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PubMed2006

Radiofrequency ablation of the liver in a rabbit model: creation of artificial ascites to minimize collateral thermal injury to the diaphragm and stomach.

PURPOSE: To assess whether the creation of artificial ascites during radiofrequency (RF) ablation of the subcapsular portion of the liver can minimize collateral thermal injury to the diaphragm and stomach. MATERIALS AND METHODS: A total of 20 percutaneous RF ablation procedures were performed in the livers of 10 rabbits (control, n = 5; experimental, n = 5) with use of an internally cooled electrode (1-cm active tip). In the experimental group, artificial ascites was established before RF ablation by dripping 320 mL of normal saline solution via a 20-gauge sheathed needle to separate the liver from the diaphragm and stomach. In each rabbit, two subcapsular ablation zones were made in the inferior tip of the left lobe of the liver adjacent to the stomach and in the far dome of the right lobe next to the diaphragm consecutively. After the animals were killed 3 days after the procedure, the frequency, size, and degree of thermal injury were compared between the experimental and control groups. The degree of thermal injury was graded by visual inspection according to a four-point scoring system. Representative cases underwent gross and histologic analysis. RESULTS: Artificial ascites was achieved successfully with a single puncture in all rabbits in the experimental group. Mean procedure time for the formation of artificial ascites was 9 minutes. There was no difference in the size of the RF ablation zones in the liver between the two groups (P > .05). Thermal injury in the adjacent organs was observed significantly more frequently in the control group compared with the experimental group (diaphragm, 100% vs 0; stomach, 80% vs 20%; P < .05). CONCLUSION: Creation of artificial ascites may be a simple and useful technique that can be used to reduce the frequency and severity of thermal injury during RF ablation of subcapsular hepatic tumors.

Animals↗
PubMed1991

Suppression of lymphocyte signal transduction by murine mastocytoma ascites.

The lymphocyte signal transduction, as determined by intracellular free Ca2+ mobilization of concanavalin A-stimulated T lymphocytes and of anti-immunoglobulin mu chain antibody-stimulated B lymphocytes, was suppressed in spleen cells from mice injected with murine P1.HTR mastocytoma-induced ascites and in spleen cells treated with the ascites in vitro. The suppression was observed both at the peak level and in the reactive pattern of Ca2+ influx. In the suppression, the ascites were replaceable with tumor culture supernatants or tumor homogenates. Correspondingly, primary and secondary cytotoxic T lymphocyte (CTL) responses of DBA/2 mice to allogeneic antigen were also significantly suppressed by injection of the syngeneic P1.HTR tumor-derived ascites. This new finding suggested that the mechanism of the tumorous ascites or of the tumor-derived factor-mediated immunosuppression involves at least in part the suppression of the early event of the signal transduction for lymphocyte activation.

Animals↗
PubMed1977

Specific chalone inhibition of the regeneration of the JB-1 ascites tumour studied by flow microfluorometry.

The variation in the DNA distribution in the JB-1 and the Lla2 ascites tumour was investigated by means of flow microfluorometry (FMF) in the plateau stage and during the initiation of the regenerative growth induced by percutaneous aspiration. The study showed that a considerable influx of cells with G1DNA content into the S phase occurred in both tumours about 10 hr after aspiration. In the JB-1 tumour, these initial regenerative changes could be reversibly blocked by injections of cell-free plateau JB-1 ascitic fluid or an ultrafiltrate of this ascites. In contrast to these observations no delay in the regenerative changes was observed in the L1a2 tumour after treatment with JB-1 ascites or the ultrafiltrate. The study supports the assumption of a specific growth regulation of the JB-1 ascites tumour and emphasizes the suitability of FMF analyses in cell-kinetic studies in which short-term fluctuations take place in the distribution of cells with different DNA content.

Animals↗
PubMed1985

Bactericidal activity of ascitic fluid in patients with nephrotic syndrome.

Patients with nephrotic syndrome are unusually susceptible to infections, including primary peritonitis. In this study, we have evaluated nine adult patients with nephrotic syndrome and ascites for ascitic fluid bactericidal activity, complement and immunoglobulin concentrations. Eight of nine patients had diminished ascitic fluid bactericidal activity while twelve control peritoneal fluids had normal bactericidal activity. Complement (C3 and C4) and immunoglobulin (IgG and IgM) concentrations were significantly lower in nephrotic syndrome ascitic fluid than peritoneal fluid from normal subjects. These findings may explain the high occurrence rate of primary peritonitis in nephrotic patients with ascites.

Ascitic Fluid↗
PubMedDate not supplied

Spontaneous bacterial peritonitis and culture negative neutrocytic ascites in patients with non-alcoholic liver cirrhosis.

Medical records of 18 patients with spontaneous bacterial peritonitis (SBP) and 19 patients with culture negative neutrocytic ascites (CNNA) were reviewed. The diagnosis of SBP was based on a positive ascitic fluid culture, a polymorphonuclear cell count (PMN) greater than 250 cells/mm3 and the absence of an intra-abdominal source of infection. The diagnosis of CNNA was based on a PMN count greater than 250 cells/mm3, a negative ascitic fluid culture, the absence of an intra-abdominal source of infection and no antibiotic treatment in the preceding 30 days. All patients in both groups had liver cirrhosis, which was mainly (62.2%) due to HBV infection. A single strain, mostly 'a Gram-negative' bacillus, was recovered from the ascitic fluid culture in the vast majority of patients (83%) with SBP. There were no significant differences between the clinical data of both groups. However, the CNNA group had a significantly better Pugh score (P value = 0.01) with a mean score of 9.42 +/- 2.24, compared to the SBP group (10.94 +/- 2.88). The only significant difference in the laboratory data was that the total bilirubin was higher in the SBP group (P < 0.01). Hospital mortality was significantly higher in the SBP patients compared to those with CNNA, 50 and 16%, respectively (P < 0.03). Recurrent ascitic fluid infection occurred in one of five patients who initially presented. In contrast no recurrence was documented in 12 patients with CNNA. Spontaneous bacterial peritonitis is a serious complication of liver cirrhosis with significantly higher mortality than CNNA. A single organism, usually enteric, is the most common causative agent.

Adult↗
PubMed1997

Case report: successful palliative treatment with intraperitoneal OK-432 injection for epithelioid haemangioendothelioma presenting with intractable ascites.

Epithelioid haemangioendothelioma is an unusual type of endothelium-derived vascular tumour of borderline malignancy, which has high variability in clinical presentations, depending on the primary site of involvement. We report on a 20-year-old woman who presented with progressive abdominal fullness for 6 months. Multiple lung and liver nodules with pleural effusion and profuse ascites were found. The diagnosis of epithelioid haemangioendothelioma was made after wedge biopsy of the liver. The ascites was intractable and refractory to strong diuretic therapy and repeated paracentesis. Therefore, six courses of intraperitoneal injection of OK-432 were administered. The ascites subsided to a minimal amount after treatment and the patient remained symptom-free for approximately 8 months. The ascites recurred later and another three courses of intraperitoneal injection of OK-432 were administered. The ascites disappeared again. The patient has remained symptom-free since the end of the second period of treatment.

Adult↗
PubMed2005

Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed.

OBJECTIVE: To compare the survival after transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites and variceal bleed, and to identify the factors predictive of survival. METHODS: Single tertiary center, retrospective-prospective study. Chart review was performed on all patients who underwent TIPS between 1993 and 2000 and prospective follow-up to determine survival. Pre- and post-TIPS clinical parameters were compared and Kaplan-Meier analysis was applied to compare the survival of both groups. Cox regression was used to identify predictors of survival after TIPS. RESULTS: A total of 163 patients were included, 62 with refractory ascites and 101 with variceal bleed. Both groups had similar age (48.2 vs 48.9 year; P = 0.65) and consisted of predominantly Caucasians (51%) and Mexican-Americans (39%). More than 75% had chronic hepatitis C, alcoholic liver disease or both. Overall, the median survival was significantly better for variceal bleed (2 years) compared with refractory ascites (6 months) (P < 0.001). This survival advantage persisted in patients with Mayo risk score greater than 1.17. Transjugular intrahepatic portosystemic shunt improved severe ascites in 45% of patients (P = 0.03). Mayo risk score was highly predictive of survival after TIPS with a hazard ratio of 2.3, followed by Child-Pugh score, creatinine, albumin and ethnicity, with better survival among Mexican-Americans. Shunt dysfunction (31%) and hepatic encephalopathy (27%) were the most common complications of TIPS. CONCLUSIONS: Patients who received TIPS for variceal bleed had significantly longer survival compared with those for refractory ascites. Mexican-Americans had an improved long-term survival compared with Caucasians. The reason for this ethnic difference in survival is unclear and warrants further prospective evaluation.

Ascites↗
PubMed1983

Permselectivity of the liver blood-lymph (ascitic fluid) barrier to macromolecules in decompensated cirrhosis: relation to calculated pore-size.

This study was undertaken to investigate permselectivity of the liver blood-lymph (ascitic fluid) barrier to endogeneous marcomolecules in patients with decompensated cirrhosis. Albumin (mol wt 69,000), immunoglobulin-G (mol wt 160,000) and immunoglobulin-M (mol wt 900,000) were determined in plasma and ascitic fluid from 13 cirrhotic patients. As previously substantiated in patients with cirrhosis, the ascitic fluid/plasma concentration ratio (R) of a protein is proportional to the transport rate from blood to lymph (ascitic fluid). Mean Ralb = 0.28 and RIgG = 0.29 were identical, but significantly higher than, RIgM = 0.18 (P less than 0.01). Ralb was directly correlated to RIgG (r = 0.97, P less than 0.001) and to RIgM (r = 0.78, P less than 0.005). Mean RIgG/Ralb = 1.03, which expresses the relative flux rates between IgG and albumin, was significantly above the ratio between the free diffusion coefficients (DIgG/Dalb = 0.64, P less than 0.01). Mean RIgM/Ralb = 0.61 was significantly above DIgM/Dalb = 0.39 (P less than 0.05) and significantly below unity (P less than 0.01). The results are best explained by filtration as the dominant mechanism of the liver blood-lymph (ascitic fluid) exchange of endogeneous macromolecules. A significant 'sieving' is present in this barrier to the largest macromolecule (IgM). Calculations of pore-size equivalent to the observed permselectivity of macromolecules suggest microvascular gaps (or channels) with an average radius about 300 A, i.e. in the lower end of the range of gaps in normal liver sinusoids (from 200 to 5000 A).

Adult↗
PubMed2004

Clinical characteristics and outcome of patients with cirrhosis and refractory ascites.

BACKGROUND: In patients with cirrhosis, refractory ascites is associated with a poor prognosis and is an indication for liver transplantation. However, factors that determine prognosis remain unclear. AIMS: To investigate the predictive factors of prognosis in patients with refractory ascites. METHODS: Seventy-five patients with refractory ascites were followed-up for 18+/-13 months (mean+/-SD) and survival was analyzed. RESULTS: The 1-year probability of survival was 52%. Univariate analyses showed that older patients, hepatocellular carcinoma and diabetes, all assessed at entry, were associated with significantly increased risk ratios of death. The risk ratio of death was significantly lower in abstinent alcoholics than in patients with nonalcoholic cirrhosis. The risk ratio of death did not significantly differ between patients with nonalcoholic cirrhosis and nonabstinent alcoholics. Child-Pugh score at entry had no prognostic value. Multivariate analysis showed that older age, hepatocellular carcinoma, diabetes and abstinence were independent prognostic factors. CONCLUSIONS: In patients with cirrhosis and refractory ascites, older age, hepatocellular carcinoma and diabetes, but not Child-Pugh score at entry, were independent predictive factors of poor survival while abstinence was an independent predictive factor of good survival. These findings should be taken into account when deciding on liver transplantation in patients with refractory ascites.

Adult↗
PubMed2005

Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis.

UNLABELLED: Transjugular intrahepatic portosystemic shunt (TIPS) is a more effective treatment for refractory ascites than large volume paracentesis (LVP), but the magnitude of its effect in terms of control of ascites, encephalopathy and survival has not been established. AIM: This meta-analysis compare TIPS to LVP in terms of control of ascites at 4 and 12 months, encephalopathy and survival at 1 and 2 years. RESULTS: Five randomized controlled trials involving 330 patients were included. In the TIPS group, control of ascites was more frequently achieved at 4 months (66% vs 23.8%, mean difference: 41.4%, 95% confidence interval (CI): 29.5-53.2%, P < 0.001) and 12 months (54.8% vs 18.9%, mean difference: 35%, 95% CI: 24.9-45.1%, P < 0.001), whereas encephalopathy was higher (54.9% vs 38.1%, mean difference: 17%, 95% CI: 7.3-26.6%, P < 0.001). Survival at 1 year (61.7% vs 56.5%, mean difference: 3.2%, 95% CI: -14.7 to 21.9%) and 2 years (50% vs 42.8%, mean difference: 6.8%, 95% CI: -10 to 23.6%) were not significantly different. CONCLUSIONS: TIPS is a more effective treatment for refractory ascites than LVP. However, TIPS increase encephalopathy and does not improve survival.

Aged↗
PubMed1998

Ascitic fluid to serum bilirubin concentration ratio for the classification of transudates or exudates.

OBJECTIVE: We compared the ascitic fluid to serum bilirubin ratio with three other ways of classifying ascitic fluid to the categories of exudate or transudate: the serum-ascites albumin gradient, the total protein concentration of the fluid, and the adaptation of Light's criteria for the detection of pleural fluid exudate, i.e., fluid to serum protein or LDH ratio or fluid LDH concentration. (Recently it has been reported that the pleural fluid to serum bilirubin ratio is statistically equivalent to Light's criteria.) Also, we evaluated whether the addition of the bilirubin ratio to the other criteria increases their diagnostic accuracy. METHODS: Eighty-one specimens of ascitic fluid from 81 different patients were obtained. They were analyzed prospectively by SMA12, whereas the category of the fluid was determined according to the clinical diagnosis. The diagnostic accuracy of each criterion alone and in combination with the bilirubin ratio, with reference to the contended etiology, were evaluated. RESULTS: The best criterion is the albumin gradient (overall accuracy = 0.84). The bilirubin and LDH ratio criteria had equivalent overall accuracy (0.815 and 0.802, respectively). The addition of the bilirubin ratio to any criterion did not improve its predictive or overall accuracy. CONCLUSIONS: Ascitic fluid to serum bilirubin ratio is an additional marker for the distinction of transudate from exudate. A ratio > 0.6 has a statistically significant association with exudate.

Ascitic Fluid↗
PubMed1999

Ascites and severe hepatitis complicating Epstein-Barr infection.

Epstein-Barr (EB) virus infection is common, with up to 90% of individuals demonstrating positive titers by age 20. Although elevated liver function tests commonly occur, severe hepatitis is rare. Only six cases of ascites complicating Epstein-Barr infection are reported, but none clearly demonstrate the absence of other causes of hepatic dysfunction. A 37-yr-old male presented with a 4-wk history of upper respiratory tract symptoms. Over 3 days before admission he developed jaundice and right upper quadrant pain. After hospitalization, the patient developed tense ascites requiring paracentesis. Serum-ascitic albumin gradient was 0.3 g/dL. Liver function tests peaked at the following values: prothrombin time of 24.5 s, total bilirubin of 18.0 mg/dL, and transaminases in excess of 5000 IU/L. EB Virus IgG and IgM titers were 1:640 and >1:40, respectively. Other viral serologies and polymerase chain reactions were negative. The patient experienced a complete clinical and laboratory recovery over the next 6 months. This represents the first documentation of ascites complicating Epstein-Barr infection without other sources of hepatic dysfunction. It demonstrates a narrow serum-ascitic albumin gradient in these patients, and that complete recovery can occur with supportive care.

Adult↗
PubMed2000

Rapid onset of massive ascites as the initial presentation of systemic lupus erythematosus.

Ascites in systemic lupus erythematosus (SLE) is rarely massive, and either accompanies the typical manifestations of active disease or results from nephrotic syndrome, protein-losing enteropathy, constrictive pericarditis, and conditions unrelated to lupus. Marked ascites has been attributed to chronic lupus peritonitis, characterized by the insidious onset of massive, painless ascites and unrelated to disease activity. Regardless of the etiology, ascites typically has a gradual onset and occurs after a diagnosis of SLE has been made. We describe a young woman presenting with the rapid development of massive ascites as the initial manifestation of SLE.

Adult↗
PubMed2000

Hepatic tissue endothelin-1 levels in chronic liver disease correlate with disease severity and ascites.

OBJECTIVES: Plasma endothelin-1 (ET-1) levels are increased in patients with cirrhosis and ET-1 production is increased in the liver itself during experimental injury. These data suggest a possible role for this vasoactive peptide in intrahepatic microcirculatory changes that contribute to the pathogenesis of portal hypertension in cirrhosis. Therefore the aims of this study were to determine whether ET-1 levels were abnormal in the livers of patients with cirrhosis and to investigate possible clinical correlates of altered hepatic ET-1 in cirrhosis. METHODS: Liver specimens were obtained from explants at the time of liver transplantation in 62 cirrhotic patients; 49 without pretransplantation transjugular intrahepatic portosystemic shunt (TIPS) and 13 with pretransplantation TIPS. The presence of ascites was evaluated by physical examination and ultrasonography. Control specimens consisted of livers with normal morphology obtained from patients who died from nonliver-related causes. Hepatic ET-1 was measured by enzyme immunoassay. RESULTS: Hepatic ET-1 levels in cirrhotics without (0.17 pg/mg liver tissue) or with TIPS (0.12 pg/mg) were higher than in control patients [0.04 pg/mg (p = 0.02 for ET-1 levels in cirrhotics with or without TIPS vs. control)]. In cirrhotics without ascites who had not had TIPS, ET-1 levels (0.07 pg/mg [0.04-1.00]) were similar to those of the controls. In contrast, ET-1 content was increased in cirrhotics with small (0.11 pg/mg; p = 0.0002) and moderate-to-large (0.69 pg/mg; p = 0.0002) amounts of ascites compared to patients without ascites. There was a modest correlation between ET-1 levels and Child-Pugh score (correlation coefficient 0.32; p = 0.03) and ET-1 levels were significantly higher in patients with Child-Pugh score of 13 or greater (0.88 pg/mg; p = 0.02) than in those with Child-Pugh score of 12 or less (0.16 pg/mg). CONCLUSIONS: Hepatic tissue ET-1 levels are increased in the liver of patients with cirrhosis. This increase appears to be proportional to the severity of both liver disease and ascites. These data raise a possible role for ET-1 in modulation of intrahepatic resistance in cirrhotic portal hypertension.

Adult↗
PubMed2003

Pancreatic ascites: study of therapeutic options by analysis of case reports and case series between the years 1975 and 2000.

OBJECTIVE: Because of the low incidence of pancreatic ascites, only case reports and case series have been published, and no randomized controlled trials have been performed to find out which is the best therapeutic approach. The aim of this study was to evaluate the utility of the different treatments for pancreatic ascites by a thorough review of all case reports described in the literature in which an independent analysis of the efficacy of the treatment administered to each patient is possible. METHODS: We conducted an analysis of all case reports and case series of pancreatic ascites published between 1975 and 2000 in which clinical data of every patient could be identified individually. A total of 139 cases were studied. Clinical characteristics, treatments administered, and response to therapy of every patient were registered. Conservative therapy included drainage of ascitic fluid, total parenteral nutrition and diet, and somatostatin analogues. Interventional therapy was either endoscopic or surgical. RESULTS: After multivariate analysis, the only treatments related to success were surgery (adjusted OR = 8.2, 95% CI = 3.0-22.9) and transpapillary stent (adjusted OR = 7.3, 95% CI = 0.8-62.9). No significant relationship was found between failure or death and the use of other treatments, age, sex, year of publication, underlying disease, site of leakage, or serum amylase levels. The apparent lack of effect of somatostatin analogues could be attributed to the small number of cases and the heterogeneity of the dosages. CONCLUSIONS: Conservative therapy is not advisable for pancreatic ascites because of the high proportion of failures. Interventional therapy with surgery or transpapillary stent has a positive effect in the clinical outcome.

Adolescent↗
PubMed2004

Vascular endothelial growth factor (VEGF) levels as a tool to discriminate between malignant and nonmalignant ascites.

Ascites formation is commonly associated with cancer, although it is also present in other diseases. The aim of this study was to evaluate the usefulness of vascular endothelial growth factor as a malignancy marker in ascites of different etiologies. The levels of VEGF in 32 malignant and in 31 non-malignant ascites were determined by enzyme immunoassay (ELISA). VEGF levels were significantly higher in malignant than in non-malignant ascites (median=1265.9 pg/ml x 114.6 pg/ml; p<0.0001). We observed 72% sensitivity and 90% specificity, using 662 pg/ml as a cut-off value. Therefore, this approach can be used as a marker for a first screening to discriminate between malignant and nonmalignant ascites.

Ascites↗
PubMed1979

Congenital ascites due to mesenteric vessel constriction caused by malrotation of the intestines.

A newborn premature girl with congenital, non-chylous ascites is presented. The ascites recurred although laparocentesis was performed three times. The ascites was probably due to a superior mesenteric vein constriction caused by a malrotation of the intestines. After division of the Ladd-bands no ascites recurred. Non-chylous, congenital ascites may have a surgically treatable cause.

Ascites↗
PubMed1993

[A case of spontaneous bacterial peritonitis with ascites caused by hypoproteinemia after a massive bleeding from a gastric ulcer].

A case of spontaneous bacterial peritonitis (SBP) developed in an old man whose ascitic fluid was related neither to portal hypertension nor nephrotic syndrome, but with severe hypoalbuminemia emerged after a massive bleeding from a gastric ulcer in a malnutrition state. Ascitic fluid, increasing day by day, yielded Enterobacter cloacae and Bacteroides fragilis. Though autopsy was not carried out because of refusal of his family, neither liver necropsy, nor abdominal CT scan nor repeated abdominal ultrasonography showed findings suggesting existence of liver cirrhosis. In the presence of his ascites, the extent of a chemiluminescence (CL) response of polymorphonuclear cells from volunteers was significantly lower than that of his serum. This report shows that SBP can develop in a patient with ascites unrelated to portal hypertension when ascitic fluid induces little CL response.

Aged↗