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PubMed1991

[Spontaneous bacterial peritonitis: a frequent and recurrent complication in cirrhotic patients with ascites].

One hundred and twenty consecutive patients with liver cirrhosis and ascites were prospectively studied in order to analyze the frequency, clinical and bacteriological features, recurrence, and prognosis of spontaneous bacterial peritonitis (SBP). Two variants of SBP were defined: culture positive SBP and culture negative neutrocytic ascites (CNNA). During a follow-up of 6 +/- 2 months, thirty three episodes in 23 patients were identified. Nineteen episodes had ascites positive cultures (58%). The total mortality rate associated with SBP was 39%. (47% for culture positive form and 29% for CNNA). Seven of 15 cirrhotics who had recovered from a first episode of SBP (46%) had 10 recurrences. Mortality associated with SBP recurrence was 50%. Six-month survival probability was 65% in patients with sterile ascites and 33% in SPB (p < 0.05). Impairment of liver function was present in 23 episodes (70%) but abdominal complaints occurred only in one/third and 4 (12%) were asymptomatic. E coli was the most frequent agent involved in culture positive SBP. We confirm that SBP is a frequent, recurrent and severe complication of ascites in cirrhotics. Episodes of SBP without abdominal symptoms or with a silent course are not infrequent. Then, SBP recognition requires ample use of diagnostic paracentesis.

Adult↗
PubMed1991

[Effect of malignant ascitic fluids and OK-432 on the induction of LAK activity in peripheral blood mononuclear cells of gynecological cancer patients].

Recently, successful treatment of peritonitis carcinomatosa by intraperitoneal administration of lymphokine-activated killer (LAK) cells followed by intraperitoneal recombinant interleukin 2 (rIL-2) has been reported by several authors, in spite of the well documented results of the immunosuppressive activity of malignant ascitic fluid. We investigated the effect of malignant ascitic fluid on in vitro induction of LAK cells obtained from patients' peripheral blood mononuclear cells. We also examined whether Streptococcal preparation OK-432, which has been instilled into the peritoneal cavity to treat malignant ascites, is able to synergize with rIL-2 to induce LAK activity, and the following results were obtained; 1. A little augmentation of LAK activity was observed at a lower concentration of malignant ascitic fluid, while the results were diversified at a concentration higher than 10%. In two cases out of six, a severe suppressive effect was observed at a concentration higher than 40%. At the higher concentration, fewer cells were recovered after a 5 day culture in all cases. 2. No augmentation of LAK activity following the combination of OK-432 with rIL-2 was observed. At a lower concentration of OK-432 (ranging from 0.01-0.04KE/ml), the number of cells increased in comparison with rIL-2 alone. These results suggest that the potential of adoptively transferred LAK cells followed by rIL-2 was not effectively suppressed by malignant ascitic fluid in vivo and that the administration of OK-432 followed by rIL-2 could induce a larger number of various killer cells than rIL-2 alone.

Ascites↗
PubMed1991

Cancer antigen 125 in serum and ascitic fluid of patients with liver diseases.

Serum concentrations of cancer antigen 125 (CA 125) were determined for 373 patients with various liver diseases: 57 with acute hepatitis, 57 with chronic hepatitis, 244 with liver cirrhosis (86 compensated and 158 decompensated), and 15 with primary liver cancer. The antigen was measured simultaneously in the serum and ascitic fluid of 46 of the patients with liver cirrhosis and sequentially in the serum and ascitic fluid of another 25 cirrhotics treated with paracentesis and (or) diuretics. Abnormal results for CA 125 were detected in sera from 4% of the patients with acute or chronic hepatitis, 60% of the patients with liver cirrhosis, and 67% of the patients with primary liver cancer. The main factor associated with abnormal serum concentrations of this antigen was the presence of ascites, with pathological CA 125 values in 94% of patients with ascites without jaundice (mean 566 +/- 528 arb. units/mL), compared with only 40% of patients with jaundice and without ascites (mean 40.1 +/- 28.5 arb. units/mL) (P less than 0.001). High concentrations of CA 125 were mainly associated with spontaneous bacterial peritonitis. The serum concentration of CA 125 decreased after treatment with paracentesis, but increased in patients treated with diuretics rather than paracentesis. The release of this antigen in liver cirrhosis appears to be independent of the liver disorder and, rather, results from peritoneal synthesis of this antigen.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

Paracentesis: a re-evaluated procedure in the management of cirrhotic patients with ascites.

Paracentesis is the oldest method for treating patients with ascites, but the fear of serious side-effects and the coincident introduction of effective non-toxic diuretic drugs led to its abandonment during the fifties. In recent years, several studies have investigated whether abdominal evacuation of ascitic fluid is truly dangerous for cirrhotic patients. The results of some randomized controlled trials comparing paracentesis with a traditional diuretic therapy showed that the rate of complications after paracentesis, particularly when the procedure was combined with a sufficient plasma expansion, was equal to or lower than that of diuretic treatment. Moreover, the ability of paracentesis to resolve tense ascites, both in terms of number of successes and of time required to obtain ascites resolution, was similar or even higher. These data and the recent new interest of several investigators in employing ascitic fluid examination for diagnostic purposes have increased the use of this procedure in the clinical practice.

Ascites↗
PubMedDate not supplied

[Neonatal chylous ascites: report of two cases].

Chylous ascites in neonates is an unusual and etiologically poor understood entity. Our first case was a female newborn who suffered from abdominal distension and recurrent vomiting after birth. The history, physical, laboratory, and radiologic evaluations were not diagnostic except the evidence of obvious ascites. Paracentesis was performed and ascitic fluid was obtained. She was later discharged on a strict low-fat medium-chain triglycerides formula. She was found to have continue increase in abdominal girth, poor growth and development, and respiratory distress in which led her to readmission at 8 months of age. Exploratory laparotomy was done in order to rule out an anatomical lesion in which may be obstructing the lymphatic flow; but no such lesion could be found. She expired at 1 year of age with chylothorax, chylopericardium and lobar pneumonia. The second case, a 37-day-old male baby, who was admitted because of right inguinal hernia. Milky ascitic fluid in the abdomen was incidentally found during herniorrhaphy. Analysis of the fluid revealed protein 1,616 mg/dl, glucose 487 mg/dl, and triglyceride 796 mg/dl. Culture of peritoneal fluid grew no bacteria. Other laboratory findings were: serum protein 4.8 mg/dl, and BUN 14 mg/dl. A plain film of abdomen and sonogram showed massive ascites. The infant was then put on Pregestimil with the hope that the medium-chain triglyceride formula would improve his condition. Since then the child's abdominal girth did not increase and he continued to growth and develop normally at 4 months follow up.

Chylous Ascites↗
PubMed1990

[Computed tomography in ascites].

Ascites can be found in a variety of diseases and may represent either a late complication or the clinical sign of a pathologic condition. The presence of even small fluid collections in peritoneal recess can be easily detected by CT. A number of reports confirm CT prediction of the benign/malignant nature of ascites. The CT scans of 100 patients affected with histologically confirmed ascites were reviewed to evaluate CT contribution to the assessment of the benign/malignant nature of ascites. On the basis of our results, it can be concluded that the only highly predictive CT finding of malignant ascites is the presence of a coexisting mass. Other findings do not allow the two types of collections to be discriminated.

Ascites↗
PubMed1990

[Multi-drug chemotherapy for patients with peritonitis carcinomatosa associated with ascites].

Between 1973 and 1987, 257 patients with ascites were seen in our divisions and 101 deaths due to cancer out of those who received multi-drug anticancer chemotherapy were surveyed: 1) They consisted of 45 ovarian cancers, 15 uterine corpus cancers, 5 uterine cervical cancers and 36 unknown primary cancers, or cancers other than gynecologic malignancies. 2) Survival time from the time of aspiration of ascites tended to be longer in four years from 1977 and 1981 than in four years from 1973. 3) The survival time was different in each patient groups having various combination chemotherapy and the longest was seen in the group of patients who received THP-ADM and CDDP-containing regimen as the next. 4) Patients survived for the longest period when a total amount of ascites less than 100 ml was aspirated and patients whose ascites was drained out more than 50,000 ml were the next longest survivors. 5) Clinical efficacy by multi-drug chemotherapy for malignant ascites was possibly predicted by our drug sensitivity assay by using primary cultured cancer cells.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Atrial natriuretic factor in the ascitic fluid of cirrhotic patients.

The simultaneous measurement of plasma and ascitic fluid atrial natriuretic factor (ANF) concentrations in six cirrhotic patients revealed that ANF is present in high concentrations (mean = 89 +/- 4 pg/ml) in the ascitic fluid of these patients. The concentration of atrial natriuretic factor in ascitic fluid was nearly equal to the concentration in plasma (96 +/- 8 pg/ml). The plasma levels of ANF in the cirrhotic patients were considerably higher than the mean plasma concentration of this peptide hormone in 54 persons without cirrhosis (67 +/- 3 pg/ml). The data demonstrate that atrial natriuretic factor is present in ascitic fluid in high concentrations that are nearly equal to that in plasma. This suggests that its presence in ascitic fluid is due to capillary leakage in the hepatic sinusoids.

Ascitic Fluid↗
PubMed1989

Dilated cardiomyopathy associated with chylous ascites.

Chylous ascites is a well-documented sequelae of traumatic rupture of the thoracic duct and mechanical obstruction of the lymphatic system due to neoplastic, inflammatory, or congenital anomalies. Less commonly, chylous ascites results from altered hemodynamics and lymphatic flow, as seen in cirrhosis and constrictive pericarditis. Rarely, severe right-sided heart failure from a variety of causes has also resulted in chylous ascites or a protein-losing enteropathy. We report a case of chylous ascites due to dilated cardiomyopathy with autopsy findings. The pathophysiology of chylous ascites formation in right heart failure will be discussed, with a review of the literature.

Aged↗
PubMed1989

[Lymphovenous anastomosis in severe ascites].

The authors dealt with 37 patients suffering from advanced liver cirrhosis with ascites. Eighteen patients out of them underwent Denver peritoneum-jugular shunt as a first choice procedure, the other 19 patients underwent lymphovenous anastomosis. The extremely advanced hepatic damage and the general conditions of these patients discouraged us to perform a portocaval shunt. In the 19 patients who underwent lymphovenous anastomosis we had no mortality rate. Two patients showed post-operative complications: 1 patient complained which hoarseness regressed in 5 months and the other patient suffered from a spleno-mesenteric-portal thrombosis with digestive hemorrhage from gastro-esophageal varices. In 6 patients out of 19 who underwent lymphovenous anastomosis, we did not obtain any immediate positive effects on ascites. In 4 patients, after 3 months, the ascites came back ingravescent and in the other 9 patients the positive effects on ascites were still evident after 1 year. Despite failure to obtain very comforting results, they suggest to employ this technique at any rate, as the first procedure, to make ascites more "manageable", because of its safety.

Anastomosis, Surgical↗
PubMed1989

Propranolol prevents first gastrointestinal bleeding in non-ascitic cirrhotic patients. Final report of a multicenter randomized trial. The Italian Multicenter Project for Propranolol in Prevention of Bleeding.

We report here the final analysis of a multicentre randomized, single-blind trial of propranolol for prophylaxis of first bleeding in cirrhosis. One hundred and seventy-four consecutive patients with large esophageal varices were randomly assigned to either propranolol in doses reducing the resting heart rate by 25% (85 patients) or to a placebo (vitamin K: 89 patients). Three were lost to follow-up and 26 had to be withdrawn from propranolol because of side effects (n = 23) or low compliance (n = 3). The cumulative value over 42 months of patients free of bleeding was 74% (95% confidence interval = 85%-63%) in the propranolol and 59% (95% CI = 79%-43%) in the control group and the corresponding survival figures were 51% (95% CI = 63%-39%) and 59% (95% CI = 75%-43%): neither of the differences was significant. A retrospective analysis according to the presence of ascites at randomization showed that in the subset without ascites the proportion of patients free of bleeding was significantly higher in the propranolol group than in the control group (83% vs. 61%; 95% CI = 97%-69% and 78%-44%, respectively; P = 0.028); this difference was even more evident in the ascites-free period (94% vs. 58%; 95% CI = 100%-86% and 76%-40%, respectively; P = 0.002). No differences were found in patients with ascites at randomization. Survival was not significantly affected by treatment in any subgroup, although it was shorter in the ascitic patients given propranolol than in controls (33% vs. 49%; 95% CI = 51%-15% and 71%-27%, respectively; P = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Variation of C3 in ascitic fluid from cirrhotic patients subjected to intestinal sterilization or selective intestinal decontamination].

Patients with liver cirrhosis with ascites and low levels of C3 and Total Proteins in ascitic fluid show a greater predisposition to the development of spontaneous bacterial peritonitis. The variation of C3 and Total Proteins levels in ascitic fluid in two groups of patients with liver cirrhosis was studied. Group I (n = 14) underwent intestinal sterilization (n = 7) or selective intestinal decontamination (= 7). Group II was a control. A statistically significant increase in C3 (p less than 0.01) and Total Proteins (p less than 0.015) levels in ascitic fluid in Group I patients was found. There were no changes in the control group. The incidence of side effects was higher in those patients who underwent intestinal sterilization. Our results suggest that selective intestinal decontamination may be useful as a prophylactic measure against spontaneous bacterial peritonitis in those patients with liver cirrhosis at high risk of infection by increasing the bactericidal capacity of ascitic fluid.

Adult↗
PubMedDate not supplied

[Ascitic fluid from alcoholic cirrhosis patients does not enhance chemotaxis of polynuclear neutrophils].

Infected ascites are common in alcoholic cirrhosis. The mechanisms by which they contain few neutrophil granulocytes remain unknown. Ascitic fluids from 25 patients were studied for their chemotactic properties using Nelson's method 1975 (migration under agarose). Ascitic fluids were compared to plasmas from controls and to a standard attractant (FMLP, 10-7 M). Some fluids were diluted or concentrated by lyophilization, an inactivator was searched for, and the concentration of some complement components was determined. Ascitic fluids failed to be chemoattractant under agarose (25 cases), even concentrated 10 times (3 cases). Some complement components (CH5O, C3, C4 and factor B) could not be detected. It is likely that the absence of chemoattractant properties under agarose in ascitic fluids is related to a deficit in complement components. That might depend on deficient synthesis, or mainly on enhanced consumption. The impaired chemotaxis may serve to explain the low level of neutrophil granulocytes in infected fluids and the severity of infections.

Aged↗
PubMedDate not supplied

[Comparative characteristics of the lipid composition of lipoproteins of the blood plasma and ascitic fluid in liver cirrhosis].

Comparison of phospholipid content in different fractions of lipoproteins of the ascitic fluid and blood plasma showed selective accumulation of high density lipoproteins (HDLP) in the ascitic fluid. The ascitic fluid HDLP differed from blood plasma HDLP in a larger fraction of triglycerides and cholesterol oleate. No significant difference was revealed in the lipoprotein (LP) low density lipid spectrum in the two fluids. The very low density LP (VLDLP) of the ascitic fluid differed from blood plasma VLDLP by higher ratios of phosphatidylcholine (PC) (sphingomyelin and PC) unesterified cholesterol; the PC in VLDLP of the ascitic fluid had a relatively higher content of linoleic and oleic acids. It is suggested that the detected differences are associated with dynamic insufficiency of lymph drainage in portal hypertension, as the result of which LP of intestinal genesis, spreading in the interstitium of the wall of the small intestine, enter the abdominal cavity by bypassing the blood plasma.

Ascitic Fluid↗
PubMed1989

Establishment of ascitic tumor of human pre-B acute lymphoblastic leukemia in nonconditioned nude mice.

In the present study, an ascitic tumor of NALM-6, a human pre-B acute lymphoblastic leukemia cell line, was established in nude mice which had not been subjected to any preconditioning such as X-irradiation and/or splenectomy. The ascitic tumor was also established in X-irradiated mice. Under various conditions, the tumor transplantability was 100%. NALM-6 cells were initially inoculated i.p. into 8-day-old nude mice after being admixed with X-irradiated HT-1080, a human fibrosarcoma cell line. Then, the in vivo grown (for 10 wk) tumor cells were serially transplanted i.p. into X-irradiated adult (10 to 12 wk old) nude mice. After the serial passages, we succeeded in establishing a highly transplantable NALM-6 ascitic tumor in nonpreconditioned as well as X-irradiated nude mice without the addition of HT-1080 cells. The ascitic tumor cells do not lose transplantability after in vitro culture for 20 days. Cellular radioimmunoassay and fluorescence-activated cell sorter analysis indicated that the in vivo established NALM-6 tumor cells retained the antigenic phenotype of the parental NALM-6 cells. Titration experiments revealed a reciprocal relationship between survival time of the mice and the number of tumor cells inoculated. When appropriate numbers of tumor cells (e.g., 4 x 10(6) cells) were used for the inoculation, survival times of individual mice fell within a relatively narrow range; this narrow range will facilitate the experiments where the present tumor model is used for evaluating the in vivo efficacy of antitumor agents. The present ascitic tumor models, particularly the one established in nonpreconditioned nude mice, will be useful for evaluating the in vivo efficacy of anti-human leukemia agents as well as for studying the in vivo biological behavior of the transplanted leukemia cells.

Animals↗
PubMedDate not supplied

Prostaglandins and the tumor-dependent growth inhibitory activity of Yoshida ascites fluid.

The content of prostaglandins in Yoshida tumor ascites fluid was evaluated by extraction of the arachidonic acid metabolites by means of octadecylsilyl-silica chromatography (ODS-extracts). The pattern of association of the icosanoids to ascites fluid colloids was determined by sequential precipitation with polyethylene glycol and extraction of the precipitates with methanol (M-extracts). Thin layer chromatographic analysis of these extracts demonstrated in the ODS-extract the presence of chromatographic fractions corresponding to prostaglandin E2 (4.6 micrograms/mL) and prostaglandin A2 (3.0 micrograms/mL), while in the M-extract only the fraction corresponding to prostaglandin A2 (9.2 micrograms/mL) was detected. This fraction was as the growth inhibitory activity reduced by approximately 60% in M-extracts from animals treated with Indomethacin. These results support previous indications that arachidonic acid metabolites are involved in the cytostatic activity of ascites fluid extracts. The preferential association of prostaglandin E2 to the ascites macroglobulin fraction could be a consequence of the presence of an unidentified tumor-dependent amphiphilic polymer in the Yoshida ascites fluid.

Animals↗
PubMedDate not supplied

The relationship of right ventricular hypertrophy, right ventricular failure, and ascites to weight gain in broiler and roaster chickens.

Nine hundred twenty-five male progeny from 50 sire families of a commercial sire line were weighed at 14, 28, and 47 days and scored for right ventricular hypertrophydilation at 48 days. Broilers with marked hypertrophy of the right ventricle at processing (298 of 925) were significantly heavier than their more normal contemporaries at 14 and 28 days of age. These results suggest that rapidly growing broilers are more susceptible to increased pulmonary arterial pressure resulting in right ventricular hypertrophy, right ventricular failure, and ascites than slower-growing broilers. Thirty-five (3.5% of 997) broilers died from right ventricular failure and ascites, and 14 (1.5% of 925) has ascites at processing. Two hundred fifty-nine sibs were kept on full feed to 16 weeks of age. Between 7 and 16 weeks, 68 (26.3%) of these cockerels died from right ventricular failure and ascites and a further 27 (10.4%) had marked right ventricular hypertrophy-dilation when processed at 16 weeks. Thus most of the 298 broilers classified as having marked right ventricular hypertrophy at 7 weeks would likely have died from right ventricular failure and ascites if they had been kept on full feed until 16 weeks.

Animals↗
PubMed1988

[Pharmacokinetics of netilmicin in cirrhotic patients with or without ascites].

The pharmacokinetics of netilmicin after intramuscular injection (2 mg/kg) was investigated comparatively in cirrhotic patients with or without ascites, and in healthy subjects. In patients with ascites, the same pharmacokinetic parameters were measured after the ascites had been cured. Twenty-four hours after intramuscular injection, the residual levels in cirrhotic patients were moderately higher than in controls, showing that liver failure or ascites did not significantly modify the pharmacokinetics of netilmicin. Serum concentrations were bactericidal. The ascitic fluid level was lower than the therapeutic range, but it was sustained for nearly 24 hours after intraperitoneal injection (2 mg/kg). These results indicate that netilmicin may be administered to cirrhotic patients without peritoneal infection using the same regimen as in healthy subjects. The peritoneal route may be preferable in case of peritoneal infection.

Adult↗