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PubMed2003

Spontaneous healing of chylous ascites after abdominal aortic aneurysm repair.

Postoperative chylous ascites is a rare complication of aortic surgery. This report presents a patient with chylous ascites after abdominal aneurysmectomy. After a retrospective analysis of full blood count measurements, we observed an association between the number of lymphocytes in the patient's total blood count and the development and evaluation of chylous ascites. We believe that this hypothesis might be helpful, as it suggests that the number of lymphocytes in a patient's total blood count may be used as a prognostic factor for the development of chylous ascites. Furthermore, our patient appears to be of interest from a therapeutical point of view, since repeated therapeutic paracenteses alone were sufficient in treating chylous ascites, a finding in contradiction to international literature.

Aortic Aneurysm, Abdominal↗
PubMed2006

The transjugular intrahepatic portosystemic shunt for the management of cirrhotic refractory ascites.

Cirrhotic ascites results from sinusoidal hypertension and sodium retention, which is secondary to a decreased effective arterial blood volume. Transjugular intrahepatic portosystemic shunt (TIPS) placement is currently indicated in cirrhotic patients with refractory ascites who require large-volume paracentesis (LVP) more than two or three times per month. TIPS placement is associated with normalization of sinusoidal pressure and a significant improvement in urinary sodium excretion that correlates with suppression of plasma renin activity, which is, itself, indicative of an improvement in effective arterial blood volume. Compared with serial LVP, placement of an uncovered TIPS stent is more effective at preventing ascites from recurring; however, increased incidence of hepatic encephalopathy and shunt dysfunction rates after TIPS placement are important issues that increase its cost. Although evidence suggests that TIPS placement might result in better patient survival, this needs to be confirmed, particularly in light of the development of polytetrafluoroethylene-covered stents. Favorable results apply to centers experienced in placing the TIPS, with the aim being to decrease the portosystemic gradient to <12 mmHg but >5 mmHg. This article reviews the pathophysiologic basis for the use of a TIPS in patients with refractory ascites, the results of controlled trials comparing TIPS placement (using uncovered stents) versus LVP, and a systematic review of predictors of death after TIPS placement for refractory ascites.

Ascites↗
PubMed2001

Serial analysis of serum and ascitic fluid levels of soluble adhesion molecules and chemokines in patients with spontaneous bacterial peritonitis.

The aim of this work was the evaluation of serum and ascitic fluid levels of chemokines (IL-8, growth-regulated oncogene (Gro-alpha), and monocyte chemotactic protein-1 (MCP-1)), and of soluble adhesion molecules (P-selectin, E-selectin, L-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)) in patients with spontaneous bacterial peritonitis (SBP). These compounds were serially analysed in serum and ascitic fluid by ELISA in patients with SBP (n = 20), non-infected cirrhotic controls (n = 12), and healthy controls (n = 15). Infected and non-infected cirrhotic patients showed significantly higher serum levels of adhesion molecules. SBP was associated with significantly higher serum and ascitic fluid levels of IL-8, Gro-alpha and ICAM-1 and with ascitic fluid concentrations of MCP-1. Significantly elevated serum levels of both ICAM-1 and VCAM-1 were detected in patient non-survivors after SBP. Thus, higher ascitic fluid levels of chemokines could be implicated in the peritoneal infiltrate in patients with SBP. Prognostic significance can be attributed to serum levels of ICAM-1 and VCAM-1 in these patients.

Ascitic Fluid↗
PubMed2001

Ultrastructural and molecular changes in the left and right ventricular myocardium associated with ascites syndrome in broiler chickens raised at low altitude.

The present study examines ultrastructural and molecular changes in ventricular myocardium associated with ascites cases in fast-growing broilers raised at low altitude. Extensive ultrastructural lesions were seen in the left and right ventricular myocardium of broilers with fulminant heart failure and ascites. Significant changes included lesions in the myofibril contractile apparatus, altered mitochondria, marked reduction in the myofibril component, and changes in the extracellular matrix (ECM) architecture. No lesions were observed in hearts of slow growing broilers, but mild to moderate changes (predominantly in the left ventriculum) were apparent in the hearts from some clinically normal, fast-growing broilers. SDS-PAGE profiles of washed myofibrils showed several distinctly different bands in preparations from left ventricular myocardium of ascitic birds. Western blot analysis of these samples revealed several fragments of myosin heavy chain, M-protein, and titin. Based on gelatinolytic activity, matrix metalloproteinases (MMP) in the cytosolic fraction of ventricular myocardium homogenates were identified as MMP-2. The relative activity of this enzyme appears to be considerably higher in preparations from broilers, particularly in the preparations from the left ventriculum of fast-growing broilers, in comparison to leghorns or slow growing broilers. The nature and distribution of the changes in the heart indicate that chronic cardiomyopathic process in the left ventricular myocardium occurs during the development of ascites. It is postulated that progressive deterioration of the left heart pump function caused by initial lesions in the left ventricular myocardium is a significant factor in the development of pulmonary hypertension and the pathogenesis of ascites in broilers raised at low altitude.

Altitude↗
PubMed2002

Management of refractory ascites and hepatorenal syndrome.

Refractory ascites and hepatorenal syndrome (HRS) are the late complications of the terminal stages of cirrhosis. The definitions of refractory ascites and HRS proposed by the International Ascites Club in 1996 are now widely accepted, and are useful in diagnosis, treatment and research in this field. In both conditions, the only treatment of proven value for improved survival is liver transplantation. However, because of better understanding about the pathophysiology of HRS, including the roles of portal hypertension, ascites formation and hemodynamic derangements, treatments such as transjugular intrahepatic portasystemic shunt (TIPS) and new pharmacological agents may be considered to alleviate the problem prior to transplantation. Symptomatic treatment of refractory ascites includes TIPS and repeated large volume paracentesis. Transjugular intrahepatic portasystemic shunt can improve survival while waiting for liver transplantation. Practical management guidelines for TIPS and large volume paracentesis, including the prevention and management of further complications, are considered in this review.

Ascites↗
PubMed1996

Fetal echocardiography guidelines to predict survival of fetuses with ascites.

In a retrospective analysis of the standard protocols for fetal echocardiographic examination, 27 fetuses (mean gestational age 29 +/- 5.4 weeks) with ascites were evaluated. Fetal cardiomegaly (increased heart area/chest area ratio), the presence or absence of atrioventricular valve regurgitation, inferior vena cava and ductus venosus Doppler flow velocity and umbilical vein pulsation were evaluated quantitatively in a group of survivors and non-survivors. A statistically significant difference between the two groups was found for the presence of atrioventricular valve regurgitation (p = 0.003), and for cardiomegaly (p = 0.009). There was no statistical difference for the presence of abnormal venous flow and umbilical pulsation (p > 0.05). Abnormal venous Doppler flow velocities in the inferior vena cava and ductus venosus were observed more frequently than umbilical vein pulsation. The mean heart area/chest area ratios in the group of survivors and in the group of non-survivors were 0.34 +/- 0.09 and 0.48 +/- 0.08, respectively (p < 0.001). The mean gestational ages at the time of diagnosis of ascites in the groups of survivors and non-survivors were 33 +/- 3.3 weeks and 28 +/- 5.1 weeks, respectively (p < 0.05); the mean gestational ages at the time of delivery were 35.6 +/- 2.3 weeks and 33.3 +/- 4.9 weeks, respectively (p = 0.33). In terms of different echocardiographic features as well as the gestational age of the unborn patient with ascites, there is apparently no single indicator of a poor prognosis. Our results suggest that the prognosis is usually poor in a fetus with ascites, when cardiomegaly is detected, as well as the presence of tricuspid and mitral valve regurgitation. This is regardless of the type of venous flow and regardless of the etiology of the ascites.

Ascites↗
PubMed1998

Reinfusion and concentration of ascitic fluid during hemodialysis in a cirrhotic uremic patient.

Management of tense ascites in cirrhotic patients on chronic hemodialysis is still a matter of speculation. A considerable problem with these patients is the frequent occurrence of hypotension during ultrafiltration. We describe a patient in whom ascitic fluid was reinfused on the arterial line and ultrafiltrated during standard treatment by using a single dialysis monitor, standard dialysis (SD) lines, and a standard hollow-fiber dialyzer. After 30 to 60 minutes of dialysis, with the patient lying on his left side, a gauge #16 IV catheter was introduced into the left lower abdomen and connected to the reinfusion line. The ascitic fluid was pumped from the abdomen to the arterious inlet of the coil at 500 to 2,000 mL/hr and ultrafiltered. In an individual patient, 13 sessions of ascites reinfusion-ultrafiltration dialysis (ARD) were performed over 3 months and compared with 18 SD sessions performed during the same period. In all procedures, the same SD equipment was used. During ARD, the average weight loss was 2.9 (SD 1.0) kg compared with a weight loss of 0.3 (0.04) kg during SD (P < 0.01). Baseline mean blood pressure was similar in both procedures; after starting dialysis, mean arterial pressure (MAP) dropped by an average of 15 mm Hg at 30 and 60 minutes. Subsequently, during ARD, MAP increased progressively by an average of 20 mm Hg at 180 minutes, whereas MAP did not change significantly during SD. Comparison between procedures by nonparametric one-way analysis of variance showed that body weight became significantly different at 120, 150, and 180 minutes (P < 0.01) and MAP at 150 and 180 minutes (P < 0.02 and P < 0.01, respectively). No major complications occurred. During ARD, on average urea reduction rate was 67%. ARD may represent an effective and safe combination between hemodialysis and the palliative treatment of tense ascites in cirrhotic uremic patients.

Aged↗
PubMed1997

Low albumin gradient ascites complicating severe pseudomembranous colitis.

Pseudomembranous colitis (PMC) is a frequently severe, sometimes fatal iatrogenic disease that is antibiotic-associated in almost all cases. The most common clinical features of PMC include abdominal pain, watery diarrhea, fever, leukocytosis, hypoalbuminemia, and hypovolemia. Ascites, not considered a well-known feature of PMC, is fairly common, based on a review of the English language literature but has not been characterized fully. This case report describes 5 patients with PMC who presented with low serum-ascites albumin gradient (SAAG) and neutrocytic ascites, without evidence of infectious, malignant, or inflammatory peritoneal disease, which has not been reported previously. In 1 patient, massive low SAAG ascites was the presenting manifestation of PMC, a feature also not reported previously. Three of the 5 (60%) patients had acquired immunodeficiency syndrome. The characteristics of the fluid specimens in these 5 patients and the possible pathogenetic mechanisms are proposed. The findings suggest that PMC should be included in the differential diagnosis of low SAAG ascites, especially in patients with acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis.

BACKGROUND & AIMS: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain. METHODS: Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs. RESULTS: Twenty patients treated with TIPS and 18 treated with paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 +/- 43 vs. 325 +/- 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the paracentesis group (P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the paracentesis group. CONCLUSIONS: In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated paracentesis plus albumin.

Ascites↗
PubMed2005

Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis.

BACKGROUND & AIMS: Several trials showed that uncovered transjugular intrahepatic portosystemic shunt (TIPS) is superior to paracentesis for the control of refractory ascites. However, the results for encephalopathy and mortality were not consistent across trials. We performed a systematic review of randomized controlled trials of TIPS for refractory ascites to assess the overall treatment effects and to explore potential reasons of heterogeneity. METHODS: Pertinent studies were retrieved trough MEDLINE (1968-2004), EMBASE (1986-2004), the Cochrane Library (2004;4), and reference lists of key articles. Outcome measures were recurrence of ascites, encephalopathy, and mortality. Metaregression analysis was used to explore heterogeneity. RESULTS: Five trials were identified including 330 patients. Successful TIPS placement ranged from 77% to 100% and portosystemic pressure gradient reduction ranged from 6.0 to 14.0 mm Hg. Metaregression analysis showed that bilirubin levels and successful TIPS placement rates were associated significantly with log-odds ratio for death after TIPS, explained heterogeneity of trials for mortality, and suggested an outlier trial. After exclusion of the outlier trial, pooled odds ratios for recurrence of ascites with TIPS was .14 (confidence interval, .07-.27), for encephalopathy was 2.26 (confidence interval, 1.35-3.76), and for mortality was .74 (confidence interval, .40-1.37), without any significant heterogeneity. CONCLUSIONS: Uncovered TIPS is significantly better than paracentesis for control of refractory ascites. Although it increases encephalopathy, it also is associated with a trend toward improvement of survival. Future TIPS trials should select patients on the basis of bilirubin levels and predictors of the risk for post-TIPS encephalopathy, and assess costs and quality of life.

Ascites↗
PubMed1983

Endoscopic diagnosis of ascites in Assiut province, upper Egypt.

Fifty-nine case of ascites not due to cardiac or renal disease were subjected to clinical, endoscopic and laboratory investigations, including bacteriology and histopathology. Provisional diagnosis divided the cases into 38 patients with ascites as the main finding, and 21 patients with liver cirrhosis and ascites. After investigation, the final diagnosis was totally different from the provisional in 15 cases. Predominance of tuberculosis of the peritoneum per se or in addition to liver cirrhosis was striking, and its documentation was possible only through laparoscopy and biopsy. Oesophagoscopy, a simple procedure, revealing varices in undiagnosed ascites, points to liver cirrhosis. Laparoscopy confirms the diagnosis and reveals other additional factors for ascites as malignancy or tuberculosis.

Ascites↗
PubMed1981

[The antenatal ultra-sonic diagnosis of ascites in the newborn (author's transl)].

The antenatal diagnosis of fetal ascites by ultrasonography is possible by the typical finding of a zone free of echos in the fetal abdomen. Among 7,833 newborns 2 live born infants with fetal ascites were observed. The fetal prognosis can be improved by early diagnosis and differential diagnostic tests during the pregnancy. The antenatal diagnosis includes a search for hydrops, congenital anomalies of the heart, anomalies of the lower urinary tract, intra-abdominal calcifications and diagnosis of the sex. Infectious causes such as syphilis, toxoplasmosis, cytomegaly and hepatitis must be excluded. Delivery may have to be by cesarean section paracentesis of the fetal ascites through the maternal abdominal wall may be necessary. A neonatalogist must be present at birth. The neonatal diagnosis of the ascites starts with a flat plate of the abdomen in search of calcifications, bowel distensions, and pneumoperitoneum. Intravenous pyelogram and cystography show urine-ascites which has the best therapeutic prognosis. The investigation should be finished within 12 hours after birth. Acute respiratory distress may require neonatal paracentesis.

Ascites↗
PubMed2000

A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites.

BACKGROUND: In patients with cirrhosis and ascites, creation of a transjugular intrahepatic portosystemic shunt may reduce the ascites and improve renal function. However, the benefit of this procedure as compared with that of large-volume paracentesis is uncertain. METHODS: We randomly assigned 60 patients with cirrhosis and refractory or recurrent ascites (Child-Pugh class B in 42 patients and class C in 18 patients) to treatment with a transjugular shunt (29 patients) or large-volume paracentesis (31 patients). The mean (+/-SD) duration of follow-up was 45+/-16 months among those assigned to shunting and 44+/-18 months among those assigned to paracentesis. The primary outcome was survival without liver transplantation. RESULTS: Among the patients in the shunt group, 15 died and 1 underwent liver transplantation during the study period, as compared with 23 patients and 2 patients, respectively, in the paracentesis group. The probability of survival without liver transplantation was 69 percent at one year and 58 percent at two years in the shunt group, as compared with 52 percent and 32 percent in the paracentesis group (P=0.11 for the overall comparison, by the log-rank test). In a multivariate analysis, treatment with transjugular shunting was independently associated with survival without the need for transplantation (P=0.02). At three months, 61 percent of the patients in the shunt group and 18 percent of those in the paracentesis group had no ascites (P=0.006). The frequency of hepatic encephalopathy was similar in the two groups. Of the patients assigned to paracentesis in whom this procedure was unsuccessful, 10 received a transjugular shunt a mean of 5.5+/-4 months after randomization; 4 had a response to this rescue treatment. CONCLUSIONS: In comparison with large-volume paracentesis, the creation of a transjugular intrahepatic portosystemic shunt can improve the chance of survival without liver transplantation in patients with refractory or recurrent ascites.

Adult↗
PubMed2004

Effects of dietary L-carnitine and coenzyme Q10 supplementation on performance and ascites mortality of broilers.

The study was conducted to determine the effects of dietary L-carnitine and coenzyme Q10 (CoQ10) supplementation on growth performance and ascites mortality of broilers. A 3 x 3 factorial arrangement was employed with three levels (0, 75 and 150 mg/kg) of L-carnitine and three levels of CoQ10 (0, 20 and 40 mg/kg) supplementation during the experiment. Five hundred and forty one-day-old Arbor Acre male broiler chicks were randomly allocated into nine groups with six replicates each. All birds were fed with the basal diets from day 1 to 7 and changed to the experimental diets from day 8. During day 15 to 21 all the birds were exposed to low ambient temperature (15-18 degrees C) to induce ascites. The results showed that under this condition, growth performance of broilers were not significantly affected by CoQ10 or L-carnitine + CoQ10 supplementation during week 0-3 and 0-6, but body weight gain (BWG) of broilers was significantly reduced by 150 mg/ kg L-carnitine during week 0-6. Packed cell volume (PCV) of broilers was significantly decreased by L-carnitine and L-carnitine + CoQ10 supplementation (P < 0.05). Erythrocyte osmotic fragility (EOF), ascites heart index (AHI) and ascites mortality of broilers were significantly decreased by L-carnitine, CoQ10 and L-carnitine + CoQ10 supplementation. Though no significant changes were observed in total antioxidative capability (T-AOC), total superoxide dismutase (T-SOD) was increased by L-carnitine, CoQ10 and L-carnitine + CoQ10 supplementation (P < 0.05). Malonaldehyde (MDA) content was significantly decreased by CoQ10 and L-carnitine + CoQ10 supplementation. The results indicate that dietary L-carnitine and CoQ10 supplementation reduce ascites mortality of broilers; the reason may be partially associated with their antioxidative effects.

Animal Feed↗
PubMed1992

Whole blood and plasma viscosity values in normal and ascitic broiler chickens.

1. Whole blood and plasma viscosity values in normal and ascitic broiler chickens were measured. 2. The mean blood viscosity value in ascitic broilers was greater than that of the controls. There was a small but significant difference in the opposite direction between plasma viscosity values of the respective groups of birds. 3. Although the haematocrit and arterial pressure index values in the ascitic birds were raised, there was a fall in the concentration of total plasma protein. 4. The data suggest that the raised viscosity in the ascitic birds was caused by a polycythemia and not by any influence of plasma protein. 5. The cumulative effect of these factors, such as raised blood viscosity values and larger deformed red cells flowing through constricted lung arterioles, may contribute to the pulmonary hypertension and ascites seen in some young commercial broilers.

Animals↗
PubMed1996

Different characteristics in chick embryos of two broiler lines differing in susceptibility to ascites.

1. The relationship between the length of incubation, hatching, hypoxic condition, thyroid hormones and the occurrence of ascites were studied in embryos of 2 broiler lines differing in susceptibility to the ascites syndrome. 2. Both the time of external pipping (ep) and hatching of embryos from the ascites-resistant (AR) broiler line was earlier compared to the ascites-sensitive line (AS). The interval between internal pipping (ip) and ep was the same between the lines, but the interval between ep and hatching was shorter in the resistant line. 3. The T3 and T4 concentrations in plasma of the AS line were lower compared to the AR line. 4. Analyses of partial pressures of oxygen (pO2) and carbon dioxide (pCO2) in the air cell of the egg revealed that at day 18 the AS embryos had lower pO2 and higher pCO2 concentrations compared to the AR embryos. 5. The delay in hatching of the AS embryos might induce a more pronounced and/or extended hypoxic environment, thereby creating an environment that evokes ascites.

Animals↗
PubMed1999

Performance and physiological variables in broiler chicken lines differing in susceptibility to the ascites syndrome: 1. Changes in blood gases as a function of ambient temperature.

1. Male broilers of 5 genetic stocks (A, B, C, D, E) selected in different ways for fast growth and low food conversion ratio (FCR) and differing in ascites sensitivity were subjected to 2 different ambient temperature step down regimens: high temperature (HT: 33 to 20 degrees C over 33 d) and low temperature (LT: 30 to 15 degrees C over 17 d). 2. Ascites incidence was recorded daily. Food intake and body weight gain were measured weekly and FCR was calculated. Heat production (Hp) was calculated using the comparative slaughter method. At 28 d venous samples were taken for blood gas analysis and haematocrit and relative heart, lung and liver weights were recorded. 3. Populations A and C showed the highest growth rates combined with a low FCR and a higher ascites incidence. A low FCR in these stocks was attributable to low values for Hp. These stocks also had low PO2 and high pCO2 in venous blood at low ambient temperature compared with other stocks. Stock B, which exhibited the slowest growth rate and the highest FCR, was not susceptible to ascites and showed higher Hp and PO2 and pCO2 at low ambient temperature. Populations D and E were intermediate for almost all variables. Heart and lung weights were both increased at LT, while liver weight did not differ between temperature regimes. 4. Our results show that a high haematocrit is not necessarily linked with an increased susceptibility to ascites.

Animals↗
PubMed2000

Transjugular intrahepatic portosystemic shunt for cirrhosis and ascites: Effects in patients with organic or functional renal failure.

BACKGROUND: A transjugular intrahepatic portosystemic shunt (TIPS) is increasingly being used for treatment of patients with refractory ascites and functional renal failure. In contrast, organic renal disease is commonly considered a relative contraindication for TIPS placement. The aim of this pilot study was to investigate the effects of TIPS in patients with refractory ascites and organic or functional renal impairment. METHODS: A TIPS was placed for refractory or intractable ascites in 10 consecutive patients with liver cirrhosis and impaired renal function (serum creatinine > 1.5 mg/100 ml). Four of them had organic kidney disorders. Of these patients, three had moderate renal impairment, and one had end-stage renal disease and needed hemodialysis every other day. The other six patients had functional renal impairment due to the underlying liver disease. RESULTS: TIPS was effective in reducing ascites in 8 of 10 patients, including all patients with organic renal disease. Furthermore, after TIPS the renal function improved in all patients. Serum creatinine and serum urea levels decreased significantly from 1.8 +/- 0.1 to 1.5 +/- 0.1 mg/100 ml (P < 0.05) and from 107 +/- 13 to 78 +/- 14 mg/100 ml (P < 0.05), respectively. The renal function of the three patients with organic renal failure improved similarly, as observed in the six patients with functional renal failure. In the patient on hemodialysis, TIPS was effective in reducing the frequency of paracenteses. CONCLUSION: TIPS may be useful in patients with functional and in patients with organic renal disease, resulting in improvement of ascites and renal function.

Aged↗