the use of a permanent Tenckhoff catheter (PTC) for drainage of RA in 10 patients. The cause of RA was cardiomyopathy in 7 patients, malignancy with liver metastasis in 2, and end-stage liver disease in 1 patient. The volume of ascites drained (AD) ranged from 0.5-7.0 L, with a mean of 2.6 L. Mean blood pressure pre-AD was 112/68 mm Hg, and post-AD was 109/66 mm Hg (p > 0.05). Heart rate pre- and post-AD was 80 bpm and 81 bpm, respectively (p > 0.05). The number of ADs ranged from two to 63 (mean: 16). There was no fluid replacement during or post-AD. There were no complications or infections from AD. The mean interval between ADs was 7.8 days. Mean duration of survival was six months. All patients eventually expired. In conclusion, PTC can be a useful and safe alternative for draining RA at home in terminally ill patients. Complications of repeated paracentesis are minimized, and the need for hospitalization is avoided. AD with PTC may be preferred to repeated paracentesis in RA.

Adult↗
PubMed1976

[Diagnosis and treatment of conductive deafness due to middle-ear effusion in childhood (author's transl)].

Results of follow-up examinations of 132 ears with serous or mucous middle ear effusions indicate that this disease is common in childhood and is also found in adults. In childhood adenoid growth as well as repeated catarrhal infection of the paranasal sinuses and the weakness of the levator palati play an important role in the development of middle ear effusions and deafness. With the aid of the operation microscope we were able to recognize this characteristic disease through the tympanic membrane. We perform regularly adenoidectomy together with paracentesis in this condition. In cases which had undergon several adenoidectomies we limit our treatment in the first instance to paracentesis. If cure is not so achieved we insert an inert tube into the tympanic membrane after the paracentesis. In persistent and difficult cases of glue ear radiation of the eustachion tube and antrotomy may be necessary.

Age Factors↗
PubMed1997

Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites.

Cirrhosis is associated with cardiovascular abnormalities. Scanty information is available as to whether these include left ventricle diastolic dysfunction and wall thickness increase. To this aim in 27 cirrhotic patients with tense ascites, 17 cirrhotic patients with previous episodes of ascites (not actual), and 11 controls we investigated by echocardiography and echocolor Doppler left ventricle diastolic function (E wave, A wave, E/A ratio, deceleration time of E wave), systolic function (ejection fraction), and wall thickness (left ventricle posterior wall thickness + interventricular septum thickness) along with neurohumoral variables. All measurements (supine position) were repeated after total paracentesis (10.7 +/- 0.6 L of ascites) in ascitic patients. Both in patients with and without ascites E/A ratio was reduced as compared with controls (0.93 +/- 0.07 and 0.97 +/- 0.06 vs. 1.18 +/- 0.08, P < .05) while left ventricle wall thickness was increased (18.6 +/- 0.6 and 20.1 +/- 0.8 vs. 17.2 +/- 0.7, P < .05 and P < .01, respectively), irrespective of the postviral or alcoholic cause of liver disease. In all cirrhotics both right and left atrial and right ventricle diameters were significantly greater. Ejection fraction was slightly but significantly (P < .01) reduced in ascitic patients. Paracentesis induced a reduction of the highly increased basal plasma renin activity, aldosterone, norepinephrine (P < .01), and epinephrine (P < .05) and improved diastolic function (E/A, P < .05). Systolic function was unaffected. Thus, irrespective of ascites and cause, advanced cirrhosis is associated with left ventricle diastolic dysfunction and wall thickness increase. We can speculate that neurohumoral overactivity, known to stimulate cardiac tissue growth, may challenge the heart, promoting fibrosis and exerting a further hindrance to ventricular relaxation in patients with cirrhosis experiencing episodes of ascites.

Aged↗
PubMed1999

Prognostic importance of serial cytokine changes in ascites and pleural effusion in women with severe ovarian hyperstimulation syndrome.

OBJECTIVE: To determine the prognostic value of various cytokine levels in ascites and pleural effusion during the evolution of severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A longitudinal study. SETTING: University teaching hospital. PATIENT(S): Twenty patients with severe OHSS who required either paracentesis or thoracentesis or both from whom ascites (n = 56) or pleural effusion (n = 12) samples were obtained. Control peritoneal fluid was obtained from 20 patients undergoing ovarian stimulation for IVF. INTERVENTION(S): Abdominal paracentesis for tense ascites and thoracentesis for massive pleural effusion. Control peritoneal fluid was obtained before oocyte retrieval. MAIN OUTCOME MEASURE(S): Levels of interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), E2, and progesterone concentrations in ascites and pleural effusion. RESULT(S): Levels of VEGF and IL-6 in ascites dropped significantly during the course of OHSS and were not correlated with E2 concentrations. Levels of VEGF were significantly correlated with levels of IL-1 beta, IL-8, and TNF-alpha, as well as progesterone concentrations, hematocrit, and white blood cell counts. None of the cytokine levels measured in pleural effusion were correlated with the course of OHSS. CONCLUSION(S): These results suggest that local cytokines might be involved in the evolution of severe OHSS and possibly serve as prognostic markers for this syndrome.

Adult↗
PubMed2006

Validation of body mass index for the diagnosis of malnutrition in patients with liver cirrhosis.

OBJECTIVES: Simple clinical tools are needed to detect malnutrition in cirrhotic patients. We have validated optimal body mass index (BMI) cut-offs for the diagnosis of malnutrition in accordance with the importance of ascites. METHODS: BMI, mid-arm muscle circumference (MAMC) and triceps skinfold thickness (TST) were measured before paracentesis in study (SP) and validation (VP) populations of 875 and 294 cirrhotic patients, respectively with no ascite (NA), mild (MA), tense ascites (TA) (NA/MA/TA: SP: 327, 270, 278; VP: 111, 69, 114). Preserved nutritional status (SP: 259; VP: 93), malnutrition including severe and moderate malnutrition (SP: 251 and 365; VP: 92 and 109) were defined from MAMC and TST measurements. RESULTS: Optimal BMI cut-off values were 22, 23 and 25 kg/m2 in NA, MA and TA patients, respectively. In the whole SP and VP, sensitivities of these cut-offs were 86.2% and 89.1%, respectively; the corresponding negative predictive values (NPV) for the diagnosis of severe malnutrition were 92.3% and 93.2%; specificities and positive predictive values (PPV) were 87.7% and 89.9%, 92.7% and 93.6%, respectively for the diagnosis of malnutrition. In the entire VP, peripheral oedema did not change sensitivity and NPV of BMI cut-offs for the diagnosis of severe malnutrition and tended to increase specificity and PPV for the diagnosis of malnutrition. 96.7% of the malnourished TA patients in the VP before paracentesis were correctly identified after removal of ascites. CONCLUSION: BMI is a reliable parameter to detect malnutrition in cirrhotic patients with the above mentioned cut-offs. Peripheral oedema and removal of ascites do not affect its diagnostic performance.

Adult↗