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PubMed1989

Thoracic duct lymph in a patient with chylous ascites and a carcinoid tumor.

An adult patient with both intraabdominal carcinoid tumor and chylous ascites underwent thoracic duct drainage in an attempt to relieve accumulation of intraabdominal fluid. After cannulation of the left cervical thoracic duct, lymph flow rate was normal (1.4ml/min) and 24 hours of drainage was without effect on the ascites. In contrast to the chylous nature of the ascitic fluid, however, thoracic duct lymph was non-chylous and its protein content was lower than that of the ascitic fluid. The administration of secretin intravenously increased both the flow and amylase content of thoracic duct lymph. These observations signify that the chylous ascitic fluid neither leaked from nor had access to thoracic duct lymph but originated instead from obstructed mesenteric lacteals.

Abdominal Neoplasms↗
PubMedDate not supplied

Osmotic disequilibrium causing ascites during chronic hemodialysis.

UNLABELLED: Ascites formation is a recognized complication of chronic hemodialysis (CHD). The cause is an enigma after tumors, tuberculosis, and heart, liver, and pancreatic diseases are excluded. A 55-year-old patient who developed intractable ascites about 6 months after starting CHD was studied. The premise was that osmotic disequilibrium during HD may be the causative factor. Other causes of ascites were excluded. The study method relied on determining simultaneous serum and ascites osmolality (Sosm and Aosm) at the start and finish of a standard 4 hour HD session. THE RESULTS: Sosm and Aosm at the start averaged 310 and 309 mosm/L, respectively. At the end, Sosm averaged 285 and Aosm averaged 301 mosm/L, giving a 16 mosm concentration gradient. Two days later, Sosm and Aosm were equal again. It is concluded that the osmotic gradient at the end of 4 hours of HD favors movement of water from the intravascular space into the ascitic fluid space until osmotic equilibrium is once again achieved.

Ascites↗
PubMed1979

[Treatment of cirrhotic ascites].

The treatment of cirrhotic ascites is based on restriction of dietary sodium and fluid intake coupled with diuretics. Ascitic fluid must always be sampled and infection ruled out. Large abdominal paracenteses are dangerous. Most patients with ascites respond to the dietary-diuretic regimen. The clinician must be watchful for overdiuresis. Some patients need diuretics in ever-increasing doses in an attempt to increase urine flow and are at particular risk of functional renal failure. In these diuretic-resistant cases the ascitic fluid can be withdrawn, ultra-filtered and reinfused by means of suitable apparatus. In 1974, LeVeen and co-workers described a peritoneo-venous shunt system which provides more continuous treatment over many months. The morbidity and mortality of this shunt are difficult to determine from published reports. Long-term controlled studies are needed. The beneficial effect on survival of treatment of cirrhotic ascites is still questioned.

Ascites↗
PubMed1983

The rapid determination of ascitic fluid L-lactate for the diagnosis of spontaneous bacterial peritonitis.

We have prospectively studied the value of ascitic fluid lactic acid levels by a rapid kit method in the diagnosis of SBP. Forty-five nonconsecutive patients admitted with ascites were investigated and their ascitic fluid cell counts and clinical presentation compared with ascitic fluid lactic acid levels. There were seven patients with SBP, six of whom had positive cultures. PMN were greater than 250/mm3 in 6/7 and lactic acid levels greater than 33 mg/dl in 7/7. In eight patients with malignancy without evidence of infection PMN was greater than 250/mm3 in 8/8 and lactic acid greater than 33 mg/dl in 1/8. In the 30 patients (31 samples) with cirrhotic ascites without SBP, 5/31 had elevated PMN and none had elevated lactic acid levels. From this small number of patients, the predictive value of PMN greater than 250/mm3 is 32% compared to 88% for lactic acid levels (if patients with malignancy are included). The predictive value of a PMN less than 250/mm3 is 96% and of lactic acid less than 33 mg/dl is 100%. Our study confirms that of Brook et al. (5), which used the same method and when the lactic acid results of both studies are combined, the sensitivity of lactic acid in SBP is 100% (15/15), the specificity is 96% (79/82), the predictive value positive is 83% (15/18), and the predictive value negative is 100% (76/76). We conclude that lactic acid levels above 33 mg/dl are more reliable than a PMN above 250/mm3 but that PMN and lactic acid levels below these values both accurately predict the absence of SBP. Lactic acid levels can be determined within 15 min and with minimal cost (presently $1.45/test) by a readily available kit as well as by automated equipment.

Ascites↗
PubMed1983

[Effect of cancerous ascites on natural killer activity].

The effect of cancerous ascites on NK activity was evaluated by a 12-hr exposure method. Erythroleukemia cell line, K 562, was used as the target cells, the effector cells were isolated from 34 healthy volunteers. The final protein concentration of ascites was adjusted to 0.02, 0.2 and 2.0 mg/ml, after centrifugation and membrane filtration. When ascites was added at the start of assay, NK activity was almost completely suppressed by cancerous ascites of 2.0 mg/ml; it was not suppressed by 0.02, 0.2 mg/ml. No suppression was found when cancerous ascites was added 6 hrs after the start of assay. Our results suggest that the lowered NK activity of cancer patients may be attributable to unknown factor (s) released from cancer cells.

Ascites↗
PubMed1980

The influence of ascites on the pharmacokinetics of amikacin.

The pharmacokinetics of Amikacin are studied after the administration of 7.5 mg/kg body weight to 10 ascitic patients diagnosed with various hepatic disorders. The antibiotic was determined microbiologically in plasma and in the ascitic fluid. The antibiotic follows a two-compartment kinetic model, and it may be seen that once the rapid disposition phase has ended, an inflexion in the plasma-time levels curve takes place, with a passing increase in the plasma concentrations. From the pharmacokinetic study of Amikacin in these patients, it may be deduced that the ascitic liquid forms part of the central compartment for the effects of distribution, though not for the effects of elimination. The plasma half-life of the slow disposition phase is analogous to that obtained from non-ascitic patients with normal renal function. In one of the patients, the antibiotic was administered intraperitoneally; following this, the plasma concentrations of Amikacin were detected. In the last of the 10 patients included in the survey, the evolution of the plasma concentrations of the antibiotic were studied while the patient was undergoing a multiple dosage regimen with the aim of determining the accumulation of Amikacin in the ascitic fluid. A dosage regimen of multiple doses is programmed which should guarantee the efficiency and safety of the antibiotic.

Amikacin↗
PubMed1994

[Mechanism of ascites formation and its management in liver cirrhosis].

The "underfilling" and "overflow" theories have been proposed as the pathogenesis of ascites formation in patients with liver cirrhosis. The "peripheral arterial vasodilation hypothesis" has been also proposed recently. Essential treatment of ascites are; restriction of physical activity, sodium restriction, supplement of albumin, and diuretic therapy. Alternative therapy for refractory ascites include peritoneal-venous shunt, ascites ultrafiltration and reinfusion and body oppression therapy. Assessment of liver function, renal function and the systemic hemodynamic state as well as characterization of ascitic fluid are also needed to evaluate the effectiveness of the therapy.

Adult↗
PubMed1993

Pathogenesis of malignant ascites formation: initiating events that lead to fluid accumulation.

Initiating events leading to the accumulation of malignant ascites in the peritoneal cavity were investigated in two syngeneic transplantable murine ascites-producing tumors, MOT mouse ovarian tumor and the TA3/St mammary carcinoma. The transport of two tracers, 125I-labeled human serum albumin (125I-HSA) and 51Cr-labeled red blood cells (51Cr-RBC), into and out of the peritoneal cavity was studied at early times after i.p. tumor cell injection, prior to abundant fluid accumulation, and at intervals of 5 to 360 min after i.v. or i.p. tracer injection. Tracer influx and efflux rates were estimated from the mass of tracer passing into or out of the peritoneal cavity following a bolus injection of tracer into either the blood or the peritoneal cavity. Efflux of 125I-HSA from the peritoneal cavity was markedly reduced (3- to 5-fold) within 1 day of i.p. injection of either type of tumor cell. Significantly reduced efflux preceded any increase in tumor cell number and by itself did not induce peritoneal fluid accumulation. 125I-HSA tracer influx from plasma to peritoneal fluid did not increase detectably until 5 to 7 days after tumor cell injection, when the tumor cell number had increased by 10- to 100-fold. Only at relatively late stages of ascites tumor growth, when the flow rate into the peritoneal cavity had increased relative to the flow rate out of the peritoneum, was there net peritoneal fluid accumulation. Thus, increased influx, in addition to impaired efflux, were required for malignant ascites accumulation. Following i.p. injection, the efflux rates of 125I-HSA always exceeded those of 51Cr-RBC, even in ascites tumor-bearing animals. Furthermore, 125I-HSA tracer disappeared from the peritoneal cavity more rapidly than it appeared in the plasma, suggesting that 125I-HSA moves more rapidly through the channels by which 51Cr-RBC egress from the peritoneum (primarily diaphragmatic lymphatics) and/or has access to additional pathways not open to 51Cr-RBC. Finally, flow rates into and out of the blood and peritoneum were used to obtain kinetic parameters that characterized tracer transport: k1, the rate constant for tracer transport from the blood to the peritoneum; k2, the rate constant for tracer transport from the peritoneal cavity to the blood; and k6, the rate constant for tracer transport from the peritoneal cavity to surrounding interstitial tissue.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1976

Pancreatic ascites: recognition and management.

In a patient with chronic ascites, an abnormally raised ascitic fluid amylase concentration and a protein content above 2.5 gm/100 ml is diagnostic of pancreatic ascites. Thirty-one episodes in 26 patients treated between 1958 and 1975 have been analyzed. Twenty patients (65%) experienced abdominal pain and ten (32%) had concomitant pleural effusions roentgenographically. Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes (70%), an abdominal mass could only be palpated in two of 26 patients. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7 of 21 episodes (33%). Endoscopic retrograde pancreatography is invaluable in delineating the pancreatic ductal system and, in conjunction with intraoperative pancreatography, makes a vital contribution to rational surgical therapy. Medical treatment or external drainage during 18 episodes resulted in death in four (22%) and recurrences of ascites or pancreatic pseudocyst in nine (64%). Since routine pancreatography followed by pancreatic resection or internal drainage has been instituted, mortality and recurrence have been reduced to zero.

Adult↗
PubMed1986

LeVeen vs Denver peritoneovenous shunts for intractable ascites of cirrhosis. A randomized, prospective trial.

Peritoneovenous shunts (PVSs) have provided salutary effects on medically recalcitrant ascites, functional renal impairment, nutritional derangements, ventilatory embarrassment, and locomotion potential in patients with cirrhosis. While the LeVeen (LPVS) and Denver (DPVS) PVSs are most frequently implanted in such patients, postoperative complications of bleeding gastroesophageal varices, sepsis, and shunt occlusion occur with notable frequency. Addressing primarily the complication of PVS occlusion, a randomized prospective trial of LPVSs and DPVSs was conducted in cirrhotic patients with refractory ascites. From July 1, 1982 to July 1, 1984, 26 initial PVSs were implanted for hepatic-related intractable ascites. Twenty-two patients were eligible for randomization (cirrhosis, sterile ascites, initial PVS, total bilirubin level less than or equal to 6.0 mg/dL, prothrombin time less than or equal to 5-s prolongation, serum creatinine level less than or equal to 2.0 mg/dL [creatinine clearance rate greater than or equal to 20 mL/min], absence of recent [less than 30 days] bleeding gastroesophageal varices, or absent spontaneous encephalopathy). Twelve LPVSs and ten DPVSs were implanted; however, one patient with a DPVS was found to have hepatic polycystic disease and was excluded from analysis. All patients were followed up until death or Jan 1, 1985. The PVS patency determinations included contrast shuntography, technetium Tc 99m albumin scintigraphy, sequential manual compression (DPVS), and operative or autopsy observation. Using the Kaplan-Meier actuarial analysis, the LPVS patency proved to be highly superior to that of the DPVS, while survival was not significantly different. As LPVS and DPVS complications other than patency are comparable, the LPVS is preferred for its superior patency in cirrhotic patients with intractable ascites.

Actuarial Analysis↗
PubMed1988

Should portosystemic shunt be reconsidered in the treatment of intractable ascites in cirrhosis?

Fifty-seven cirrhotic patients with intractable ascites had a portosystemic shunt. In 35 patients, a peritoneovenous shunt had previously failed. Forty-six patients were in Pugh's class B and 11 were in class C. There were three operative deaths (5.3%). Fifty-three (98.2%) of the 54 survivors were cleared of ascites. In one patient, ascites persisted because of postshunt heart failure that resulted in a marked increase of caval pressure. Twenty-seven patients (50%) had late encephalopathy, which was severe and disabling in 12 (22%). One- and three-year survival rates were 72% and 36%, respectively. These results suggest that although portosystemic shunts are remarkably effective in dealing with ascites, the high rate of postoperative encephalopathy is a strong argument against their routine use in the management of intractable ascites in cirrhosis.

Adult↗
PubMed1999

Myeloma ascites--a favorable outcome with cyclophosphamide therapy.

A 71-year-old woman with multiple myeloma (MM) in remission was admitted for evaluation of recent abdominal distension and was diagnosed as having massive myeloma ascites. The fluid was characterized by a total nucleated cell count of 6,600/mm3 (67% plasma cells), with a plasma cell CD38+ phenotype. Chemical analysis of the fluid showed lactate dehydrogenase of 122 IU/L, total protein of 2.9 g/dL, albumin of 2.4 g/dL, diastase of 38 IU/dL, cholesterol of 46 mg/dL, and C-reactive protein of 3 g/dL. The serum-ascites albumin gradient (SAAG) was low (0.9). Electrophoresis of the ascitic fluid showed a monoclonal spike in the gamma region and immunoelectrophoresis confirmed the presence of lambda light chains similar to those seen in the urine. Further analysis of the ascitic fluid showed markedly elevated levels of beta2 microglobulin (11,161 microg/L) and interleukin-6 (146 pg/ml compared to serum level of 4.3 pg/ml). There was evidence of intraabdominal masses that completely resolved with continuous high-dose cyclophosphamide (750 mg/m2/day for four days) followed by clinical improvement and disappearance of the ascites. We stress the value of complete fluid characterization and intensive chemotherapy to achieve a favorable outcome.

ADP-ribosyl Cyclase↗
PubMed1996

High mortality after abdominal operation in patients with large-volume malignant ascites.

Advanced intra-abdominal cancers are frequently associated with malignant ascites. The aim of this study was to document the frequency and clinical course of patients found to have large-volume ( > or = 3 L) malignant ascites when undergoing a major abdominal operation. Between October 1, 1987 and September 1, 1992, 385 patients with malignant ascites were admitted to hospitals associated with a university medical center. Seventeen with large volume ascites underwent exploration for palliation of bowel obstruction or debulking of tumor. Operative mortality was 41% and mortality correlated with the presence of a nonovarian primary and advanced age. We conclude that patients with large volume nonovarian malignant ascites have a high mortality rate following a major abdominal operation. New approaches such as neoadjuvant or intraperitoneal chemotherapy or possibly peritoneovenous shunt placement at the time of the abdominal operation, are needed to improve the dismal results in this subgroup of patients.

Abdominal Neoplasms↗
PubMed1997

Optic chiasm glioma, electrolyte abnormalities, nonobstructive hydrocephalus and ascites.

A 4-year-old girl with optic chiasm glioma (OCG), nonobstructive hydrocephalus and ventriculoperitoneal shunt is described, in whom marked ascites developed. The ascitic fluid was protein-rich and its amount correlated with cerebrospinal fluid (CSF) protein. The CSF protein level and the amount of ascitic fluid were influenced by chemotherapy. Very unusual hypernatremia, up to 190 mEq/l with no associated alteration in mental status, was also found. It is suggested that altered absorption ability owing to the high protein content was the cause of both the nonobstructive hydrocephalus and the ascites. The unusual well being with very high sodium concentrations may have resulted from osmoreceptor dysfunction, presumably caused by hypothalamic involvement as well as by the high CSF protein. This combination of findings may point toward specific characteristics of OCG. In an effort to reduce the amount of the ascitic fluid, a further chemotherapeutic trial may be done, before converting the shunt to the vetriculoatrial system.

Ascites↗
PubMed1980

Palliation of malignant ascites by the LeVeen peritoneo-venous shunt.

A LeVeen peritoneo-venous shunt was placed in each of 5 patients under local anesthesia to relieve symptomatic malignant ascites. All patients had marked ascites due to histologically documented intraabdominal carcinomatosis, extensive hepatic neoplasm, or a combination of malignant ascites and severe parenchymal liver disease. Cases included metastatic breast carcinoma, pancreatic carcinoma, melanoma, and primary cholangiocarcinoma. Prompt relief of respiratory distress and discomfort associated with tense ascites was achieved in all patients; however, survival was short (one week to seven months) due to advanced disease. The LeVeen shunt can provide effective palliation of malignant ascites in carefully selected symptomatic patients.

Abdominal Neoplasms↗
PubMed1993

Serum and ascitic fluid levels of interleukin-1, interleukin-6, and tumor necrosis factor-alpha in patients with ovarian epithelial cancer.

BACKGROUND: Recent studies have shown that multiple cytokines are secreted by ovarian epithelial cancer cells. Previous studies have shown that the cancer cell lines secrete macrophage colony-stimulating factor (M-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 (IL-1), interleukin-6 (IL-6), and transforming growth factor-alpha (TGF-alpha). Concomitantly, the serum levels of one of the growth factors (M-CSF) was found to be significantly elevated in patients with primary ovarian cancer and in second-look patients. The authors evaluated the serum levels of IL-1 alpha, IL-1 beta, IL-6, and tumor necrosis factor-alpha (TNF-alpha) in patients with primary ovarian epithelial cancer. These levels were then compared with cytokine concentration found in normal peritoneal fluid. METHODS: Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of cytokines in normal peritoneal fluid, ascites, and serum. RESULTS: In serum, TNF-alpha and IL-6 were significantly increased in primary ovarian cancer patients when compared with control subjects (P < 0.0001 for both cytokines). TNF-alpha and IL-6 were also significantly higher than the levels found in second-look patients (P < 0.007 for TNF-alpha, and P = 0.0002 for IL-6). The levels of IL-1 alpha and beta were not elevated in ovarian cancer. TNF-alpha in the ascites was higher when compared with normal peritoneal fluid and was statistically significantly different when a cut-off point between 71-110 pg was selected (P < 0.005). The levels of IL-6 in ascites from patients with primary ovarian cancer also showed a marked increase (P < 0.0001) when compared with peritoneal fluid from control subjects. CONCLUSIONS: Levels of IL-1, IL-6, and TNF-alpha were determined in normal peritoneal fluid, ovarian malignant ascites, normal serum, and serum from patients with ovarian cancer. This study showed that the patients with ovarian cancer have elevated levels of IL-6 and TNF-alpha in serum and ascitic fluid. A larger study would help in evaluating the potential use of cytokines as tumor markers in ovarian cancer.

Ascitic Fluid↗
PubMed1995

The significance of urokinase- type plasminogen activator, its inhibitors, and its receptor in ascites of patients with epithelial ovarian cancer.

BACKGROUND: Strong correlations have been reported between expression of urokinase-type plasminogen activator (uPA) and poor prognosis in several human carcinomas. The clinical significance of secreted levels of uPA, its receptor (uPAR), and its inhibitors (PAI-1 and PAI-2) in the ascites of patients with epithelial ovarian cancer patients was investigated. METHODS: uPA, uPAR, PAI-1, and PAI-2 were measured in the primary ascites of 36 patients with epithelial ovarian cancer by enzyme-linked immunosorbent assay, and normalized to protein content. The relationship between levels of these factors in ascites and clinicopathologic variables, survival, and disease free interval (DFI) was studied. Because high levels of macrophage colony stimulating factor (CSF-1) in ascites is a known poor prognostic indicator for ovarian cancer, the effect of CSF-1 on secretion of PAI-2 by ovarian cancer cells was also examined in vitro. RESULTS: High uPA levels per se did not correlate with either survival or DFI. However, the ratio of uPAR normalized for uPA content correlated inversely with FIGO stage and residual disease, with a significant association between high uPAR/uPA level and prolonged survival and DFI. High PAI-1 levels (> 0.120 ng/mg) proved to be a good prognostic factor, correlating with both prolonged DFI and residual disease < or = 5 cm among Stage 3 patients. Conversely, high levels of PAI-2 (> 0.061 ng/mg) indicated a poor prognosis in Stage 3 patients, as high PAI-2 levels were associated with shorter DFI and survival. CSF-1 stimulated the secretion of PAI-2 by 2.4-fold in Bix3 ovarian carcinoma cells. Multivariate analysis revealed that the two independent prognostic factors for DFI in Stage 3 patients were PAI-1 and PAI-2; Stage 3 patients with high secreted PAI-1 and low PAI-2 levels have a median DFI that was prolonged by 30 months relative to the rest of the group. CONCLUSION: Secreted uPAR/uPA appears to measure tumor burden and predicts prolonged DFI and survival, but was not found to be an independent prognostic factor on multivariate analysis. High levels of PAI-1 in ascites were independently associated with prolonged DFI among Stage 3 patients. Therefore, secreted uPAR and PAI-1 may modulate uPA activity and lead to improved outcome. This contrasts with the finding that secreted PAI-2 is an independent factor indicating poor prognosis, which may relate in part to the actions of CSF-1. This study emphasizes the importance of uPA, its receptor, and its inhibitors in patients with epithelial ovarian cancer.

Adult↗
PubMed1988

Immunocytochemical presentation of alpha-fetoprotein-producing gastric cancer in ascitic fluid: a case study.

A case of primary gastric cancer without hepatic metastasis showing extremely high alpha-fetoprotein (AFP) levels is reported. This case illustrates the application of the immuno-peroxidase technique to ascitic fluid cytology. Papanicolaou-stained smears of the ascites permitted the diagnosis of a metastatic carcinoma. A positive reaction to AFP was demonstrated in the tumor cells in the ascitic fluid cellular samples as well as in the paraffin-embedded tissue section of the primary gastric carcinoma. Rising AFP levels were also detected in ascitic fluid. AFP fractionation using lectin-affinity-crossed-line immunoelectrophoresis showed the hepatic rather than yolk sac type. Reports of such occurrences are few; no study, to the best of our knowledge, has previously documented cytological and immunocytochemical diagnosis in ascitic fluid. AFP-producing gastric cancer should be considered in the differential diagnosis.

Adenocarcinoma↗