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PubMed1995

Diagnostic analysis of total protein, albumin, white cell count and differential in ascitic fluid.

Accurate and precise procedures are described for the measurement of total protein, albumin, white cell count and differential in ascitic fluid. The total protein method (biuret) on the serum chemistry analyser, Bayer-Technicon Chem-1, was calibrated against the biuret reference method in the measuring range from 1-100 g/l, covering serum as well as ascitic fluid values. The albumin method (bromcresol green) on the Chem-1 was calibrated for the measurement range from 1-50 g/l against the new human plasma protein international reference preparations and compared to the nephelometric method on the Beckman Array, which was also calibrated against these reference preparations. A good correlation was obtained for total protein between the Chem-1 (y) and the biuret reference method (x) in 58 ascitic fluids (y = 1.02x -0.3; r = 1.00). A good correlation between the Chem-1 (y) and the Array (x) was also obtained for albumin (r = 0.99). The bromcresol green method, however, which is not fully specific, resulted in significantly higher results (y = 1.32x - 1.3). The immunochemical procedure is considered the more accurate and therefore the bromcresol green method is not suitable for the determination of albumin in ascitic fluids. The white cell count in ascitic fluid can be measured reliably by most haematology analysers if the sample is fresh and homogeneous, but the differential is flagged as a result of differing morphology. Handmade smears from ascitic fluid, however, show uneven distribution of cells and disturbed morphology.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗
PubMedDate not supplied

Chylous ascites: report of one case.

Chylous ascites is rare if found in the pediatric age group, and is usually of unknown etiology or comes from congenital anomalies of the lymphatic system. A 3.2 kg male newborn was born at 36-week gestation by Cesarean section prompted by fetal distress. Distended abdomen was noted after birth and abdominal ultrasound revealed significant ascites. Repeated paracenteses were done to relieve the respiratory distress, and a milky ascitic fluid with specific gravity of 1.031, WBC 1.32 x 10(4)/mm3 (lymphocytes predominant), and triglycerides 812 mg/dl was noted at the third tapping after feeding with normal infant formula. The lipoprotein electrophoresis of the ascites showed great increase in proportion of chylomicron to 19.05%. Pregestimil was given, and the ascites gradually subsided. The patient was discharged on the 13th day after birth. His growth was normal at one-month follow up without recurrence of ascites.

Chylous Ascites↗
PubMed1994

Evaluation of culture techniques for detection of spontaneous bacterial peritonitis in cirrhotic ascites.

This prospective study was done in cirrhotic patients to evaluate ascitic fluid culture techniques by the conventional method and by an alternate method of bedside ascitic fluid inoculation into blood culture bottles, with an aim to improve bacteriological diagnosis of spontaneous bacterial peritonitis (SBP). Of the 300 patients who were evaluated, 43 who had a total leukocyte count greater than 500/mm3 or a polymorphonuclear cell count greater than 250/mm3 in ascitic fluid were included. There were 30 episodes of SBP in 28 patients and another 15 patients had culture-negative neutrocytic ascites (CNNA). Escherichia coli was the commonest organism cultured, being found in 60%. There was significantly greater (p < 0.001) ascitic fluid culture positivity with direct inoculation into blood culture bottles, i.e. 66.7% compared to 31.1% by conventional method at 48 hours, and this was evident even 24 hours after inoculation i.e. 33.3% positivity compared to 4.4%. Bacteremia was present in 53.3% of patients with SBP and 33.3% with CNNA. Ascitic fluid inoculation directly into blood culture bottles leads to a significantly increased percentage of culture positivity and reduces the time needed for detection of SBP from 48 to 24 hours.

Ascitic Fluid↗
PubMed1995

Transjugular intrahepatic portosystemic shunts for refractory ascites: assessment of clinical and hormonal response and renal function.

Cirrhosis is frequently complicated by ascites that may become resistant to diuretic therapy. Transjugular intrahepatic portosystemic shunts (TIPS) represent a new treatment for this debilitating condition. The aim of this study was to ascertain the clinical efficacy of TIPS, as well as its impact on renal function and on hormonal parameters. Five inpatients with refractory ascites were studied prospectively before TIPS, and 3 and 14 days after TIPS. After TIPS, ascites completely resolved or was minimal in all patients. Diuretics were discontinued in three subjects and decreased by at least 50% in two. One patient developed liver failure after TIPS and required liver transplantation; the others remained stable after a mean follow-up of 14 months. Mean urinary sodium excretion increased from 2.1 +/- 0.6 mEq/24 hr before TIPS to 13.0 +/- 4.3 mEq/24 hr 14 days after TIPS. Mean serum creatinine and glomerular filtration rate also tended to improve during the study period. With the exception of the patient who developed liver failure, plasma aldosterone concentration decreased from a mean of 126.0 +/- 29.9 ng/dL to 22.8 +/- 6.8 ng/dL (P = .04), and plasma renin activity decreased from a mean of 9.0 +/- 3.0 micrograms/L/h to 0.9 +/- 0.1 microgram/L/h (P = .08). Additionally, 19 patients who underwent TIPS for refractory ascites outside of this protocol were followed prospectively for a mean of 282 days. Clinical improvement in ascites control was noted in 74%, and the mean dose of diuretics was decreased by more than 50%. Nonresponders more often had underlying renal disease. In conclusion, TIPS is an effective therapy for refractory ascites in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Ascites].

Ascites is most frequently a symptom of advanced chronic liver disease. The pathogenesis of ascites with portal hypertension is complex, and the interaction between liver and kidney is incompletely known. Due to the differing pathogenetic mechanisms and the consecutively different therapeutic approaches, the differential diagnosis of ascites has to be clearly evaluated by measurement of certain laboratory parameters in the ascitic fluid. The prior to therapy basic principles in the therapy of the portal ascites include bed rest, dietary restriction of sodium and water intake, therapeutic paracentesis and diuretics in increasing doses. With this basic therapeutic approach 85 to 90% of the patients can be treated successfully. In patients with complicated forms of ascites or hepatorenal syndrome, other therapeutic strategies have to be used.

Ascites↗
PubMed1993

Inferior vena cava stenosis and pancreatic ascites complicating chronic calcific pancreatitis: a case report.

A 19-year-old Thai male, who was a regular drinker, presented with massive ascites, back pain and leg edema for four months. On examination there was obvious clinical evidence of an inferior vena cava obstruction. Inferior vena cavography showed narrowing of the hepatic portion of IVC with collateral circulation. Surgical dilatation of the inferior vena cava was performed. The ascites were diagnosed four months later as pancreatic ascites with a very high ascitic amylase level. Computerised axial tomography and endoscopic retrograde pancreatography showed evidence of chronic calcific pancreatitis and pseudocyst. After further medical treatment, ascites and inferior vena cava stenosis subsided which was confirmed by repeated vena cavography, computerised axial tomography and magnetic resonance imaging. The cause of inferior vena cava stenosis and clinical obstruction in this case most likely resulted from phlebitis secondary to pancreatitis. The etiology of chronic calcific pancreatitis in this case might be alcoholic abuse and/or nutritional tropical pancreatitis. Inferior vena cava stenosis and associated pancreatic ascites complicating chronic calcific pancreatitis has not been previously reported in Thailand.

Adult↗
PubMed1994

[Complication of ascites in pregnancy-induced hypertension].

Twenty three pregnancy-induced hypertension (PIH) patients with ascites were treated in Beijing Obstetrics and Gynecology Hospital from Jan. 1981 to April 1992. The incidence of ascites in PIH was 1.9/1000 in total in this study, and 21.6/1000 in severe PIH. Clinical manifestations showed an early onset of PIH at 29.4 +/- 4.8 weeks, and ascites occurred at 32.4 +/- 7.4 weeks. There were 18 cases out of 23 who had no routine antenatal care, all of them had complications with IUGR. Laboratory studies: ascites showed transudate in all of them except one with chronic nephritis exhibiting milky appearance. 10% of patients had abnormal complete blood count (CBC) and 13%-17% abnormal electrolytes. 17.0% of the patients had GPT > 30IU, 21.0% urea nitrogen > 35 g/L, 95.7% had plasma albumin < 35 g/L. The ratio of A/G was < 1.5 in all patients. We conclude that once PIH was 1.5 in all patients. We conclude that once PIH was complicated by ascites, it can not be cured by active treatment. It is an indication for termination of pregnancy. After delivery the ascites and pleural effusion gradually disappeared in 2 weeks. Perinatal mortality rate was as high as 42.1% because of premature induced labor and IUGR.

Adult↗
PubMedDate not supplied

Exudative v/s transudative ascites: differentiation based on fluid echogenicity on high resolution sonography.

Real time sonography was performed in 52 patients with ascites to evaluate the accuracy of sonography in differentiating an exudative from a transudative collection. The echogenicity of ascites was graded I, II and III using the echogenicity of normal abdominal viscera as comparative standard reference points. Grade I collections (31 patients) were either absolutely anechoic, or showed few internal echoes secondary to particulate matter. Grade II collections (7 patients) were hypoechoic as compared to the liver and spleen. Grade III collections (14 patients) had an echogenicity similar to or greater than that of the liver and spleen. The results of diagnostic aspiration in all patients were then compared to the sonographic grade of the ascitic fluid. All transudates (28 patients) had a Grade I echogenicity. Only 3 patients with an exudative ascites had a Grade I echogenicity. The remaining 21 patients with an exudative collection had an echogenicity equal to or greater than Grade II. Using these results, an ascitic fluid echogenicity of Grade I had a 92.32% sensitivity, 100% specificity, a positive predictive value of 1 and a negative predictive value of 0.875 in diagnosing transudates. An ascitic fluid echogenicity of Grade II or more had a sensitivity of 87.5%, specificity of 100%, a positive predictive value of 1 and a negative predictive value of 0.903 in diagnosing transudates.

Adult↗
PubMed1993

Prevalence of peritonitis and the ascitic fluid protein concentration among chronic liver disease patients.

The prevalence of spontaneous bacterial peritonitis (SBP) or its variants, bacterascites (BA), and culture-negative neutrocytic ascites (CNNA), may vary depending on the underlying liver disease and protein content of ascites. In this study, we compared the frequency of peritonitis (SBP, BA, CNNA) upon admission in alcoholic (ALD), cholestatic (CLD), and hepatocellular liver disease (HLD); determined the relationship between Child's class and prevalence of peritonitis; and assessed ascitic total protein as a risk factor for peritonitis. Between January 1989 and April 1991, 113 consecutive patients were admitted with chronic liver disease and ascites (49, ALD; 22, CLD; and 42, HLD). All had admission paracentesis. SBP was defined as polymorphonuclear cell count (PMN) > or = 250 mm3 with a positive culture, BA as PMN < 250/mm3 and positive culture, and CNNA as PMN > or = 250/mm3 with negative culture. No patients with obvious intraabdominal source for infection (i.e., secondary peritonitis) were included in the analysis. The prevalence of peritonitis was 8/113 (7%); four patients had SBP, one BA, and three CNNA. The occurrence of peritonitis was independent of the type of liver disease (ALD, 8%; CLD, 9%; HDL, 5%). Neither ascitic fluid total protein nor the severity of liver disease (Child's class) predicted the occurrence of peritonitis. We conclude that the occurrence of peritonitis is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of peritonitis. Also, ascitic fluid total protein < 1.0 g/dl may not be a sensitive predictor of risk of peritonitis.

Ascitic Fluid↗
PubMed1993

Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients.

Ascites is a complication of chronic liver disease that is associated with decreased survival. The purpose of the present study was to identify some prognostic factors easily obtainable by the clinician in a large group of cirrhotic patients with ascites, possibly useful for first screening of outpatients as candidates for liver transplantation. We studied 134 ambulatory patients with cirrhosis who came to our outpatient clinic between July 1983 and March 1989 because of an episode of ascites. These patients were then followed up for an average period of 31 +/- 23 months and survival was determined. Thirty-one variables determined at the time of inclusion were analyzed with a Cox proportional hazards model to identify predictors of mortality. Cumulative mortality as of June 30, 1991, was 59%. Factors independently correlated with death were: refractory ascites (relative risk, 4.78), low albumin levels (3.77), high Child-Pugh score (3.31), encephalopathy (2.71), high bilirubin levels (2.03), high gamma-glutamyl-transferase levels (1.87), and old age (1.57). The results show that 1) the occurrence of refractory ascites has a prognostic value superior to those of other variables, and 2) simple clinical and biochemical parameters, most of them components of the Child-Pugh score, are useful for a first screening of ascitic cirrhotic patients as candidates for liver transplantation.

Aged↗
PubMed1993

Pancreatic ascites.

Pancreatic ascites is the accumulation of high protein, amylase-rich intraperitoneal fluid which occurs during the course of chronic pancreatitis, in association with rupture of a pseudocyst or disruption of a pancreatic duct. This is an uncommon complication, with less than 250 cases reported in the literature. We have treated 6 patients with pancreatic ascites. Five were males with a history of chronic alcoholism, but no known pancreatic disease. The diagnosis was made by ascitic tap and the site of the leakage identified by ERCP. Treatment was initiated with total parenteral nutrition in all cases. In 5 patients, the ascites failed to respond to medical therapy. Surgical intervention was indicted in 3 of these patients. The diagnosis of pancreatic ascites should be considered in patients with refractory ascites, and a combination of medical care and judicious surgery have contributed to an improved outcome.

Adolescent↗
PubMed1995

[Influence of liver cirrhosis with and without ascites on ventilatory mechanics].

BACKGROUND: The thoracic cavity plays an important role in the mechanical ventilatory function, and the alteration of some of its structures, such as those which occur in decompensated cirrhosis of the liver, for example the presence of ascites and muscle atrophy, directly influence its normal function. METHODS: In the present study we have evaluated the ventilatory function and respiratory muscular tension by means of the calculation of volumes, flows and resistances of the airways, and also the maximum inspiratory and expiratory pressures (Pimax, Pemax). PATIENTS: One hundred patients with liver cirrhosis and ascites without associated respiratory illness, mean age 57 +/- 15 years (range 32-80), were studied. We evaluated the respiratory function before and after the disappearance of the ascites. RESULTS: A restrictive pattern was evident, and various parameters were altered. The most affected being that of the reserve expiratory volume. No associated bronchial obstruction was observed. Respiratory muscular tension was decreased in both the Pimax and the Pemax. With the disappearance of the ascites we found an improvement in the affected parameters, but this did not reach normality. CONCLUSION: In liver cirrhosis associated with ascites, the most common respiratory pattern, is a decrease in ventilatory function of a restrictive type, and also a decrease in the respiratory muscular tension. These alterations improve after the resolution of the ascites.

Adult↗
PubMed1996

[Study of arterial blood gases in liver cirrhosis with and without ascites].

OBJECTIVE: The study of the disturbances of arterial gases and the changes in the arterial pH which are present in patients with liver cirrhosis and ascites and their modification after the disappearance of ascites by treatment. EXPERIMENTAL DESIGN: Open study,with protocol and prospective, to evaluate the changes in measurement of the arterial gases and acid-base, parameters in matching groups of patients. PATIENTS: We include 24 patients, 15 males and 9 females, without preliminary or cardio-respiratory pathology age range between 37 and 77 years, average of 56.8 years, all of them diagnosed of liver cirrhosis of different etiologies and with important ascites. All of them finished the study. RESULTS: In patients with liver cirrhosis and ascites a fall in the PaO2 and in the PaCO2 was demonstrated the pH in the upper limit of the normality compatible with hypoxemia and respiratory alkalosis. After the disappearance of the ascites, a significant improvement in the PaO2 (p < 0.05), without any changes in the PaCO2 and pH values was apparent. CONCLUSIONS: In patients with liver cirrhosis, with or without ascites, hyperventilation is present, that can be multifactorial in origin, but which really has an unknown cause. We have found no relationship with the circulating levels of progesterone.

Acid-Base Equilibrium↗
PubMed1977

Detection of endotoxin in plasma and ascitic fluid of patients with cirrhosis: its clinical significance.

Endotoxin was measured by the Limulus assay in plasma and ascites in 46 patients with cirrhosis having demonstrable esophageal varices, of whom 29 had ascites and 17 did not. It was positive in ascitic fluid in 23 (79.3%) of the former group. In plasma, a positive test was obtained in 22 (75.9%) in the group with ascites and only 4 (23.5%) without ascites, the difference being significant (P less than 0.01). Of the 23 positive ascites specimens, 17 showed high titers (greater than or equal to 10(-3) microgram per ml). Hepatic uptake of 198Au colloid was markedly reduced in 11 of the 17 patients with endotoxemia who were studied by scanning. Death occurred within 6 months in 47.8% of the patients with a positive endotoxin test, whereas only 16.7% of those with a negative test died in the same period (P less than 0.05). No hypotension was noted in patients with toxemia and only 2 ran a fever above 37.5 degrees C. Development of tolerance to endotoxin is suspected. A follow-up study has demonstrated sustained endotoxemia in some of these patients.

Ascitic Fluid↗
PubMed1996

[Natural course and physiopathology of ascites in the cirrhotic patient].

Ascites formation in cirrhosis results from the interaction of "local" and "systemic" pathogenetic factors. Among local factors, post-sinusoidal portal hypertension plays the most important role, while the main systemic event is renal sodium retention. The latter precedes ascites formation and leads to plasma volume expansion. Many factors are responsible for renal sodium retention, but secondary hyperaldosteronism and reduced renal perfusion prevail. The events promoting the onset of sodium retention are far from being clarified. However, there is evidence that the main afferent mechanism is represented by the "effective" hypovolemia secondary to splanchnic venous vasodilation, due to portal hypertension, and reduced peripheral vascular resistance, which becomes evident in the advanced stage of the disease. Systemic hemodynamic abnormalities are responsible for the progressive reduction of renal perfusion, which ends in the hepatorenal syndrome. The appearance of ascites is a crucial event in the natural history of cirrhosis and has a negative prognostic meaning. In fact, ascites appears when pathogenetic factors, such as liver function abnormalities, portal and systemic hemodynamics, and renal function, have reached a critical threshold severity. Second, ascites itself induces additional complications, closely linked to its presence, such as spontaneous bacterial peritonitis, restrictive respiratory failure, or rupture of abdominal hernias. Finally, ascites implies pharmacological or invasive treatment which can lead to further morbidity or even to death.

Ascites↗
PubMedDate not supplied

Ceftriaxone in the treatment of spontaneous bacterial peritonitis: ascitic fluid polymorphonuclear count response and short-term prognosis.

BACKGROUND/AIMS: In this study, ascitic fluid polymorphonuclear (PMN) response, short-term prognosis, and factors related to hospital mortality were investigated in 62 cases of spontaneous bacterial peritonitis occurring in cirrhotic patients treated with Ceftriaxone (1g every 12 hours). METHODOLOGY: The diagnostic criteria for (SBP) were ascitic fluid PMN count < 250 cells/mm3 and no evidence of secondary peritonitis. Analysis of ascitic fluid samples were obtained on admission, and on the 4th and 10th days of antibiotic therapy. RESULTS: The etiology of cirrhosis was alcohol in 63% of the cases, and 79.5% of patients belonged to Child-Pugh Class C. Ascitic fluid analysis showed positive cultures in 47% of the cases, and a marked decrease in PMN count during treatment (admission: 7762 +/- 2837; 4th day: 388 +/- 91; 10th day: 173 +/- 59 cells/mm3). Ascitic PMN was < 250 cells/mm3 within 4 days of treatment in 33% of the cases. The hospital mortality rate was 24%, and was related to gastrointestinal hemorrhage, hepatic encephalopathy, renal failure and 4th day ascitic fluid PMN count. CONCLUSION: Ceftriaxone is a safe and effective option for the treatment of SBP.

Ascitic Fluid↗
PubMed1996

The matrix metalloproteinase inhibitor batimastat (BB-94) retards human breast cancer solid tumor growth but not ascites formation in nude mice.

Matrix metalloproteinases (MMPs) are thought to play a significant role in tumor invasion and metastasis as well as angiogenesis. Batimastat, also known as BB-94, acts as an inhibitor of metalloproteinase activity by binding the zinc ion in the active site of MMPs. In our study, the hormone-independent MDA435/LCC6 human breast cancer cell line was used to seed solid tumors s.c. into the region of the mammary fat pad in athymic nude mice. Mice were treated with 50 mg/kg batimastat i.p. Tumor volume measurements showed a statistically significant decrease in tumor size between batimastat-treated and control animals. In contrast, we also used the same MDA435/LCC6 cell line to propagate a malignant ascites in nude mice, which yielded a very different response to batimastat. Batimastat, in previously published literature, had been shown to prolong the life of mice bearing ovarian ascites tumors. Treatment with batimastat in our ascites model produced no increase in survival or significant suppression of ascites formation. However, treated animals showed dramatic tumor cell consolidation and less dispersed ascites cells compared with control animals. Two potential targets of batimastat, gelatinase A and B (MMP-2 and -9, respectively), were examined in both tumor sites. These metalloproteinases were present in both solid tumor and ascites fluid and in both cases were host derived and not produced by the tumor. We conclude that batimastat may have different effects on tumor progression and growth depending on the site of tumor implantation.

Animals↗
PubMedDate not supplied

[Isolated ascites revealing a hypothyroidism. Study of 2 cases].

Ascites is an uncommon feature of hypothyroidism. We report two patients with hypothyroidism revealed by ascites. Among the 44 myxedema ascites cases found in the literature, there were observed 17 cases of ascites as the first manifestation of hypothyroidism. In this rare presentation of hypothyroidism, diagnosis is often delayed. Biological analysis of ascites usually shows high protein and cholesterol concentrations and a low or high cell count with a high proportion of lymphocytes. An increase in capillary permeability may play a role in the pathogenesis of ascites.

Aged↗