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At least 919 records · Page 51Linked to original sources
PubMed1997

Role of fibronectin in diagnosis of malignant ascites.

The aim of the study was to evaluate the role of ascitic fluid fibronectin in the diagnosis of malignant ascites. Fibronectin is a glycoprotein which plays an important role in regulating the organisation of the cell cytoskeleton and cell morphology. Ascitic fluid samples from 35 patients, 20 with portal hypertension (Group-I) and 15 with malignant ascites (Group-II) were analysed for proteins, cell counts, fibronectin levels and malignant cell cytology. Mean ascitic fluid fibronectin level was found to be significantly higher in malignant ascites as compared to portal hypertension (p < 0.001). At a cut off value of 94.67 microg/ml, the sensitivity, specificity, positive accuracy, negative accuracy and overall diagnostic accuracy was found to be 100%, 95%, 93.8%, 100% and 97.1% respectively.

Adult↗
PubMed1992

Diagnostic evaluation of ascitic adenosine deaminase activity in tubercular peritonitis.

Activity of adenosine deaminase (ADA) in serum and peritoneal fluid was studied prospectively in 24 aetiologically proved cases of ascites and 10 age-matched controls. Patients were divided into 3 groups according to causes of ascites, viz. malignant ascites (11), tubercular peritonitis (7) and cirrhosis of liver (6). Serum ADA values and peritoneal: serum ADA ratio did not show any consistent pattern in any group. But in patients with tubercular peritonitis ADA activity in ascitic fluid was significantly higher (P < .001) than in the other groups. An ascitic ADA level of 30 units/L had a sensitivity of 100% and specificity of 94.1% for tubercular peritonitis. These findings suggest that the ascitic fluid ADA activity is useful for the diagnosis of tubercular peritonitis; this method is simple and least invasive.

Adenosine Deaminase↗
PubMedDate not supplied

Usefulness of ascites/serum lactic dehydrogenase activity ratio in the initial approach to ascites.

To investigate the usefulness of ascitic fluid protein and lactic dehydrogenase activity separating uncomplicated portal hypertension related ascites (PHRA) from non PHRA and complicated PHRA, 58 patients with full diagnosis of the cause of ascites were prospectively studied. Ascitic fluid protein led to misclassify 30% of non PHRA and complicated PHRA, and 13% uncomplicated PHRA. Ascites/serum protein ratio did not improve the diagnostic efficacy of ascites protein concentration alone. Lactic dehydrogenase activity classified properly all uncomplicated PHRA but only 64% of non PHRA and complicated PHRA. All PHRA without complications and 92% of non PHRA and PHRA with complications were correctly allocated by ascites/serum dehydrogenase activity ratio. This criteria had higher sensitivity and efficiency than total protein concentration (p < 0.05). Our data suggest that ascites/serum lactic dehydrogenase ratio may offer advantages over ascites total protein concentration discriminating uncomplicated PHRA from non PHRA and PHRA with complications in the initial approach to a peritoneal effusion.

Ascites↗
PubMed1989

[Biochemical markers of the tumor origin of ascites].

In order to determine the best biochemical tests to detect cancer as the cause of ascites formation, ascitic fluid level of fibronectin, cholesterol, phospholipids and triglycerides were compared for 73 patients. The median values and the cut-off concentrations of these parameters were determined on 53 ascitic fluids without malignant cytology and 20 ascitic fluids characterized by a malignant cytology. The results showed that ascitic fluid fibronectin and cholesterol levels had a higher discriminating value than phospholipids and triglycerides to separate ascites caused by neoplasms. Cholesterol and fibronectin gave the same sensitivity and negative predictive value but cholesterol showed the highest specificity and positive predictive value.

Adult↗
PubMed1988

Ascites and the anatomy of the peritoneal sacs of broilers.

Although the ascites syndrome of broilers is well documented, all the authors fail to describe exactly in which of the various coelomic cavities ascitic fluid is found. Determination of the precise location of this fluid is essential if the pathogenesis of the syndrome is to be understood and explained. Post-mortem examinations were done on 100 broilers that had ascites or had died of the ascites syndrome. In all of them large quantities of fluid were found in the ventral hepatic peritoneal cavities, moderate amounts in the right dorsal hepatic peritoneal cavities and small amounts in the intestinal peritoneal and pericardial cavities. No ascitic fluid was found in the left dorsal hepatic peritoneal cavity. The amount of ascitic fluid effusing from the liver was directly proportional to the surface area of the liver in a given peritoneal cavity.

Animals↗
PubMed1986

Antibody-guided irradiation of malignant ascites in ovarian cancer: a new therapeutic method possessing specificity against cancer cells.

Immunocytology of ascitic fluid of a patient with ovarian cancer demonstrated reactivity with two tumor-associated monoclonal antibodies, AUA1 and HMFG2. AUA1 radiolabeled with 48.6 mCi 131I was given intraperitoneally. There was a reduction in the rate of reaccumulation of ascites. Cytology of recurrent ascites revealed reactivity with antibody HMFG2 but not AUA1. The patient was further treated intraperitoneally with 39.0 mCi 131I-labeled HMFG2. There has been no reaccumulation of ascites. It is concluded that antibody-guided irradiation may be an effective treatment of malignant ascites secondary to ovarian cancer. Furthermore, this case illustrates the specificity of antibody interactions in the mediation of therapeutic effect and the possibility of tumor selection after irradiation with a single monoclonal antibody. If specificity plays a role, all major specificities should be covered by an appropriate panel of radioactively labeled antibodies. It is recommended that for comprehensive therapy of malignant ascites secondary to ovarian cancer, a mixture of antibodies such as HMFG2 and AUA1 should be used.

Adenocarcinoma↗
PubMed1982

Does spontaneous bacterial peritonitis occur in malignant ascites?

Spontaneous bacterial peritonitis is a well-described entity estimated to occur in 8% of patients with cirrhotic ascites. Characteristic clinical findings may often be absent and the only manifestation may be decompensation of liver function. Ascites at Memorial Hospital is most commonly related to malignancy. We reviewed the records of 101 patients with ascitic fluid cytology positive for malignancy during the calendar year 1979. The most common malignant cytological diagnosis was adenocarcinoma, seen in 76 patients. Of the 101 patients with positive ascitic fluid cytology, 65 fluid specimens had microbiological studies performed which included aerobic, anerobic, fungal, and acid fast bacterial cultures. Only three patients had positive ascitic fluid cultures. We believe that these three patients had other reasons for peritonitis and do not represent true spontaneous bacterial peritonitis. Ascites alone, without liver disease, seem to predispose to spontaneous bacterial peritonitis. Perhaps, the presence of liver disease with less than normally effective hepatic reticuloendothelial function and portasystemic shunting is needed for the development of spontaneous bacterial peritonitis.

Adenocarcinoma↗
PubMed1981

Impaired peritoneal fluid drainage in nephrogenic ascites.

In three chronic hemodialysis patients with nephrogenic ascites and in four patients with ascites of other causes the rate of transfer of fluid from peritoneal cavity to plasma was measured by a radio-labelled albumin method. Ascitic fluid removal rate was lower in the patients with nephrogenic ascites (median 14, range 10 to 21 ml/hr) than in those with normal renal function (median 45, range 10 to 73 ml/hr). These results suggest that lymphatic drainage of the peritoneum is impaired in nephrogenic ascites and that this may contribute to the development of the condition and to the propensity of fluid overloaded dialysis patients to develop ascites. A retained substance or one liberated from abnormal kidneys may be responsible for reversible depression of lymphatic flow in uremia.

Adult↗
PubMed1980

Lymph imbalance in the genesis and perpetuation of the ascites syndrome in hepatic cirrhosis.

Despite extensive study, the pathogenesis of cirrhotic ascites and its relationship to salt and water retention and the hepatorenal syndrome remain unclear. This article reexamines the underlying disturbance in microcirculatory exchange of fluid and protein in the liver and digestive tract and specifically stresses that, in keeping with current interpretation of the Starling hypothesis, ascites appears when the driving force of elevated portal pressure overwhelms the "safety factors" of widened transmural colloid asmotic pressure gradient and accelerated regional lymph flow. In light of recent findings that enhancement of ascitic fluid returned to the bloodstream produces a natriuresis, diuresis, and amelioration of ascites, a "lymph imbalance" theory distinct from the "classic" and "overflow" theories is advanced. This theory proposes that a circulatory imbalance between the rate of fluid leaving and returning to the bloodstream (i.e., the relative rates of lymph formation and lymph absorption) is responsible for a maldistribution of extracellular fluid, which, in turn, stimulates renal salt and water retention, progression of ascites, and finally, the hepatorenal syndrome. Should compensatory factors suffice to prevent or reverse this lymph imbalance, the full cycle is not activated or, if already operating, is deactivated. Thus, portacaval shunt (by reducing the rate of lymph formation) or peritoneovenous shunt (by acting as a megalymphatic collateral to accelerate resorption as well as prevent sequestration of peritoneal fluid), both tend to restore the lymph balance and thereby suppress salt and water retention, correct functional oliguria, and ameliorate ascites.

Acute Kidney Injury↗
PubMed1993

Paracentesis. The importance of optimal ascitic fluid analysis.

An accumulation of peritoneal fluid can result from a variety of conditions, cirrhosis of the liver being responsible for about 75% of all patients with ascites. Malignancy accounts for 10-12% and cardiac failure for about 5%. The remaining 8-10% of ascites cases have a variety of causes, including tuberculosis, pancreatic disease and kidney disease. An early and accurate diagnosis often depends on an appropriate ascitic fluid analysis. Patients with known liver cirrhosis and clinical deterioration also need to have a paracentesis, with a determination of the ascitic fluid leukocyte and neutrophil count and adequate bacteriological cultures of their ascitic fluid. The diagnostic value of different ascitic fluid parameters and their ability to distinguish between several aetiologies and their complications, is discussed.

Ascites↗
PubMed1976

[Treatment of cirrhotic ascites by means of venous concentrated reinjected of the peritoneal fluid].

Thanks to diuretics, adequate diet, and other measures, the treatment of cirrhotic ascites in recent years has brought better results. Nonetheless, a certain number of patients do not respond to the above mentioned treatment. Such patients are afflicted with so called Refractory Ascites on which diuretics have no effect. In recent years the concentrated continuous reinjection methods has been accepted. During a nine month period, we have treated and analyzed thirty patients with severe Hepatic Ascitogenic Cirrhosis. The results have shown: 8 patients with satisfactory improvement with one reinjection, in 2 patients Ascites did not reoccur; 6 patients died; 6 patients failed to return for a control reexamination; in 2 patients, ascites persisted even after repeated reinjections. The patients were given diuretics the third week following the reinjection, and were put on a low salt diet. Ascites reoccurred, and to a greater degree during the second third, and fourth month. A reduced sodium level was corrected by the reinjection and by the administration of NaCl during the reinjection. K and Cl levels did not change significantly. Urea levels, which were elevated in many cases were normalized. Ammoniums and Phenols also tended to normalize following reinjection. Bilirubin values were highly variable especially in two patients. One of whom had a severely damaged liver (direct bilirubin), the other of whom had bleeding varicoses of the esophagus (indirect bilirubin). Both of these patients died. In such cases reinjection should not be performed until the bilirubin values fall below 5 mgr %. Of the six patients who died, four died of unforeseen esophageal hemorrhaging. A larger number of patients grew more tolerant of diuretics. Preparation for a Portocaval Shunt with the reinjection method is of a special advantage because of an overall improvement in condition, making surgery possible. Complications resulting from reinjection were insignificant and transitory. As a whole, our results (sixteen patients in satisfactory condition), showed that Continuous Venous Reinjection of peritoneal fluid, even though a palliative method, represents a significant step forward in the treatment of Ascites in the severely ill.

Adult↗
PubMed1987

Elevation of CA 125 in patients with benign and malignant ascites.

The presence of CA 125, an ovarian cancer-associated antigen, was assessed in serum and ascites from patients with ovarian cancer (n = 47), hepatocellular carcinoma (n = 21), and liver cirrhosis (n = 40). Abnormal levels of serum CA 125 were observed in 49% of ovarian cancer patients, and in 89% of these same patients with ascites. In all cases of cirrhosis or hepatocellular carcinoma with ascites, CA 125 levels were above 35 U/ml. The specificity and sensitivity of CA 125 measurement for detecting ascites in chronic liver diseases were 73% and 100%, respectively. Furthermore, the CA 125 level was always higher in ascites than in serum. The authors conclude that CA 125 is a nonspecific marker of ascites. This result must be considered in the interpretation of CA 125 elevation in patients with ovarian cancer. Moreover, CA 125 may be of value in the diagnosis and monitoring of peritoneal diseases.

Adult↗
PubMed2002

Comparative analysis of CA125, tissue polypeptide specific antigen, and soluble interleukin-2 receptor alpha levels in sera, cyst, and ascitic fluids from patients with ovarian carcinoma.

BACKGROUND: The serum markers CA125, tissue polypeptide specific antigen (TPS), and soluble interleukin-2 receptor alpha (sIL-2Ralpha) concentrations were determined in sera, cyst, and ascitic fluids from patients with malignant and benign ovarian neoplasms. METHODS: CA125, TPS, and sIL-2Ralpha concentrations were measured in sera, cyst, and ascitic fluids by immunoassays in 67 patients with carcinoma and in 32 patients with benign ovarian neoplasms. RESULTS: CA125, TPS, and sIL-2Ralpha levels were elevated significantly in sera from patients who had ovarian carcinoma compared with patients who had benign neoplasms (P < 0.001). Patients who had International Federation of Gynecology and Obstetrics (FIGO) Stage III-IV disease had significantly higher serum levels for the markers studied compared with patients who had FIGO Stage I-II disease (P < 0.001 for CA125; P = 0.02 for TPS and sIL-2Ralpha). Concurrent measurement of CA125 and sIL-2Ralpha in sera identified 100% of ovarian carcinomas in FIGO Stage I-II. All patients with carcinoma demonstrated markedly higher levels of CA125 and TPS for both cyst and ascites compared with corresponding sera (P < 0.001). The level of sIL-2Ralpha was higher statistically in ascitic fluid compared with the level in serum (P < 0.001); however, its values in sera and cyst fluids were comparable. In ascitic fluid, the CA125 level was significantly higher in patients who had FIGO Stage III-IV disease compared with patients who had FIGO Stage I-II disease (P = 0.002), whereas such correlations were not found for TPS or sIL-2Ralpha. In cyst fluids, the levels of all studied markers were independent of the FIGO stage. In cyst fluids from patients with benign ovarian neoplasms, TPS and sIL-2Ralpha levels were significantly lower compared with the levels in patients with ovarian carcinoma (P < 0.001), whereas the values of CA125 were overlapping. CA125 and TPS concentrations were higher in cyst fluids compared with corresponding sera, whereas sIL-2Ralpha levels were comparable and low in cyst fluids and in the circulation of patients with benign neoplasms. CONCLUSIONS: In patients with ovarian carcinoma, TPS and CA125 concentrations were significantly higher in the place of their generation compared with the concentrations in blood circulation. sIL-2Ralpha values were higher in ascites compared with the values in corresponding sera, and its concentrations in sera and cyst fluids were comparable. The assessment of serum sIL-2Ralpha levels showed potential complementary value to CA125 for the detection of ovarian carcinoma in early FIGO stages; however, a 9% false positive rate limited the significance of cumulative value for a combination of these circulating markers.

Ascitic Fluid↗
PubMedDate not supplied

Temporal relationship between hyperaldosteronism, sodium retention and ascites formation in rats with experimental cirrhosis.

To investigate the role of aldosterone in sodium retention and ascites in cirrhosis, the urinary sodium excretion, sodium balance and urinary excretion of aldosterone-18-glucuronide (UAldV) were serially measured in 11 rats undergoing cirrhosis induction with carbon tetrachloride (CT) and phenobarbital (CT rats) and in 10 control rats which received phenobarbital. All CT rats developed ascites, seven within the ninth week after starting the program and four within the 10th week. One week before the onset of ascites, CT rats and control rats were different with respect to sodium excretion (1.41 +/- 0.15 vs. 1.82 +/- 0.1 mEq per day), sodium balance (0.57 +/- 0.12 vs. 0.20 +/- 0.09 mEq per day) and UAldV (67.8 +/- 9.5 vs. 25.7 +/- 1.7 ng per day). These differences were more pronounced within the week in which ascites was detected in CT rats. Before these 2 weeks, both groups did not differ with respect to these parameters. In the 132 urine samples obtained in CT rats, there was a correlation between sodium excretion and UAldV (r = -0.53; p less than 0.001). Twenty-one additional CT rats were divided into two groups. Eleven animals were given spironolactone (20 mg per day s.c. in olive oil) from the 6th week, and 10 only received olive oil. Thirteen weeks after starting the program, all rats not treated with spironolactone had sodium retention and ascites (in five rats, ascites appeared within the ninth week and in five within the tenth week); this occurred in only one animal treated with spironolactone.(ABSTRACT TRUNCATED AT 250 WORDS)

Aldosterone↗
PubMedDate not supplied

Ascitic fluid chemical analysis before, during and after spontaneous bacterial peritonitis.

A retrospective analysis of 22 patients whose ascitic fluid had been analyzed prior to the onset of spontaneous bacterial peritonitis, during infection and/or after treatment of peritonitis revealed that neither the ascitic fluid total protein nor the absolute ascitic fluid glucose changed during the infection or after treatment of the infection although the ascitic fluid/serum glucose ratio did decrease (p less than 0.001) with infection. The ascitic fluid lactate dehydrogenase increased significantly (p less than 0.05) during infection compared to the baseline value. Contrary to the typical findings in infected body fluids, the total protein content and absolute glucose content of "spontaneously" infected ascitic fluid do not measurably change.

Ascitic Fluid↗
PubMedDate not supplied

Diuresis of cirrhotic ascites increases its opsonic activity and may help prevent spontaneous bacterial peritonitis.

Serial ascitic fluid samples were obtained during diuresis in seven patients with portal hypertension-related ascites. The samples were tested for concentrations of total protein, CH100, C3 and C4 as well as for in vitro opsonic activity. These parameters were all found to increase to a statistically significant degree when the initial specimen was compared to the final specimen: total protein = 1.5 vs. 2.7 gm per dl; CH100 = 9.3 vs. 20.2 units per ml; C3 = 13.4 vs. 23.8 mg per dl; C4 = 1.9 vs. 3.6 mg per dl, and opsonic activity = 0.8 vs. 1.9 log kill. This increased opsonic activity resulted in a greater than 10-fold increase in bacterial killing. This study demonstrates that diuresis of patients with cirrhotic ascites increases the concentrations of ascitic fluid complement components and increases the opsonic activity of ascitic fluid and may help protect patients from bacterial infection of their ascites.

Ascitic Fluid↗
PubMed1992

Variability of atrial natriuretic peptide plasma levels in ascitic cirrhotics: pathophysiological and clinical implications.

Ascitic cirrhotic patients are a heterogenous population with respect to factors that may affect plasma human atrial natriuretic peptide levels (such as degree of plasma volume and plasma levels of angiotensin II, vasopressin and norepinephrine). Thus the proven variability of plasma human atrial natriuretic peptide values in ascitic cirrhotic patients may be due also to the selection of patients, not only to the study conditions. The response to standardized stepped-care medical treatment of ascites makes it possible to characterize ascitic cirrhotic patients with different patterns of renal sodium excretion, intrarenal sodium handling, plasma renin activity, plasma aldosterone and thus, probably, effective circulating volume. Consequently, we evaluated human atrial natriuretic peptide plasma levels in controls (n = 23), in ascitic cirrhotic patients who underwent spontaneous diuresis (group A, n = 7) and in cirrhotic patients who required diuretic treatment (group B, n = 44). The last group was then divided into two subgroups. Subgroup B-R (n = 25) included patients who responded to spironolactone alone, whereas subgroup B-NR (n = 19) included patients who did not respond to 500 mg/day spironolactone. All patients were maintained on identical normocaloric restricted sodium intake (80 mEq/day) throughout the study. Ascitic cirrhotic patients, as a whole, had higher values of human atrial natriuretic peptide than did controls (70.8 +/- 46.6 pg/ml vs. 41.7 +/- 16.3 pg/ml, p < 0.025). No difference was found in human atrial natriuretic peptide/plasma renin activity between the two groups (87 +/- 160 pg/ng/hr vs. 44 +/- 73 pg/ng/hr, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2004

Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death.

Despite the adoption of "sickest first" liver transplantation, pretransplant death remains common, and many early deaths occur despite initially low Model for End-stage Liver Disease (MELD) scores. From 1997-2003, we studied 507 cirrhotic United States veterans referred for consideration of liver transplantation to identify additional predictors of early mortality. Most of the patients were male (98%) with cirrhosis caused by hepatitis C and/or alcohol (88%). Data for 296 patients referred prior to February 27, 2002 (training group), were analyzed; findings were validated in 211 patients referred subsequently (validation group). In the training group, 61 patients (21%) died within 180 days without transplantation; their median initial MELD score was 21. MELD score, persistent ascites, and low serum sodium (<135 meq/L) were independent predictors of early mortality. In patients with a MELD score of less than 21, only low serum sodium and persistent ascites were independent predictors of mortality; for MELD scores above 21, only MELD was independently predictive. Prognostic significance of persistent ascites and low serum sodium for low MELD score patients was confirmed in the validation group. Risk varied continuously with worsening hyponatremia. Modifying MELD, by including points for persistent ascites and low serum sodium, improved prediction of early pretransplant mortality in low MELD score patients. In conclusion, persistent ascites and low serum sodium identify patients with cirrhosis with high mortality risk despite low MELD scores. Ascites, hyponatremia, and other findings indicative of hemodynamic decompensation merit further prospective study as prognostic indicators in patients awaiting liver transplantation, and should be considered in setting minimal listing criteria.

Adult↗