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PubMed1996

In vitro NMR proton T1 measurements in peritoneal ascites.

The proton spin-lattice relaxation rate (1/T1) in malignant and non-malignant ascites was measured with an FT NMR spectrometer operating at 60 MHz. The mean relaxation rate in non-malignant ascites was significantly smaller than that of malignant ascites. However, the 1/T1 of malignant ascites overlaps with that of non-malignant ascites over all concentrations of total protein (TP) in samples. The 1/T1 in non-malignant ascites correlates strongly with TP, whilst the 1/T1 in malignant ascites shows only a moderate correlation. T1 measurements before and after addition of ascorbic acid (reductant) suggest that there is a small paramagnetic contribution of ions to the 1/T1 in malignant ascites. The least-squares fitting of 1/T1 versus TP for non-malignant data gives a linear relationship, and suggests that the T1 mechanism in non-malignant ascites is caused by a fast chemical exchange of water molecules between protein-bound water and free water.

Ascites↗
PubMed2000

VEGF/Flk-1 interaction, a requirement for malignant ascites recurrence.

Vascular endothelial growth factor (VEGF) plays an important role in the production of ascitic fluid associated with malignant tumor growth. In an experimental model for malignant ascites formation, mice were inoculated intraperitoneally with syngeneic mouse sarcoma tumor cells. Ascites development was not prevented by administering tumor necrosis factor (TNF) simultaneously with the tumor cell inoculation. When the malignant ascites was first drained and renewal of ascites was monitored, however, a TNF dose-dependent inhibition of ascitic fluid accumulation was observed. Northern blot analyses indicated transient downregulation by TNF on the expression of VEGF mRNA in tumor cells. Monoclonal antibody, (mAb) DC101 generated against the mouse VEGF receptor Flk-1 prevented the recurrence of malignant ascites in mice similar to TNF inhibition. In addition, exogenous soluble human Flt-1 used as an inhibitor of endogenous VEGF binding also inhibited ascites recurrence. These data demonstrate that the observed inhibitory effect of TNF on reestablishment of malignant ascites can be achieved equally by inhibition of the interaction of VEGF with its receptor Flk-1.

Animals↗
PubMed1998

Evaluation of minimally invasive indices for predicting ascites susceptibility in three successive hatches of broilers exposed to cool temperatures.

Broilers from three consecutive hatches were exposed to cool temperatures to amplify the incidence of pulmonary hypertension syndrome (PHS, ascites). The largest apparently healthy individuals on Day 42 were evaluated using minimally invasive diagnostic indices [percentage saturation of hemoglobin with oxygen, hematocrit (HCT), heart rate, electrocardiogram (ECG) Lead II, body weight), then they were subjected to the ongoing pressures of fast growth and cool temperatures to determine which of these indices are predictive of the subsequent onset of PHS. Approximately 20% of the males and females evaluated on Day 42 subsequently developed PHS by Day 51. When data for all hatches were pooled and broilers that subsequently developed ascites were compared with those that did not (nonascitic), body weights, heart rates, and percentage saturation of hemoglobin with oxygen were lower on Day 42 for ascitic than for nonascitic males, and HCT was higher in ascitic males and females than in nonascitic males and females, respectively. Comparisons of the ECG Lead II wave amplitudes for all hatches pooled indicated that RS-wave amplitude was larger in ascitic than in nonascitic males, and that S-wave amplitude was more negative in ascitic males and females than in nonascitic males and females. Necropsies conducted on Day 51 revealed higher right:total ventricular weight ratios in ascitic than in nonascitic broilers, whereas normalizing the left ventricle plus septum weight for differences in body weight generated similar values for ascitic and nonascitic males and females, respectively. These results support a primary role for pulmonary hypertension but not cardiomyopathy in the pathogenesis of ascites triggered by cool temperatures. Values obtained for minimally invasive diagnostic indices on Day 42 also establish predictive thresholds that can be used to evaluate the PHS susceptibility of large and apparently healthy male and female broilers.

Animals↗
PubMed2000

Effect of dietary aspirin on ascites in broilers raised in a hypobaric chamber.

During the course of ascites development in broilers, many factors can interact to cause hypoxia. To counteract hypoxia, birds with ascites develop greatly increased hematocrit and red cell counts. Increasing hematocrits result in more viscous blood. Prostaglandins are involved in the regulation of constriction and dilation of pulmonary blood vessels and in the formation of blood clots. Dietary aspirin, a prostaglandin inhibitor, was used in an attempt to promote vasodilation and inhibit blood clotting in broilers, with the objective of determining the effect of aspirin on ascites progression. The experimental design consisted of two trials with a total of 1,360, 1-d-old male broiler chicks, which were placed at either local altitude (390 m above sea level) or in a hypobaric chamber that simulated an altitude of 2,900 m above sea level. At each elevation, five dietary treatments were employed: [control, 0.025% crystalline acetylsalicylic acid (aspirin), 0.05% aspirin, 0.10% aspirin, and 0.20% aspirin]. Bird and feed weights were recorded weekly. At the end of 5 wk, blood samples and organ weights were collected, and all birds were examined for signs of ascites. In both trials, birds raised at high altitudes were significantly lighter, had a higher incidence of ascites, and had differences in hematology, compared with birds raised at local elevation. Only in Trial 2, however, did dietary aspirin appear to have any effect on ascites incidence. At the 0.20% aspirin level, a reduction in ascites incidence approached significance compared with controls (34% vs. 56%, P < or = 0.06). Unfortunately, birds fed 0.20% aspirin also were significantly (P < or = 0.01) lighter than controls. Because slowing growth rate is known to reduce ascites, this decrease in BW may have been partially responsible for any beneficial effect on ascites development and progression obtained through feeding aspirin.

Altitude↗
PubMed2003

Effect of cold stress on broilers selected for resistance or susceptibility to ascites syndrome.

Genetic selection for an ascites-resistant line of broilers is seen as a permanent solution to the ascites problem. Ascites-resistant and ascites-susceptible lines have been developed using sire family selection based on mortality data taken from siblings reared in a hypobaric chamber (simulated 2,900 m above sea level). The relaxed line is representative of the original commercial pureline stock randomly mated with no artificial selection pressure. The objectives of this study were to evaluate the differences between the lines when reared in floor pens and subjected to an ascites-inducing cold stress. Seven hundred eighty three straight run broilers were reared in floor pens at local elevation (390 m above sea level). Feed and water were available ad libitum. Birds were brooded at 32 C during the first week. The second week birds were maintained at 30 degrees C. Cold stress was applied for the remaining 4 wk at 14 degrees C. Mortalities were necropsied daily to determine cause of death. Birds and feed were weighed weekly. At 6 wk, five birds per pen were bled, and half the survivors in each pen (8 to 15 birds) were killed, necropsied, and scored for ascites. Blood gases, clinical chemistries, and blood cell counts were taken. Liver, spleen, split heart, and lung weights were recorded. Body weights were not different among the resistant, susceptible, and relaxed lines (P < 0.05). Feed conversion was better in the resistant line when compared to the susceptible and relaxed lines (P < 0.05). Ascites incidence, as measured by mortality and lesion score at necropsy, was higher in the susceptible and relaxed lines when compared to the resistant line; 18.8, 12.7, and 1.6% respectively (P < 0.001). Susceptible and relaxed lines showed more right ventricular hypertrophy when compared with the resistant line (P < 0.05). The results show that under severe cold stress at local altitude (390 m above sea level), the ascites-resistant line was growing as rapidly as the other lines and was as resistant to ascites as it had been under hypobaric conditions.

Animal Feed↗
PubMed2005

Comparison of three lines of broilers differing in ascites susceptibility or growth rate. 2. Egg weight loss, gas pressures, embryonic heat production, and physiological hormone levels.

Ascites is a metabolic disorder that accounts for over 25% of overall mortality in the broiler industry. This disorder is manifested between wk 5 and 6 posthatch, but there are previous indications that predisposition may be identified during embryonic development. In this current study, we determined embryonic physiological and metabolic parameters that may be associated with ascites predisposition. For this purpose, we used broiler eggs from 3 lines that differed in ascites sensitivity. These included an ascites-sensitive dam line (DAS), an ascites-resistant dam line (DAR), and an ascites-sensitive sire line (SASL). Eggs were incubated for 21 d under standard conditions. The following parameters were measured during incubation: egg weights at setting, egg weight losses at 18 d, embryo body weights and embryo heart weights throughout development, air cell partial gas pressures (pCO2 and pO2) levels at d 18 and at internal pipping (IP); plasma triiodothyronine, thyroxine, and corticosterone levels at d 18, IP, and hatch; heat production from d 17 until hatch, hematocrit values at hatch, and posthatch growth rate to 7 d along with hematocrit values. The data obtained revealed that selection for ascites sensitivity or rapid growth rate had no consistent influence on some of these parameters such that they could be wholly associated with ascites sensitivity for predictive purposes. Whereas differences in embryonic developmental patterns were apparent throughout embryonic development, these differences in physiological and metabolic parameters may be due partly to genetic differences unrelated to ascites sensitivity.

Animals↗
PubMed2005

Hypobaric hypoxia in ascites resistant and susceptible broiler genetic lines influences gut morphology.

Genetic selection based on rapid growth rates, improved feed conversion, and increased body weights has led to a predisposition to ascites in broiler populations. Sire-family selection was applied to a commercial elite line to produce divergent lines of ascites-resistant (RES) and ascites-susceptible (SUS) broilers by the 8th generation. One objective of this research was to determine the effects of hypobaric hypoxia on gut morphology in these genetic lines. In two separate trials, pedigree broiler chickens were randomly assigned to cages in a hypobaric chamber (simulated 2,900 m above sea level) or a matching local altitude chamber (390 m above sea level). Ascites incidence was characterized by heart enlargement and fluid accumulation in the abdominal cavity. At the end of the study on d 42, all surviving birds were killed and evaluated for the presence of ascites and 2-cm sections from the duodenum and lower ileum were collected from 5 chickens per line, per altitude for each trial for morphometric analysis. At a high altitude, ascites incidence was lower in the RES line (20.9 and 3.7%) than in the SUS line (86.4 and 66.9%, Trials 1 and 2, respectively). No ascites was observed at a local altitude. Under hypoxic conditions, duodenum villus surface area was higher (P < 0.05) in the RES line (181.3 +/- 16.8 and 219 +/- 10.9 microm) compared with the SUS line (130.1 +/- 10.5 and 134.3 +/- 9.3 microm; Trials 1 and 2, respectively). No differences in ileum villus morphology were observed for any of the parameters measured. The reduced surface area in the duodenum of birds selected for ascites susceptibility suggests reduced enteric function and may provide clues as to why these birds have increased incidence of ascites.

Altitude↗
PubMed1987

Amylase levels in ascitic fluid.

The amylase concentration of ascitic fluid and serum were measured in patients with various types of ascites to determine their normal range. The mean (+/- SD) nonpancreatic ascites amylase concentration was 42 +/- 44 IU/L (range 4-234) and the mean ascitic fluid/serum amylase concentration ratio was 0.44 +/- 0.33 (range 0.10-1.55). Of the various types of non-pancreatic ascites (sterile cirrhotic, infected, malignant, etc.), no group had a significantly different ascitic fluid amylase concentration or concentration ratio than any other group. Two patients with pancreatic ascites had a mean ascitic fluid amylase concentration of 1,957 +/- 1,093 IU/L and a mean amylase concentration ratio of 5.59 +/- 0.02--both significantly (p less than 0.001) greater than those of nonpancreatic ascites.

Amylases↗
PubMed1990

Spontaneous Salmonella infection of high-protein noncirrhotic ascites.

Spontaneous bacterial peritonitis rarely complicates high-protein (greater than 2.5 g/dl) ascites. The relatively high endogenous antimicrobial (opsonic) activity of the ascitic fluid in this setting appears to protect the patient from infection. We report two patients with high-protein, noncirrhotic ascites complicated by spontaneous peritonitis due to Salmonella species. One patient had ascites due to heart failure, whereas the other patient's ascites was due to peritoneal carcinomatosis. The ascitic fluid total protein concentrations were 3.1 and 3.3 g/dl, respectively, and the opsonic activity of the ascitic fluid specimens were 2.03 and 2.00 log kill, respectively, indicating a high degree of bacterial killing. We hypothesize that the virulence of the Salmonella species was able to overcome the high opsonic activity in the ascitic fluid, resulting in infection in these two patients. Fever, abdominal pain, or encephalopathy in a patient with high-protein ascites may suggest the presence of an unusual organism causing spontaneous bacterial peritonitis.

Ascites↗
PubMed2004

Nitric oxide in ascitic fluid is an independent predictor of the development of renal impairment in patients with cirrhosis and spontaneous bacterial peritonitis.

BACKGROUND/AIMS: Cirrhotic patients with spontaneous bacterial peritonitis show a marked activation of the cytokine cascade, and cytokines induce the synthesis of nitric oxide in vitro. Our aim was to assess whether patients with ascitic fluid infection show increased levels of nitric oxide, and whether this is related to the development of renal impairment. METHODS: Retrospective analysis of prospectively collected specimens from 168 patients with cirrhosis and presence of sterile or infected ascitic fluid. Routine biochemical data together with nitric oxide metabolites, tumour necrosis factor and interleukin-6 were measured. Univariate and multivariate analyses were performed to identify factors related to the development of renal impairment. RESULTS: Patients with infected ascites showed increased serum and ascitic-fluid levels of nitric oxide metabolites and cytokines compared with patients with sterile ascites. A significant direct correlation was observed between serum and ascitic fluid nitric oxide metabolite levels. Multivariate analysis identified ascitic-fluid nitric oxide metabolites as an independent predictor of renal impairment. CONCLUSIONS: The increased serum and ascitic fluid nitric oxide found in patients with infected ascites might induce a deterioration of the increased peripheral vasodilation found in this setting, leading to the development of renal impairment in a series of patients with spontaneous bacterial peritonitis.

Adolescent↗
PubMed2005

Use of orlistat (xenical) to treat chylous ascites.

Chylous ascites is uncommon and occurs in about 1 in 20,000 hospital admissions. Causes include disruption of the lymphatic system due to malignancy, cirrhosis, surgery, or radiation therapy. The mainstay of therapy has been low-fat diet supplemented with medium-chain triglyceride oil. However, dietary compliance can be difficult to achieve for adequate response. We report a 47-year-old man with hepatitis C and alcohol-related cirrhosis with new-onset chylous ascites and chylothorax. His ascites triglyceride was 585 mg/dL, and the pleural fluid triglyceride was 691 mg/dL. Ascitic and pleural fluid cytology and acid-fast bacilli stain were negative. The patient was treated with low-fat diet and medium-chain triglyceride oil. However, his ascites remained chylous after 1 week of treatment because of poor compliance with the dietary restrictions. Orlistat was then added to his treatment regimen. A half week later, the chylous component of his ascites resolved. Remaining high-volume clear ascites was treated with placement of a transjugular intrahepatic portosystemic shunt. To our knowledge, orlistat has never been used in the treatment of chylous ascites. This case suggests the potential value of adding orlistat to low-fat diet and medium-chain triglyceride oil in the treatment of chylous ascites, especially in patients who are unable to comply with the dietary restrictions.

Chylous Ascites↗
PubMed2006

Endoscopic transpapillary nasopancreatic drainage alone to treat pancreatic ascites and pleural effusion.

BACKGROUND: Pancreatic ascites and pleural effusion are uncommon sequelae of pancreatitis and are associated with significant morbidity and mortality. Endoscopic decompression of the pancreatic duct through transpapillary stent or nasopancreatic drain (NPD) has shown encouraging results but the experience is limited. The aim of the present study was to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage in patients with pancreatic ascites and pleural effusion. METHODS: Over a period of 9 years, 10 patients (eight male) with pancreatic ascites and/or pleural effusion with pancreatic duct disruption documented on pancreatogram were studied. After informed consent, endoscopic transpapillary NPD was placed. The end-points were resolution of ascites and/or pleural effusion or need for surgery. RESULTS: Of 10 patients (age range: 13 months-46 years), four patients had only ascites, four had only pleural effusion and two had both ascites and pleural effusion. Ascites and/or pleural effusion resolved in all the patients within 4 weeks of placement of NPD. The healing of ductal disruption was demonstrated by nasopancreatogram as early as 2 weeks and NPD could be removed without necessitating another endoscopy. No major complications related to NPD placement were noted. There was no recurrence of pancreatic ascites and/or pleural effusion at a mean follow up of 39 months. CONCLUSIONS: Pancreatic ascites and pleural effusion can be effectively treated by endoscopic retrograde pancreatography and transpapillary NPD placement.

Adolescent↗
PubMed1982

Effect of immunomodulating factors present in ascitic fluids and sera from cancer patients on the responses of cultured mononuclear cells from normal subjects.

Ascitic fluids and sera from patients with malignant tumors were tested for their ability to modulate the mitogen-induced blastogenic responses of normal subjects' peripheral blood mononuclear cells in vitro. The addition of either ascitic fluid or serum to cultures of normal blood cells greatly enhanced the blastogenic response of cells to phytohemagglutinin P, and markedly depressed the responses to concanavalin A and succinyl-concanavalin A. The blastogenic response of the cells to pokeweed mitogen was unaffected by the addition of serum and depressed by the addition of ascitic fluid. Autologous normal serum also enhanced the response to phytohemagglutinin P but had no effect on the response to the other mitogens. These activities were concentration-dependent and heat-stable (56 degrees C, 60 min) and could be detected even if the ascitic fluid or serum was added as late as the second day of culture. Cells that had been preincubated with serum or ascitic fluid and washed well before culturing with the mitogens responded in the same manner as cells cultured in the presence of serum or ascitic fluid. The mitogen-induced blastogenic responses of mononuclear cells were not affected by the addition of autologous cells that had been preincubated with either serum or ascitic fluid, washed, and treated with mitomycin C. Indomethacin (2 X 10(-7)M) did not prevent the ascitic fluid-mediated depression of blastogenic responses of normal cells. The ascitic fluid and serum of these cancer patients appeared to contain a specific immunoinhibiting substance which exerted its effects by a direct action on the responding mononuclear cells and not by the induction of suppressor cells.

Adult↗
PubMedDate not supplied

Treatment of ascites: old and new remedies.

Ascites is a common complication of chronic liver disease. Treatment of the underlying liver disease with modalities such as abstinence from alcohol in Laennec's cirrhosis, phlebotomy in hemochromatosis, copper removal in Wilson's disease, and steroids in autoimmune liver disease, can improve survival in many patients. In addition, therapy of ascites alleviates the symptoms and improves the quality of life of the patients, and probably decreases the incidence of life-threatening conditions including spontaneous bacterial peritonitis and hepatorenal syndrome. The mean survival rate at 2 years is approximately 50%. Precipitating factors such as gastrointestinal bleeding, nonsteroidal anti-inflammatory drugs and infections, should be identified, since most of them can be corrected. Most cirrhotics with ascites can be managed with a 'step-by-step' approach, including dietary salt restrictions, aldosterone antagonists, and loop diuretics. When tense or refractory ascites is present, large-volume paracentesis is safe and effective. Peritoneovenous shunting (i.e. Denver, LeVeen) is less frequently used because of perioperative morbidity and mortality, and thrombotic complications with occlusion of the stent. Reinfusion of concentrated ascites is of potential benefit and has been used in Europe. Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative procedure performed by interventional radiologists that allows decompression of portal hypertension. In many cases, ascites is improved after TIPS, but long-term randomized trials for tense or refractory ascites comparing TIPS with standard therapy are not conclusive. Liver transplantation is the ultimate step for the treatment of ascites, providing the cure for the underlying liver disease as well. Transplantation is indicated when quality of life of the patient is impaired due to recurrent episodes of ascites, or in the presence of spontaneous bacterial peritonitis and hepatorenal syndrome.

Ascites↗
PubMed1996

Human chorionic gonadotropin-beta in the differentiation of malignancy-related and nonmalignant ascites.

The clinical value of the tumor marker human chorionic gonadotropin-beta (hCG-beta) in ascitic fluid for the differentiation of malignancy-related and non-malignant ascites was evaluated. Ascitic fluid protein, cholesterol and cytological examination were determined for comparison. Thirty-six patients with malignancy-related ascites (27 peritoneal carcinomatosis, 9 miscellaneous malignant causes without peritoneal carcinomatosis) and 69 patients with nonmalignant ascites (55 with liver cirrhosis, 14 with miscellaneous nonmalignant causes) were investigated. hCG-beta concentrations were elevated in malignant samples and with a cut-off value of 10 mIU/ml hCG-beta yielded a sensitivity of 61%, specificity of 94% and efficiency of 83%. Ascitic fluid protein (cut-off value 3.0 g/100 ml) and cholesterol (cut-off value 45 mg/100 ml) concentrations showed a sensitivity of 64%/83%, specificity of 77%/81% and efficiency of 72%/82%. The combination of hCG-beta and cytological examination yielded 89.5% differential diagnostic efficiency, superior to the combinations of protein and cytology or protein and hCG-beta. hCG-beta tended to be superior to protein/cholesterol determination regarding sensitivity (44% vs. 11%/33%) and specificity (79% vs. 50%/57%) in the subgroups of patients with miscellaneous causes of ascites. In conclusion, hCG-beta is frequently elevated in malignancy-related ascites and seems to be as useful a parameter as total protein for the differentiation of malignancy-related from nonmalignant ascites.

Ascites↗
PubMedDate not supplied

The value of adenosine deaminase (ADA) determination in the diagnosis of tuberculous ascites.

In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied. Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1-tuberculous ascites (n = 8); G2-malignant ascites (n = 13); G3-spontaneous bacterial peritonitis (n = 6); G4-pancreatic ascites (n = 2); G5-miscelaneous ascites (n = 15). ADA concentration were significantly higher in G1 (133.50 +/- 24.74 U/l) compared to the other groups (G2 = 41.85 +/- 52.07 U/l; G3 = 10.63 +/- 5.87 U/l; G4 = 18.00 +/- 7.07 U/l; G5 = 11.23 +/- 7.66 U/l). At a cut-off value of > 31 U/l, the sensitivity, specificity and positive and negative predictive values were 100%, 92%, 72% and 100%, respectively. ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma. We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites. Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis.

Adenosine Deaminase↗
PubMed1984

Clinical studies of resistant ascites in liver cirrhosis.

Resistant ascites was studied in 34 patients with liver cirrhosis and ascites. The patients were initially divided into 3 groups on the basis of the weekly cumulative ascites retention curve: patients relieved of ascites within 3 weeks of admission, patients relieved between 4 and 12 weeks and patients with ascites persisting beyond 13 weeks. "Resistant ascites" was defined as "ascites persisting for more than 13 weeks after admission to the hospital". The patients were then reclassified into 3 groups : Group A being those patients relieved of ascites within 12 weeks, Group B being those with resistant ascites and group C being those who died within 12 weeks of admission. There were no differences in age and sex distribution, etiology of liver cirrhosis, past medical history or physical findings among the 3 groups. However, Group B had higher levels of serum creatinine and blood urea nitrogen than Group A on admission. Serum bilirubin was higher and serum albumin was lower in Group C than in Group B, which indicates that Group C had greater liver cell failure.

Adult↗
PubMed2001

Serum and ascites fluid cytokine levels in patients with chronic heart failure.

OBJECTIVE: Cytokines that are capable of modulating cardiovascular function were reported to be elevated in patients with advanced heart failure. We evaluated the diagnostic importance of cytokines both in the serum and ascites. MATERIAL AND METHODS: We determined serum and ascites fluid TNF-alpha, IL-1beta, IL-6, IL-8, and soluble IL-2 receptor levels in 14 patients with congestive heart failure (group 1) and in 15 patients with chronic liver disease (group 2). RESULTS: Ascites fluid IL-8 and soluble IL-2 receptor levels were found to be significantly elevated in group 1 when compared with group 2 (p = 0.014 and p = 0.005). There were no statistical differences in serum TNF-alpha, IL-1beta, IL-6, IL-8, and soluble IL-2 receptor levels and ascites fluid TNF-alpha, IL-1beta, and IL-6 levels. Ascites fluid/serum IL-1beta and IL-8 ratio was lower in group 1 when compared with group 2 (p = 0.001 and p = 0.005). Ascites fluid/serum IL-2 and IL-6 ratio was higher in group 1 when compared with group 2 (p = 0.035 and p = 0.025). CONCLUSION: Cytokine levels in ascites fluid, but not in serum, are important in congestive heart failure. Ascites fluid/serum cytokine level ratios were detected to be more conclusive and valid in the diagnosis work-up of ascites aetiology.

Aged↗