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PubMed1993

Glutamine and glutamate in ascitic fluid of dogs.

The amino acid pattern in the ascites of 79 dogs was examined. The concentration of glutamine in neoplastic ascites is significantly lower than in cardial effusions. In contrast, glutamate is significantly higher in neoplastic ascites than in cardial ascites. Using an arbitrary discrimination value of 0.28 for the glutamate/glutamine ratio, purulent or cardial ascites are easily differentiated, with a sensitivity of 100% and a specificity of 94%. The differentiation is very distinct, with no overlap between the group of patients with liver cirrhosis on the one hand and the groups of patients with purulent peritonitis, heart failure, or malignant ascites on the other hand. There was no diagnostically unsable correlation between the concentrations of the other 20 amino acids and the underlying causes of ascites formation.

Amino Acids↗
PubMed2001

[Spontaneous ascitic infection in cirrhotic Africans. Descriptive study apropos of 12 cases].

BACKGROUND: Spontaneous ascitic infection (SAI) is a frequent and serious complication of cirrhosis. OBJECTIVE: In a retrospective study, the authors report clinical and biological data associated with SAI for cirrhotic patients in an African medical centre. METHODS: Twenty-two cirrhotic patients with ascites were included in a one-year study (November 1996 to October 1997). Clinical and biological data were obtained through medical files. FINDINGS: The mean age of the 22 cirrhotic patients with ascites (12 men, 10 women) was 48.9 years. Twelve cases of SAI were found. In a univariate analysis, the more frequent data in patients with SAI when compared to patients without SAI were: fever or hypothermia (91.7% versus 10%, p = 0.002), abdominal pain (83.3% versus 40%, p = 0.046), cloudy ascitic fluid (66.7% versus 10%, p = 0.003), medium albuminemia (18.2 g/l versus 23 g/l, p = 0.02), medium prothrombin rate (42.8% versus 58.3%; p = 0.04) and ascitic fluid protein level < or = 10 g/l (91.7% versus 30%, p = 0.01). The protein level in ascitic fluid cirrhotic patients was significantly lower in SAI than in patients without SAI (7.6 g/l versus 11 g/l; p = 0.005). In a multivariate analysis, protein levels in ascitic fluid were the only factor associated with SAI (p = 0.024).

Abdominal Pain↗
PubMed1975

[Massive ascites in pancreatitis. Review apropos of 10 personal cases].

Massive ascites is are complication, but not exceptional, in pancreatitis. In a series of ten personal cases and a review of one hundred cases in the world literature, the authors attempt to define the main pathological and clinical characteristics of this disease and the best treatment. Ascites may follow abdominal trauma, involving the pancreas, sometimes it occurs during known chronic pancreatitis, often it is the first sign of pancreatic disease, whether acute or chronic. High levels of pancreatic enzymes in the ascitic fluid are the main factor in diagnosis of pancreatic ascites. The mechanism of formation of the ascites is loss of pancreatic fluid into the peritoneal cavity owing to a breach in the pancreas, the presence of enzyme-rich fluid, causing secondarily "chemical" peritonitis. Paracentesis abdominis or drainage of the fluid during exploratory laparotomy, permits one to obtain in certain cases, a cure of the ascites, but surgical drainage by an anastomosis between the pancreatic cyst and the digestive tract (pancreatico-digestive anastomosis), has the advantage of ensuring treatment of the ascites and of the responsible pancreatic disease.

Adult↗
PubMed1990

Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites.

Adenosine deaminase was estimated in ascitic fluids of 49 patients with ascites (19 tuberculous, 20 cirrhotic, and 10 malignant). The adenosine deaminase concentration in tuberculous ascitic fluid was 98.8 +/- 20.1 U/L (mean +/- SD), which was significantly more than that noted in cirrhotic (14 +/- 10.6 U/L) or malignant (14.6 +/- 6.7 U/L) ascitic fluids (p less than 0.001 for each). At a cut-off value of greater than 33 U/L, the sensitivity, specificity, positive and negative predictive value, and the overall diagnostic accuracy for diagnosing tuberculous ascites were 100%, 96.6%, 95%, 100%, and 98%, respectively. We conclude that estimation of adenosine deaminase in ascitic fluid is an easy and reliable method for diagnosing tuberculous ascites.

Adenosine Deaminase↗
PubMed1989

[Tumor markers and immunomodulator substances in ascites--their value as screening and diagnosis parameters].

The object of this study was to determine the known laboratory parameters, tumor markers and immunomodulatory substances in 69 ascites of various etiology, and to test their diagnostic significance. The usual parameters such as protein content, LDH ratio, albumin quotient and albumin gradient, fibronectin, cholesterol and cell count did not reliably differentiate the etiology in each particular case, although the mean values of the various groups differed significantly. Even cytological investigation was negative in 6 out of 29 malignant ascites. Neither were the immunomodulatory substances such as neopterin, beta 2-microglobulin and interleukin-2 receptors suitable for differentiation. In patients with carcinoma of the prostate the values of prostate-specific antigen were significantly increased in ascites. The best separation between benign hepatic or cardiac ascites and malignant ascites was provided by ferritin (sensitivity 97%, specificity 100%). The values in benign hepatic or cardiac ascites were lower than 150 ng/ml and those in malignant ascites higher than 170 ng/ml.

Adjuvants, Immunologic↗
PubMed1988

Serum-ascites albumin difference in tuberculous peritonitis.

Recent studies have shown that the serum-ascites albumin difference provides better diagnostic discrimination than the ascites total protein concentration in the separation of "transudative" (portal hypertension) ascites and "exudative" (non-portal hypertension) ascites. Published studies to date have reported the serum-ascites albumin difference in only two patients with tuberculous ascites. We looked at the serum-ascites albumin difference in our series of patients with tuberculous peritonitis. All had a low difference (less than 1.1), similar to patients with malignancy.

Adult↗
PubMed1975

Pepstatin, an inhibitor of leukokinin formation and ascitic fluid accumulation.

Ascites fluid accumulation accompanying a mastocytoma or L1210 murine tumor is significantly retarded following the i.p. or s.c. injection of moderate quantities of pepstatin, a known acid protease inhibitor. No effect on cell count was noted by pepstatin treatment. The probable mechanism by which pepstatin acts is by inhigiting the enzymatic formation of chemical mediators known as leukokinins. These are pharmoacologically active peptiedes having potent permeability characteristics previously described by this laboratory. Leukokinins are formed by cathepsin D-like enzymes present in the invading cells and in the ascites fluid acting on a protein substrate, leukokininogen. present in the ascites fluid. Pestatin inhibits the action of these leukokinin-forming enzymes invitro but has no effect on kallikreins (bradykinin-forming enzymes) in vitro. Human ascites fluid from a patient with ovarian carcioma was found to have a paepstatin-inhibited, leukokinin-generating system, as does the mouse. A 'chemical mediator' theory is proposed for ascites fromation which broadens the previously held theory of lymphatic blockage (Holm-Nielsen) and may explain the recent findings of Hirabayashi and Graham of increased plasma-ascites exchange in peritoneal carcionmatosis. Pepstatin inhibition of chemical mediator formation may represent a new therapeutic approach to ascites fluid accumulation in neoplastic disease.

Animals↗
PubMed1984

Intraabdominal pressure and ascitic fluid volume in decompensated liver cirrhosis.

Tense ascites is a widely used clinical concept lacking a quantitative correlate. In 13 patients with tense cirrhotic ascites we measured total intraabdominal pressure (IAP), hydrostatic pressure (HP), and tension. HP was defined as the level of ascitic fluid determined by percussion of the abdominal wall, and tension was the fluid level in the manometer above the HP. The total IAP is the sum of HP and tension. At a later, second measurement 11 patients significantly decreased their IAP. As expected in early stages of ascites resolution, major changes were found to be due to the reduction of the tension component, which accounted for 68% of the decrease in IAP. The HP seemed to show a definite decline only at a late stage of resolving ascites. Five patients, two with an essentially unchanged IAP and three with declining IAP, increased their ascitic fluid volume at the second study. The most probable explanation of this phenomenon is in the transfer of fluid from the edematous splanchnic organs into the peritoneal cavity in the early phase of ascites mobilization.

Abdominal Muscles↗
PubMed1984

Spontaneous chylous ascites of cirrhosis.

The spontaneous development of chylous ascites in patients with cirrhosis is documented, but its clinical features are not well defined. The incidence of this complication of chronic liver disease was 0.5% in ascitic patients in our liver unit. These patients were older than a control group with nonchylous cirrhotic ascites and, despite better liver tests, appeared to have a higher diuretic requirement. Several had disabling, recurrent spontaneous encephalopathy. The mechanism of chylous ascites in cirrhosis is probably portal hypertension causing lymphatic rupture; however, the fact that serum-to-ascites albumin gradients were similar in the two groups, indicating similar degrees of portal hypertension, suggests that other factors also play a role. Spontaneous transformation of previously clear ascites appeared to be associated with a poor prognosis. In contrast, the appearance of chylous ascites de novo in a cirrhotic patient appeared to have a more favorable outcome. Conservative management is recommended for most patients, as the degree of their liver disease appears to be the most important factor determining prognosis.

Adult↗
PubMed1978

Distinguishing between malignant and cirrhotic ascites by computerized step-wise discriminant functional analysis of its biochemistry.

This study was designed to evaluate the ability of a specifically programmed computer to select those biochemical substances most capable of distinguishing "cirrhotic ascites" from "malignant ascites". After simultaneously performing selected biochemical and electrophoretic studies on fresh unstored serum and ascites of 23 patients with documented cirrhosis and 18 patients with proven malignancies, computerized step-wise discriminant analysis of the multiple input revealed that the serum-to-ascites LDH ratio was able to distinguish "cirrhotic ascites" from "malignant ascites" with greater than 86% accuracy. Assignment to proper groups was increased to 89% with the addition of the ratio to serum total protein-to-ascites total protein. The predictive value of a positive result was 100%; specificity was 100%; the predictive value of a negative result was 85%. This type of computer analysis also permits incorporation of both additional cases and new substances thus increasing predictability and reducing type II statistical errors.

Albumins↗
PubMed1995

[Pancreatic ascites].

Two cases of pancreatic ascites have been presented. 1. A 29 year old man, heavy alcoholic, with fast growing ascites presented since long biochemic features of pancreatitis. The diagnosis of the pancreatic origin of ascites was made on the ground of the high level of amylase in the ascitic fluid. Conservative treatment was effectless. The patients refused surgical therapy. Then he died in septic shock. Autopsy confirmed the pancreatic origin of ascites. 2. A 43 year old man heavy alcoholic as well admitted because of fast growing ascites. As in the first case examination of the fluid confirmed the diagnosis of pancreatic origin of ascites. Again a high level of amylase and protein was found. After clinical treatment and parenteral nutrition the condition of the patient improved and he was dismissed 4 weeks later.

Adult↗
PubMed1997

Management of ascites. A review.

Serum-ascites fluid albumin concentration gradient, ascites fluid polymorphonuclear cell count and ascites fluid cytology afford immediate diagnosis of the etiology of ascites. When cirrhotic patients with marked ascites do not respond to diuretics, abdominal paracentesis is the next step, if the ascites is severe enough to justify the risk. When all else fails over a period of several months, a peritoneovenous shunt may be appropriate. We have many options in the management of ascites now, but, in the future, the optimal therapy will include potent and nontoxic diuretic drugs and high-volume paracentesis.

Albumins↗
PubMed2000

Clinical significance of serum and ascitic p53 autoantibodies in epithelial ovarian carcinoma.

BACKGROUND: Accumulation of mutated p53 in malignant cells can lead to the generation of anti-p53 autoantibodies in the serum and other body fluids of cancer patients. This retrospective study was performed to evaluate the prognostic significance of preoperative serum and ascitic anti-p53 antibodies in advanced ovarian carcinoma. METHODS: In 113 ovarian carcinoma patients who presented with significant amounts of ascites, anti-p53 autoantibodies were determined by a highly specific enzyme-linked immunosorbent assay of blood and ascites. Disease free and overall survival of study patients was estimated by the product limit method of Kaplan and Meier. Differences in survival were examined according to criteria of Mantel and Breslow. A multiple regression analysis based on the Cox proportional hazards model was used to determine the independence of prognostic variables. RESULTS: Serum and ascitic anti-p53 antibodies were found in 28 (25%) and 21 (19%) of the study patients, respectively. In univariate analysis, detection of anti-p53 antibodies in ascites but not in serum was found to be a sign of unfavorable disease free survival (P<0.003) and overall survival (P < 0.01). Multivariate analysis revealed that anti-p53 positivity in ascites retained independent significance only in the prediction of adverse progression free survival (P<0.01). CONCLUSIONS: The generation of a humoral immune response against p53 protein in the close tumor environment, as demonstrated by the occurrence of p53 autoantibodies in the ascitic fluid of ovarian carcinoma patients, is associated with poor disease free survival.

Adult↗
PubMed1997

Differences in the recognition of tumor-specific CD8+ T cells derived from solid tumor, metastatic lymph nodes and ascites in patients with gastric cancer.

We established gastric cancer-specific CD8+ T-cell (T(CD8+)) lines derived from different lymphocyte sources in the same patients by repeated stimulation with mitomycin-C-treated autologous tumor cells with low-dose interleukin-2, and we compared recognition patterns among the T(CD8+) derived from solid tumor, lymph node metastasis and ascites in the same patient (n = 3) to determine their similarities and differences for therapeutic purposes. We confirmed that gastric cancer-specific T(CD8+) lines can be isolated, in a MHC class I-restricted manner, from solid tumors, metastatic lymph nodes and malignant ascites. T(CD8+) lines derived from tumor-infiltrating lymphocytes (TIL) in solid tumor recognized autologous tumor cells derived from solid tumor, but not autologous tumor cells derived from ascites or metastatic lymph node, while T(CD8+) lines derived from tumor-associated lymphocytes (TAL) in malignant ascites recognized autologous tumor cells derived from ascites, but not tumor cells from solid tumor or metastatic lymph node. Furthermore, T(CD8+) lines derived from regional lymph node lymphocytes (RLNL) recognized autologous tumor cells derived from metastatic lymph nodes, but not tumor cells derived from ascites. No significant differences were seen in MHC class I expression among the tumors derived from solid tumor, lymph node metastasis or ascites in the same patient. This suggests that there are differences of recognition patterns among the TILs, TALs and RLNLs in the same patient and that it is important to consider the source of lymphocytes, e.g., a combination of TILs, TALs and RLNLs, for adoptive immunotherapy in gastric cancer patients.

Aged↗
PubMed1986

Diagnostic accuracy of fibronectin in the differential diagnosis of ascites.

To evaluate the diagnostic accuracy of fibronectin levels in ascites to differentiate malignant from non-malignant ascites, the authors studied 30 patients with sterile uncomplicated ascites in chronic liver disease, 18 patients with malignant ascites and four patients with spontaneous bacterial peritonitis. Fibronectin concentration was significantly higher in malignant ascites than in sterile ascites (P less than 0.001). High values (greater than 85 mg/l) were found in four of six cases of hepatocellular carcinoma in liver cirrhosis with negative cytologic examination, and in six of seven peritoneal carcinomatoses. Low values (less than 85 mg/l) were found in four patients with liver metastases and in one patient with intrahepatic biliary duct carcinoma in cirrhosis. In four patients with infected ascites, the fibronectin level was low. Among all other parameters (total protein concentration, lactate dehydrogenase, gamma-glutamyl-transpeptidase, pH, amylase, triglycerides, leukocyte count, and cytologic examination), fibronectin yielded the best degree of discrimination (diagnostic accuracy, 79%).

Adult↗
PubMed2004

TIPS versus paracentesis for cirrhotic patients with refractory ascites.

BACKGROUND: Ten per cent of cirrhotic patients develop refractory ascites, which carries substantial morbidity and has a one-year survival of less than 50 per cent. Patients with refractory ascites may benefit from transjugular intrahepatic portosystemic stent-shunts (TIPS). OBJECTIVES: To compare TIPS versus paracentesis standard treatment in patients with refractory ascites due to cirrhosis with regard to overall short- and long-term mortality, treatment efficacy, and complications. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (July 2003), The Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 1, 2003), MEDLINE (1966 to July 2003), EMBASE (1980 to July 2003), and CINAHL (1982 to July 2003). We supplemented the searches with reading through scientific citations, review of citations in relevant primary articles, and hand-searched abstracts from national meetings. SELECTION CRITERIA: We included randomised clinical trials comparing TIPS and paracentesis with or without volume expanders for cirrhotic patients with refractory ascites. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of the randomised clinical trials by the generation of the allocation section, allocation concealment, and follow-up. Two independent observers extracted data from each trial. We contacted trial authors for additional information. Dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI). MAIN RESULTS: Four randomised clinical trials, including 264 patients, met the inclusion criteria. Methodological quality was moderate. Thirty-day mortality (OR 1.00, 95% CI 0.10 to 10.06, P = 1.0) and 24-month mortality (OR 1.17, 95% CI 0.52 to 2.66, P = 0.70) did not differ significantly between TIPS and paracentesis treatment. TIPS significantly reduced ascites re-accumulation at three months (OR 0.07, 95% CI 0.03 to 0.18, P < 0.00001) and at 12 months follow-up (OR 0.14, 95% CI 0.06 to 0.28, P < 0.00001). Hepatic encephalopathy occurred significantly more often in the TIPS group (OR 2.11, 95% CI 1.22 to 3.66, P = 0.008). Gastrointestinal bleeding (OR 0.82, 95% CI 0.36 to 1.84, P = 0.63), acute renal failure (OR 0.64, 95% CI 0.15 to 2.72, P = 0.55), septicemia/infection (OR 1.05, 95% CI 0.22 to 4.94, P = 0.96), and disseminated intravascular coagulation (OR 0.82, 95% CI 0.26 to 1.84, P = 0.63) did not differ significantly between groups. REVIEWERS' CONCLUSIONS: TIPS removed ascites more effectively than paracentesis. After 12 months, the beneficial effects of TIPS on ascites was still present. Mortality, gastrointestinal bleeding, septicemia/infection, acute renal failure, and disseminated intravascular coagulation did not differ significantly between the two groups. Hepatic encephalopathy occurred significantly more often in the TIPS group.

Ascites↗
PubMed2006

TIPS versus paracentesis for cirrhotic patients with refractory ascites.

BACKGROUND: Refractory ascites (ie, ascites that cannot be mobilized despite sodium restriction and diuretic treatment) occurs in 10 per cent of patients with cirrhosis. It is associated with substantial morbidity and mortality with a one-year survival rate of less than 50 per cent. Few therapeutic options currently exist for the management of refractory ascites. OBJECTIVES: To compare transjugular intrahepatic portosystemic stent-shunts (TIPS) versus paracentesis for the treatment of refractory ascites in patients with cirrhosis. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (January 2006), the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2005), MEDLINE (1950 to January 2006), EMBASE (1980 to January 2006), CINAHL (1982 to August 2004), and Science Citation Index Expanded (1945 to January 2006). SELECTION CRITERIA: We included randomised clinical trials comparing TIPS and paracentesis with or without volume expanders for cirrhotic patients with refractory ascites. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of the randomised clinical trials by the generation of the allocation section, allocation concealment, and follow-up. Two authors independently extracted data from each trial. We contacted trial authors for additional information. Dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI). MAIN RESULTS: Five randomised clinical trials, including 330 patients, met the inclusion criteria. The majority of trials had adequate allocation concealment, but only one employed blinded outcome assessment. Mortality at 30-days (OR 1.00, 95% CI 0.10 to 10.06, P = 1.0) and 24-months (OR 1.29, 95% CI 0.65 to 2.56, P = 0.5) did not differ significantly between TIPS and paracentesis. Transjugular intrahepatic portosystemic stent-shunts significantly reduced the re-accumulation of ascites at 3-months (OR 0.07, 95% CI 0.03 to 0.18, P < 0.01) and 12-months (OR 0.14, 95% CI 0.06 to 0.28, P < 0.01). Hepatic encephalopathy occurred significantly more often in the TIPS group (OR 2.24, 95% CI 1.39 to 3.6, P < 0.01), but gastrointestinal bleeding, infection, and acute renal failure did not differ significantly between the two groups. AUTHORS' CONCLUSIONS: The meta-analysis supports that TIPS was more effective at removing ascites as compared with paracentesis without a significant difference in mortality, gastrointestinal bleeding, infection, and acute renal failure. However, TIPS patients develop hepatic encephalopathy significantly more often.

Ascites↗
PubMedDate not supplied

Opsonic activity of ascitic fluids by a chemiluminescent method.

Cirrhotic ascites are highly susceptible to spontaneous bacterial infection, whereas carcinogenic ascites are seldom infected. This difference may be explained by differences in their chemotactic, bactericidal and/or opsomic activities. We measured the chemotactic and opsonic activity of ascitic fluids from 35 alcoholic cirrhotic ascites and of 12 peritoneal carcinogenic ascites. Chemotactic activity was measured by the under-agarose technique and opsonic activity by a luminol-enhanced method. Ascitic fluids from alcoholic cirrhosis had low chemotactic (62 +/- 24.5% that of N-formylated peptide) and opsonic (67 +/- 50% of normal serum) activities on normal human neutrophils. In contrast, ascitic fluids from peritoneal carcinoma were found to possess high opsonic activity (114 +/- 49% of normal serum) and chemotactic activity similar to that of N-formylated peptide. During a 3-month follow-up, 11 spontaneous bacterial infections were observed among the first group against none in the carcinogenic group.

Ascites↗