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PubMed2003

[A multilevel method of treatment of ascites with liver cirrhosis].

The multilevel method of treatment of ascites includes conservative therapy, interventional radiology, new modifications of surgical interventions on the thoracic lymphatic duct for its external drainage. Conservative therapy proved to be effective in 198 (79.2%) out of 250 patients with ascites. Most of them had demonstrable edematous ascitic syndrome. Guided hypertension with "Angiotensinamid" was used in 6 (2.4%) patients because of low effectiveness of conservative therapy. Regional therapy of liver cirrhosis (second level) was used in 18 patients (7.2%). External drainage of the thoracic lymphatic duct with the dosed lymph abduction and courses of lymphosorption were fulfilled in 37 (14.6%) patients. As a result of the treatment one patient (4.2%) only had ascites remaining at the "demonstratable-tense" level, although at admission to the clinic there were 36 such patients that made up 95%. It can be concluded that the multilevel methods of treatment of ascites give additional ways for the effective control of the edematous ascitic syndrome.

Adult↗
PubMed1992

Polymorphonuclear count in ascitic fluid after laparotomy in cirrhotic patients.

In order to establish whether an ascitic polymorphonuclear count greater than 250/mm3 remains a diagnostic criterion for postoperative bacterial peritonitis, a prospective study of 16 patients with cirrhosis and ascites undergoing hepatectomy (n = 4), portocaval shunt (n = 5) and biliary and digestive surgery (n = 7) was carried out. Sixty-four consecutive specimens of ascitic fluid were obtained through abdominal one-way suction tubes left in situ. In 17 (26%) specimens, ascitic fluid was blood stained and the polymorphonuclear count was unreliable; none of these specimens demonstrated positive ascitic fluid culture. In the remaining 47 specimens the polymorphonuclear count ranged from 5 to 5,920/mm3. Positive ascitic fluid culture was significantly higher in polymorphonuclear > or = 250/mm3 group (5/13: 38%) than in polymorphonuclear < 250/mm3 group (2/34: 6%) (p < 0.02). These results suggest that, as in non-operated cirrhotic patients: (a) polymorphonuclear count should be taken in account in the diagnosis of postoperative bacterial peritonitis; (b) polymorphonuclear count greater than 250/mm3 is a good criterion for the diagnosis of bacterial postoperative peritonitis.

Ascitic Fluid↗
PubMed1992

Fetal ascitic fluid: a new source of lymphocytes for rapid chromosomal analysis.

BACKGROUND: The cells found in ascites can be processed like amniotic fluid for fetal karyotyping. We have characterized these cells and used them for a rapid cytogenetic result. CASES: Three patients presented with massive fetal ascites detected by sonography. Samples of ascitic fluid were obtained at fetal paracentesis. Cells from the fluid were cultured using standard methods for fetal blood, and were compared with fetal blood lymphocytes and amniocytes. The length of time in culture, chromosome morphology, and mitotic index of ascitic fluid cells were equivalent to those of fetal blood. In the third case, we performed immunophenotyping on the ascitic fluid cells. CONCLUSION: Ascitic fluid contains lymphocytes that permit rapid chromosomal analysis within 96 hours.

Adult↗
PubMed2004

[Inhibition of malignant ascites with endostatin adenoviral vector].

OBJECTIVE: To evaluate the therapeutical effect of endostatin adenoviral vector on malignant ascites and compare it with the combined effect of ad-endostatin and DDP. METHODS: We transfected SKOV3 cells with ad-endostatin to inhibit human umbilical vein endothelial cells (HUVEC) proliferation. Then we administered ad-endostatin intraperitoneally in BALB/c mice to detect the serum endostatin expression and in the mice with malignant ascites to evaluate the therapeutic efficacy. RESULTS: Recombinant endostatin inhibited HUVEC proliferation. Endostatin was expressed in serum after intraperitoneal injection of ad-endostatin. The effects of endostatin on inhibition of the ascites accumulation and peritoneal capillary permeability, on demotion of VEGF protein level and microvascular density in tumor tissues, on reduction of the number of red cells and tumor cells counted in malignant ascites, and on prolongation of mice survival were significant in two different malignant ascites. Furthermore, the combination of ad-endostatin with DDP increased the therapeutic efficacy. CONCLUSION: These data suggested that endostatin gene therapy may represent a potential new treatment for malignant ascites, and the therapeutic efficacy can be enhanced by a combination of ad-endostatin with chemotherapy.

Adenoviridae↗
PubMed2004

Bacterial isolation with on-site inoculation of ascites fluid into hemoculture bottle in spontaneous bacterial peritonitis.

OBJECTIVE: To compare the on-site bacterial inoculation of ascites fluid into hemoculture bottle with routine method in the patients who were preliminary diagnosed of SBP. MATERIAL AND METHOD: A retrospective analysis of case records during January-December 2001. RESULTS: A total of 673 specimens from 325 patients were retrieved from the data records at the Department of Microbiology, Siriraj Hospital in 2001. The neutrocytic ascites were found in 163 specimens (94 patients). The routine method and on-site inoculation into the hemoculture bottle were employed in 107 and 56 specimens respectively. Culture-positive neutrocytic ascites was found in the routine method 16 (14.9%) specimens and in the on-site inoculation 26 (46.4%) specimens (p < 0.0001). Among these samples, the two methods were simultaneously performed in 42 specimens of which 18 paired specimens were eligible for analysis. Positive culture was found in 2 samples in which the routine method and in an additional 5 samples in which on-site inoculation into hemoculture bottle method. Using Kappa analysis (e score = 0.328, 95% CI = -0.172 to 0.829) that can be interpreted the on-site inoculation method had a higher yield than the routine technique. Moreover, 21 cases also had their blood and ascites samples simultaneously collected and cultured. 4 of ten (19%) and 5 of eleven (23.8%) cases were found in the routine and on-site and direct inoculation groups respectively. These finding suggested that the severity of infection in among two groups were similar and unlikely to be the cause of the difference of the positive isolation rate in both groups. CONCLUSION: The on-site and direct inoculation of ascites into hemoculture bottle method had a significantly higher isolation rate than routine method (i.e. 46.4% versus 14.9% p < 0.0001) either with separated or paired samples of ascites.

Ascitic Fluid↗
PubMed1992

[Effects of autogenous reinfusion of ascitic fluid on plasma atrial natriuretic peptide and renin activity in cirrhotic patients].

Acute volume loading produced by autogenous reinfusion of ascitic fluid provides an ideal volume expansion model for studying hormonal regulation and it was carried out in 10 cirrhotic patients with massive ascites. The basal plasma ANP level in the cirrhotic patients with ascites was 1776.00 +/- 160.72 ng/L, which was significantly elevated as compared with the level in normal controls (378.36 +/- 39.58 ng/L, P less than 0.01), PRA was significantly higher in patients with ascites (5.13 +/- 0.18 micrograms/l/h) than in healthy volunteers (1.46 +/- 0.31 micrograms/l/h, P less than 0.01). During reinfusion of ascitic fluid there was a significant natriuresis and diuresis; ANP rose from a basal mean value to a peak value of 2166.00 +/- 195.70 ng/l (P less than 0.05) at periinfusion. Subsequently, ANP dropped at 1 hour after infusion (1819.00 +/- 165.92ng/L, P less than 0.05), PRA dropped progressively from a mean basal level to that of 2.48 +/- 0.58 micrograms/l/h (P less than 0.05) at periinfusion. These data demonstrate that there is no evidence for absolute deficiency of ANP in cirrhosis with ascites. The immediate diuresis and natriuresis were associated with a rise in ANP, but the sustained renal consequences may be possibly connected with suppression of RAAS.

Adult↗
PubMed1992

Coagulopathy during ascites reinfusion: prevention by antiplatelet therapy.

The development of disseminated intravascular coagulation (DIC) during a controlled IV infusion of concentrated ascitic fluid was studied in a group of patients with cirrhosis and refractory ascites. Nine studies were performed on patients who had not received prophylactic antiplatelet therapy. All developed laboratory evidence of DIC. The total collagen infused, estimated by ascitic hydroxyproline concentration, correlated significantly with both the prolongation of the partial thromboplastin time with kaolin (r = 0.8628; P less than 0.005) and the decrease in platelet count (r = 0.5674; P less than 0.05). The changes in the coagulation profile were reversible on ceasing the infusion, returning to baseline levels within 12 hours. There were no changes in the coagulation profiles of four patients studied 48 hours after beginning antiplatelet therapy with aspirin and dipyridamole. It is concluded that the infusion of concentrated ascitic fluid into a peripheral vein of patients with cirrhosis results in DIC, the severity of which correlates with the amount of collagen infused and which is completely prevented by inhibiting collagen-induced platelet aggregation. The results support the hypothesis that the DIC that complicates ascites infusion into the systemic circulation is largely related to ascitic fluid collagen.

Adult↗
PubMed2005

[The diagnostic value of telomerase activity in differentiating benign and malignant ascitic fluid].

OBJECTIVE: To investigate the changes of telomerase activity in benign and malignant ascites fluid. METHODS: The technique of telomerase TRAP-PCR-ELISA was employed to detect telomerase activity in ascites cells from 60 patients with benign or malignant ascites fluid, the cytological diagnosis and total tumor marks (carcinoembryonic antigen, et al.) were compared. RESULTS: Telomerase activity in malignant ascites fluid was significantly higher than that in benign group. Positive rate of telomerase activity detected in malignant ascites (90%) was remarkably higher than those in benign group (10%); Compared with the cytological diagnosis and total tumor marks (carcinoembryonic antigen, et al.), telomere ferment test had higher sensitivity (90%), specificity (100%) and stability. CONCLUSION: Telomerase activity may be an useful and sensitive mark in differential diagnosis of benign and malignant ascites fluid.

Adult↗
PubMed2006

[Nanoliposomal quercetin inhibits formation of malignant ascites of hepatocellular carcinoma].

BACKGROUND & OBJECTIVE: Quercetin is a potential chemotherapeutic drug with many biological activities. However, the insolubility of quercetin seriously limits its clinical use. This study was to investigate the biodistribution of quercetin encapsulated by pegylated nanoliposomes and its therapeutic efficacy on the formation of carcinomatous ascites of hepatocellular carcinoma in mice. METHODS: Nanoliposomal quercetin was prepared with conventional rotary evaporation method. BALB/c mice inoculated with hepatocellular carcinoma cells (H22) at the anterior right subaxilla for twelve days were given intravascular injection with nanoliposomal quercetin at 1.5 mg/body (based on quercetin) at different time points. Then the levels of quercetin in the plasma, tumor tissues and normal organs were tested by high pressure liquid chromatography (HPLC). Various dosages of nanoliposomal quercetin were peritoneally given to tumor-bearing mice to determine the optimal dose. The tumor-bearing mice were treated intraperitoneally with 100 mg/kg nanoliposomal quercetin once a day for 14 days. The formation of malignant ascites, increase of body weight, survival time and peritoneal capillary permeability were assessed. Apoptotic cells in ascites were detected by flow cytometry. RESULTS: Nanoliposomal quercetin was a spherical particle with 25% drug content (W/W) and 130+/-20 nm in diameter. Nanoliposomal quercetin effectively aggregated in tumor tissues and its half-life period was 4 h. Nanoliposome quercetin inhibited the formation of malignant ascites of hepatocellular carcinoma model in a dose-dependent manner. Moreover, 100 mg/kg nanoliposomal quercetin significantly enhanced the apoptosis of cancer cells in ascites, inhibited the increase of body weight, reduced peritoneal capillary permeability and prolonged the survival time of tumor-bearing mice compared with PBS control. CONCLUSION: Nanoliposomal quercetin can effectively accumulate in tumor tissues and inhibit the formation of malignant ascites, thus it might be used as a potential antitumor drug which deserves future study.

Animals↗
PubMed1991

[Umbilical hernioplasty with valve implantation in cirrhotic-ascitic patients].

The authors summarize the treatment results of patients managed by them suffering from umbilical hernia associated with intractable ascites. Through a period of 10 years, 17 out of the 164 patients operated on for umbilical hernia were cirrhotic with ascites. In the course of the presentation of the data of such treated patients, the authors point at the increased danger of postoperative complications in ascites-induced umbilical hernia, and the high mortality rate; facts backed up by data from previous study. On the basis of their experiences in ascitic-valve implantation over the past decade, during the past 3 years in 5 cases of refractory ascites-induced umbilical hernia, hernioplasty was performed together with ascitic-valve implantation at the same sitting. The observed good results unanimously speak in favour of the continuation of this method. The authors suggest that such patients have to be referred to those surgical departments/hospitals where the prerequisites for the above mentioned surgical method--personnel and material--are given.

Adult↗
PubMed1990

Presence of the N-terminal and C-terminal portions of the prohormone of atrial natriuretic factor in the ascitic fluid of cirrhotic patients.

The simultaneous measurement of plasma and ascitic fluid N-terminal and C-terminal portions of the 126 amino acid atrial natriuretic factor (ANF) prohormone (proANF) concentrations in six cirrhotic patients revealed that the C-terminus (amino acids 99 to 126; ANF) and the N-terminus (amino acids 1 to 98) are present in high concentrations (mean = 30 +/- 2 fmol/mL and 701 +/- 43 fmol/mL, respectively) in the ascitic fluid of these patients. In addition to the whole N-terminus, the midportion of the N-terminus (amino acids 31 to 67; proANF 31 to 67) was present in ascitic fluid as a separate identity at a concentration of 711 +/- 63 fmol/mL. The concentrations of the C-terminus, proANF 31 to 67, and N-terminus in ascitic fluid were nearly equal to their concentrations in plasma (32 +/- 4 fmol/mL, 761 +/- 54 fmol/mL, and 772 +/- 54 fmol/mL, respectively). The plasma levels of the N-terminus and C-terminus in the cirrhotic patients were considerably higher than the mean plasma concentrations of these peptides in 54 persons without cirrhosis (531 +/- 25 fmol/mL, 371 +/- 22 fmol/mL, and 22 +/- 1 fmol/mL, respectively [p less than 0.05; analysis of variance (ANO-VA)]. Data demonstrate that the whole N-terminus, midportion of the N-terminus (proANF 31 to 67), and C-terminus of proANF are present in ascitic fluid in high concentrations that are nearly equal to plasma levels. This suggests that their presence in ascitic fluid is due to capillary leakage of peptides in the hepatic sinusoids.

Analysis of Variance↗
PubMed1990

Epidermal growth factor and transforming growth factor alpha induce ascitic fluid in mice.

Recent studies have suggested that pleural or peritoneal effusion associated with metastatic tumors is induced by some mediators produced by the tumor cells. We studied the ability of well-characterized peptide growth factors to produce ascites in mice. Peritoneal administration of epidermal growth factor (EGF, 10 to 40 micrograms/mouse/wk) or transforming growth factor alpha (TGF-alpha, 10 to 40 micrograms/mouse/wk) via osmotic minipumps resulted in formation of bloody ascites. The amount of ascites produced was dependent on the dose of growth factors. Vehicle alone or insulin-like growth factor I (40 micrograms/mouse/wk) was without effect. Indomethacin, a blocker of prostaglandin synthesis, significantly reduced the ascites accumulation induced by EGF, suggesting that prostaglandins are involved in ascites formation induced by EGF. Dexamethasone was also effective in attenuating the effect of EGF. Thus, it is possible that peritoneal effusion associated with disseminated tumors is, at least in part, due to EGF-like materials (most likely TGF-alpha) produced by tumor cells. The mechanism by which these peptides induce bloody ascites is not known for certain, but it may be due to the reported activity for neovascularization or increased vascular permeability.

Animals↗
PubMed1987

The effect of fat-rich diet and chronic ethanol ingestion on ascitic fluid and plasma enzyme activities in acute pancreatitis in rats.

The effect of fat-rich diet (F) and chronic ethanol ingestion in experimental acute pancreatitis (AP) on plasma enzyme activities and the composition of ascitic fluid were studied in rats. 96 male Wistar rats were randomized into four groups. Two groups, one of which drank 15% (v/v) ethanol as their drinking solution, received the F-diet for 12 weeks. The rest of the rats served as controls receiving standard laboratory food (S). Half of the control animals drank ethanol and the other rats had tap water. AP was induced by retrograde bile infusion into the pancreatic ducts and relaparotomy performed after 24 hours follow-up period. All animals surviving were exsanguinated and the ascitic fluid collected. Phospholipase A2 (PLA2) correlated with the mortality rate in the S-diet receiving groups but no changes could be seen after the F-diet. Ethanol in combination with the F-diet caused a significant increase in total protein content of ascitic fluids (p less than 0.001). Trypsin inhibiting capacity was significantly decreased in the same groups (p less than 0.01) and total proteolytic activity was highest in the ascitic fluids of the F-diet and ethanol receiving rats. No significant differences in the PLA2 activities in the ascitic fluids between the groups were observed. It is suggested, that the composition of ascitic fluid generated during experimental AP is of importance to the outcome of the disease.

Acute Disease↗
PubMed1987

[Fibronectin in the ascitic fluid: its diagnostic significance].

We studied fibronectin concentration in the ascitic fluid of 102 patients, 71 with cirrhosis, 13 with hepatocellular carcinoma, 12 with malignant peritonitis, and six with miscellaneous disease. Fibronectin concentrations in the first three groups were 45 +/- 45 mg/l, 54 +/- 84 mg/l, and 144 +/- 123 mg/l, respectively. The difference between patients with cirrhosis and malignant peritonitis was significant (p less than 0.01). However, fibronectin concentration greater than 100 mg/l had a sensitivity of 58 per cent and a specificity of 86 per cent for the diagnosis of malignant peritonitis. Ascitic fluid protein content over 30 g/l had the same sensitivity and specificity was 90 per cent. Among cirrhotic patients, high fibronectin concentrations were demonstrated in those with long-standing ascites (m = 134 +/- 58 mg/l) whereas the lowest concentrations were found in patients with severe hepatocellular failure (m = 12 +/- 9 mg/l). Concentrations were significantly different, according to whether or not spontaneous bacterial peritonitis occurred later (20 +/- 13 mg/l versus 52 +/- 49 mg/l); 83 per cent of patients with spontaneous bacterial peritonitis during their clinical course had initial fibronectin concentrations above 30 mg/l in their ascites. We conclude that: 1) measurement of fibronectin concentration in ascitic fluid is of poor diagnostic value for discrimination between malignant and non malignant ascitic, 2) low concentrations of fibronectin are associated with the occurrence of spontaneous bacterial peritonitis in cirrhotic patients. Hypothetically, the quantitative defect of fibronectin could be responsible for bacterial opsonization impairment in these patients.

Ascitic Fluid↗
PubMed1988

Plasma concentrations of immunoreactive atrial natriuretic peptide in hospitalized cirrhotic and noncirrhotic patients: evidence for a role of deficient atrial natriuretic peptide in pathogenesis of cirrhotic ascites.

Atrial natriuretic peptide(s) (ANP), are thought to be released from the cardiac atria in response to distension. If decreased effective circulating blood volume is important in pathogenesis of ascites, plasma ANP levels would be expected to be decreased in ascitic subjects because of decreased atrial distension. To test this hypothesis, we measured plasma ANP by competitive radioimmunoassay in three groups of fasted, supine hospitalized subjects: nine noncirrhotic control subjects, 12 cirrhotics without ascites, and 17 cirrhotics with moderate to marked ascites. Immunoreactive plasma ANP concentrations were 195 +/- 41, 171 +/- 31, and 137 +/- 34 pg/ml (m +/- SD), respectively, in the three groups. The mean concentration in the group with cirrhosis and ascites was significantly (p less than or equal to 0.01) les than those of the other two groups, which did not differ from one another. These results support the concept that decreased effective circulating volume plays a role in pathogenesis of cirrhotic ascites, and that a relative deficiency of ANP plays a role in the sodium retention of decompensated cirrhosis.

Adult↗
PubMed1988

[Central nervous cryptococcosis giving rise to ascites after ventriculo-peritoneal shunting--a case report].

The ascites retention as a complication after ventriculo-peritoneal shunting (V-P shunt) is very rare. In this paper, a case of central nervous cryptococcosis giving rise to ascites after a V-P shunt is presented. A 45-year-old female was referred to Prefectural Gifu Hospital complaining of nausea and disturbance of recent memory. She had no remarkable medical history. CT scan films on admission showed enlarged ventricles except for the fourth ventricle, indicating an obstructed hydrocephalus. Lumbar cerebrospinal fluid (CSF) examinations revealed an increase in cell counts (mostly lymphocytes) and protein content, and positive Pandy and Nonne-Apelt reactions. Based on this information, it was tentatively suggested that she had a certain infection in the central nervous system such as mycosis or tuberculosis etc. Continuous ventricular drainage was performed for about three weeks. During this period, several lumbar and ventricular CSF cultures were negative. Therefore, a V-P shunt operation was performed. However, about seven weeks after the V-P shunt, she developed abdominal distention without any peritoneal signs. Abdominal CT scan films showed an abnormal ascites retention. Laboratory tests revealed positive CRP and increased ESR values. Again, it was suggested that she had not only a central nervous but also a peritoneal infection giving rise to ascites. From samples of ventricular CSF and ascites, cryptococcus neoformans was cultured. The lumbar CSF revealed positive latex agglutination titer for cryptococcal antigen, although the culture was negative. The ascites examination revealed an increase in cell counts (mostly lymphocytes) and protein content, and positive Rivalta and Runneberg reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Ascites↗
PubMed1987

[Course of the diffusion of cefotiam in infected ascitic fluid].

The cefotiam (CFT) penetration in infected ascitic fluid was investigated in 12 cirrhotic patients. CFT (1 g every 8 h) was given intravenously and measured by HPLC in plasmatic and ascitic samples. The mean ascitic concentrations (+/- SEM), 1 h, 3 h and 8 h after the first injection (J1) were 14.6 +/- 4.6, 11.8 +/- 3 and 8.4 +/- 2.9 micrograms/ml respectively. These values were 38, 62 and 88% of the corresponding mean plasmatic concentrations and higher than the MIC's for the organisms most commonly involved. The mean plasmatic and ascitic concentrations, a few days later (4.5 or 6 days) (Jn) were not significantly different from the corresponding values at J1. A significant decrease of polymorphonuclear cell count was observed between J1 and Jn. These results suggest that CFT diffusion into ascitic fluid is independent of inflammation and CFT is an adequate antibiotic in cirrhotic patients with infected ascitic fluid.

Adult↗
PubMed1978

Bactericidal and opsonic activity of cirrhotic ascites and nonascitic peritoneal fluid.

BA and OA of sera and uninfected ascitic fluid from patients with alcoholic cirrhosis were assayed against gram-negative enteric bacilli. This was compared with BA and OA in normal serum and in peritoneal fluid obtained at laparoscopy or laparotomy from noncirrhotic patients. Cirrhotic sera showed significantly reduced BA and OA against one of the organisms tested, Serratia marcescens. It had reduced OA but normal BA against E. coli. Ascitic fluid was markedly deficient in BA and OA against all strains tested when compared to both cirrhotic sera and nonascitic peritoneal fluid. Immunoglobulin and complement concentrations in cirrhotic ascites were reduced. Ascites did not inhibit the BA or OA of normal serum. However, replacement experiments suggested that the diminished activity of ascites was largely the result of its reduced complement concentration. The demonstrated deficit in both BA and OA of ascites may be a factor in the frequency of spontaneous enteric bacillary peritonitis in the cirrhotic patient.

Adult↗