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PubMed1998

Temporary drainage of symptomatic malignant ascites by a catheter inserted under computerized tomography.

The development of malignant ascites is an unfavorable prognostic sign in patients with advanced cancer. Interventions may be justified when discomfort and overall compromise in well-being are due to diaphragmatic spinting and abdominal compression of viscera. A patient with symptomatic ascites was admitted to hospital for temporary drainage using a catheter inserted under computerized tomography. Over 12 liters of fluids were removed in 3 days, without complications. A minimal ascitic leakage occurred after removing the cannula. Dyspnea and gastrointestinal symptoms improved and the patient died with good symptom control 15 days later. This approach should be considered in advanced cancer patients with symptomatic ascites that is not responsive to diuretics.

Aged↗
PubMed2026

Targeted Modulation of Abundant Proteins Enhances Proteomic Profiling of Ovarian Cancer Ascites: A Pilot Technical Workflow Comparison.

Ascites from ovarian cancer patients are increasingly recognized as a valuable biofluid for cancer research, as its protein composition reflects the disease state and may reveal biomarkers of treatment sensitivity and response. However, the detection of low-abundance proteins is hindered by the presence of highly abundant proteins such as albumin. In this study, we evaluated five protein preparation methods for their effectiveness in depleting high-abundance or enriching low-abundance proteins in ovarian cancer ascites. The Norgen (Nor), Minutes (Min), and Perchloric acid (PerCA) methods were based on abundant protein depletion, while the Urine (Uri) and Nanomics (Nano) kits focused on low-abundance protein enrichment. Processed samples were analyzed using label-free quantitative bottom-up proteomics by LC-MS/MS, followed by a bioinformatics assessment. Compared with undepleted ascites (UnD), Min, Nor, Nano, and PerCA increased protein identifications, whereas Uri produced profiles similar to those of UnD. Notably, PerCA and Nano enabled the identification of distinct protein subsets associated with cancer-related pathways, including immune responses and autophagy. PerCA enriched transmembrane and secreted immunomodulatory glycoproteins, whereas Nano enrichment primarily captured secreted, nuclear, and cytoplasmic soluble proteins. Overall, our results show that both high-abundance protein depletion and low-abundance enrichment improve ascites proteome coverage, each offering distinct advantages in identifying biologically relevant low-abundance proteins.

Female↗
PubMed1991

Characterization of ascites present at cesarean section.

Ascites has been reported at cesarean section delivery in pregnancies complicated by preeclampsia. The frequency and composition of peritoneal fluid collections in pregnancy have not previously been described. This descriptive study evaluated presence, composition, and characteristics of ascites present in 41 women undergoing cesarean delivery for a variety of indications. Twenty-six women had sufficient quantities of peritoneal fluid to be collected immediately after opening the parietal peritoneum. The protein content of the fluid was analyzed. The presence of fluid was not related to labor preceding delivery. All preeclamptic women in this study had fluid obtainable at cesarean section. Large volume ascites was noted in five preeclamptic women whose fluid had low total protein content, consistent with a transudate. Intrahepatic portal hypertension is one possible explanation of the large volume and low protein ascites in some preeclamptic patients. Ultrasonic measurements in preeclamptic patients and normotensive pregnant women showed uniform portal vein diameters and Doppler-derived portal vein flow velocities in all patients. The physiology of peritoneal fluid production in complicated and normal pregnancy remains unexplained.

Adult↗
PubMed2000

Using a tropism-modified adenoviral vector to circumvent inhibitory factors in ascites fluid.

Peritoneal compartmentalization of advanced stage ovarian cancer provides a rational scenario for gene therapy strategies. Several groups are exploring intraperitoneal administration of adenoviral (Ad) vectors for this purpose. We examined in vitro gene transfer in the presence of ascites fluid from ovarian cancer patients and observed significant inhibition of Ad-mediated gene transfer. The inhibitory activity was not identified as either complement or cellular factors, but depletion of IgG from ascites removed the inhibitory activity, implicating neutralizing anti-Ad antibodies. A wide range of preexisting anti-Ad antibody titers in patient ascites fluid was measured by ELISA. Western blot analysis demonstrated that the antibodies were directed primarily against the Ad fiber protein. To circumvent inhibition by neutralizing antibodies, a genetically modified adenoviral vector was tested. The Ad5Luc.RGD vector has an Arg-Gly-Asp (RGD) peptide sequence inserted into the fiber knob domain and enters cells through a nonnative pathway. Compared with the conventional Ad5 vector, Ad5Luc.RGD directed efficient gene transfer to cell lines and primary ovarian cancer cells in the presence of ascites fluid containing high-titer neutralizing anti-Ad antibodies. These results suggest that such modified Ad vectors will be needed to achieve efficient gene transfer in the clinical setting.

Adenocarcinoma↗
PubMed2003

Validation of automated blood cell counter for the determination of polymorphonuclear cell count in the ascitic fluid of cirrhotic patients with or without spontaneous bacterial peritonitis.

OBJECTIVES: Polymorphonuclear (PMN) cell count in ascitic fluid is the most useful test for the diagnosis of spontaneous bacterial peritonitis (SBP). We evaluated the validity of an automated blood cell counter for the PMN determination in ascitic fluid by comparing it with the traditional hematologic method with a light microscope in a manual counting chamber. METHODS: A total of 130 ascitic fluid samples were collected from 74 consecutive cirrhotics. The agreement between the two techniques was assessed according to Bland and Altman's method. The sensitivity, specificity, and positive and negative predictive values of the automated blood cell counter were calculated by considering the diagnosis of SBP as a PMN count > or = 250 cells/mm(3), determined by the manual method as the "gold standard." RESULTS: The mean PMN counts assessed by the manual method and the automated blood cell counter were 124 +/- 301 cells/mm(3) and 130 +/- 339 cells/mm(3), respectively (p = 0.89, ns). The mean +/- SD of the difference between manual and automated measurements was 6 +/- 61 cells/mm(3), whereas the limits of agreement were +127 cells/mm(3) (95% CI = +108 to +147) and -115 cells/mm(3) (95%CI = -96 to -135). SBP was diagnosed in 11 patients. All but one were correctly identified with the automated blood cell counter, with a sensitivity of 94% and a specificity of 100%; positive and negative predictive values were 100% and 99.1%, respectively. CONCLUSIONS: The manual method and the automated blood cell counter have a good agreement in the PMN determination in ascitic fluid, and the automated blood cell counter is a reliable tool for rapid diagnosis of SBP.

Aged↗
PubMed1976

Visualization of differences in soft-tissue densities. The liver in ascites.

The lateral liver border was demonstrated on the plain radiograph in 54 of 100 proved cases of ascites. The etiology of ascites, the density of the fluid, and the total protein content were similar whether the border was visualized or not. Tomography of the right upper quadrant indicated that the lateral liver margin is visualized in ascites as a result of contact between the liver and the surrounding fluid. Radiography of autopsied livers submerged in fluid demonstrated distinguishable differences in object density, and photodensitometry of the plain radiographs revealed a difference in blackness where the fluid and liver made contact. Comparison of mean liver density and mean ascitic fluid density showed a difference of 5%. These findings indicate that differences in soft-tissue densities (excluding fat) can be distinguished on the plain radiograph.

Ascites↗
PubMed2001

Genital tuberculosis can present as disseminated ovarian carcinoma with ascites and raised Ca-125: a case report.

In women with an adnexal mass, ascites and elevated Ca-125 levels, ovarian carcinoma must be ruled out. However, several other conditions, including genital tuberculosis, may present similarly. A 41-year-old woman with weight loss, ascites and elevated levels of Ca-125 was evaluated for ovarian cancer. Computerized tomography revealed an adnexal mass, ascites and lymph nodes on the peritoneal surface. Paracentesis of the ascitic fluid revealed a lymphocytic exudate but failed to show any malignant cells. At laparotomy, frozen sections of tissue biopsies were negative for malignancy; however, a total hysterectomy plus adnexectomy was performed. Postoperatively histologic examination revealed typical features of genital tuberculosis. Antituberculosis treatment was effectively given to the patient. Serum levels of Ca-125 were undetectable 12 weeks after treatment. In conclusion, genital tuberculosis can be misdiagnosed and confused with ovarian cancer. Intraperitoneal tuberculosis should be considered in the differential diagnosis in cases in which ovarian cancer is suspected, even when malignancy-associated risk factors are present.

Abdominal Pain↗
PubMed1997

Practical recommendations for the treatment of ascites and its complications.

Ascites is one of the earliest and most common complications of patients with cirrhosis, and is associated with complications such as dilutional hyponatraemia, renal dysfunction and spontaneous bacterial peritonitis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past 2 decades. The development of ascites is closely related to renal disturbances of functional origin, including the hepatorenal syndrome. A new definition of hepatorenal syndrome has been proposed recently and 2 different types have been defined (type I or progressive, and type III or stable). Although no effective therapy exists for this syndrome, the use of therapeutic methods (TIPS, vasoconstrictor agents, dialysis) to temporarily improve renal function and act as a 'bridge' to liver transplantation, may be of most benefit. The use of potent and safe antibiotics has improved the resolution rate and survival of patients with spontaneous bacterial peritonitis. In addition, the use of oral antibiotics will simplify the management of this condition in the near future. Finally, prophylactic antibiotic regimens represent a major step forwards in the prevention of spontaneous bacterial peritonitis in subsets of cirrhotic patients with a great risk of developing this complication.

Anti-Bacterial Agents↗
PubMed1979

Ultrasonic differentiation of types of ascitic fluid.

A review of 65 cases of proven ascites was done to assess the accuracy of ultrasound in distinguishing transudates from exudates. In 10 patients with malignant ascites, ultrasound suggested this in six by showing matted bowel loops, loculation, or hepatic metastasis. In each of the five patients with peritonitis, infected ascites was suggested by observing septations or debris within the fluid. A sonographic diagnosis of exudate was not made in any of the 50 confirmed transudates. The echographic characteristics which may suggest infected or malignant ascites are discussed.

Ascites↗
PubMed1984

Some aspects of the composition of avian ascitic fluid.

Ascitic fluid from male Single Comb White Leghorn chickens fed a diet containing 20% by weight rapeseed oil rich (51.6 weight percent) in erucic (22:1n9) acid contained 2.84 +/- .09 g/dl protein and 2.55 +/- .22 micrograms/ml DNA. A characteristic feature of ascitic fluid as compared to liver and plasma was its high polyunsaturates, low saturates, and low saturate to unsaturate ratio. In general, the fatty acid profile of ascitic fluid is more comparable to the fatty acid profile of plasma lipids than to that of liver lipids. These data suggest that there is no direct absorption of fat and transfer to the ascitic fluid.

Animal Feed↗
PubMed1976

[Pancreatic ascites (author's transl)].

Pancreatic ascites occurs in cases of pancreatic ducts being damaged or discontinued due to pancreatitis or pancreatic trauma. Serum amylase, amylase and protein levels in ascites fluid are found to be elevated in cases of pancreatic ascites and a pancreatogram made during the operation confirms it. Various operations and sometimes a simple abdominal drainage are performed for treating pancreatic ascites.

Adolescent↗
PubMed1999

Pseudomembranous colitis: an unusual cause of neutrocytic ascites.

Severe cases of pseudomembranous colitis (PMC) may be associated with intraperitoneal fluid accumulation. However, the characteristics of the liquid are seldom described. Specifically, neutrocytic ascites has only been reported once. We report a case of a severe PMC complicated by a highly neutrocytic ascites which remained culture-negative. We discuss the possible mechanisms leading to ascites formation in this condition and review ascitic fluid characteristics in patients with PMC.

Adult↗
PubMed1975

Lymphatic drainage of the peritoneal cavity in experimental ascites.

Transport of labelled protein from the abdominal cavity by the thoracic duct and by the right lymph trunk was investigated in dogs with ascites due to inferior cava vein constriction and in control animals. The greater part of peritoneal fluid protein is transported in both ascites and under normal conditions by the lymphatics of the right side. The excess protein filtered from the liver sinusoids in venous stasis is transported by the thoracic duct. In this condition large amounts of fluid accumulate in the lymphatics in consequence of a relative obstacle to outflow at the veno-lymphatic junction. Thoracic duct drainage in experimental ascites leads to large fluid and protein losses and consequently to a reduction of inferior caval pressure and of capillary filtration in the liver. The intervention reduces ascites formation but does not influence the lymphatic absorption and transport of peritoneal fluid. Consequently, it is indicated only as a temporary measure, a preliminary to portocaval shunt operation, to reduce the increased sinusoidal and portal pressures. A cervical lympho-venous anastomosis reduces thoracic duct pressure by eliminating the obstacle to lymph flow. Accordingly, the intervention facilitates the return of excess lymph into the blood stream, and reduces fluid and protein leakage into the abdominal cavity from the liver.

Animals↗
PubMedDate not supplied

[Immunological parameters in the differential diagnosis of ascites secondary to peritoneal carcinomatosis, hepatic cirrhosis, and congestive heart failure].

As a contribution to the study of ascites in patients with liver cirrhosis, congestive heart failure and peritoneal carcinomatosis evaluate in serum and ascites the concentrations of alphafetoprotein, carcinoembryonic antigen and fibronectin, they might suggest a diagnosis for the basic pathology. Forty-seven patients were studied, from whom 23 with cirrhosis, 17 peritoneal carcinomatosis and 7 with congestive heart failure. We conclude that: a) none of the tools usually employed in the analysis of ascitic fluid alone can make the base pathological process responsible for producing ascites; b) fibronectins were more useful for differential diagnosis between cirrhosis and carcinomatosis; c) alpha-fetoprotein and carcinoembryonic antigen were not useful for the definition for differential diagnosis.

Ascites↗
PubMed2007

[A case report of advanced gastric cancer with carcinomatous ascites successfully treated by outpatient chemotherapy].

The patient was a 54-year-old male with peritoneal dissemination and carcinomatous ascites of advanced gastric cancer. Although 4 months of temporary partial responses were obtained by a combination chemotherapy with TS-1 and DOC, retention of ascites appeared. Second-line combination chemotherapy with 5-FU and PTX was not effective, and we attempted to use intraperitoneal chemotherapy of low-dose CDDP. After 100 mg of CDDP had been administered, ascites almost disappeared. Then,intraperitoneal injection of low-dose CDDP and intravenous injection of 5-FU were given. Tumor marker decreased remarkably, and CT revealed reduction of peritoneal dissemination. These regimens seem to be effective in ambulant patients with advanced gastric cancer with peritoneal dissemination and carcinomatous ascites.

Ambulatory Care↗
PubMed1991

[Carcinoembryonic antigen (CEA) in ascites].

The diagnostic value of carcinoembryonic antigen (CEA) was studied prospectively in 18 patients with ascites of malignant and 28 patients with ascites of benign genesis. Both sensitivity and specificity reached 83%. With a prevalence of malignant disease of 38%, the positive and negative predictive values were 75% and 89%, respectively. In contrast to frequent false-positive CEA values in the serum of liver cirrhotics (48.3%), false-positive CEA values in the ascites of the same patients were observed in only 17.3%. It is thus recommended that if CEA determination is to be employed, it should be done in the ascites itself.

Ascites↗
PubMed1990

[Paracentesis combined with albumin infusion in the treatment of tense ascites in cirrhotic patients].

We randomized 31 cirrhotic patients with tense ascites to a Group A receiving only diuretic therapy (spironolactone, furosemide, n = 14) or a Group B treated with paracentesis and intravenous albumin infusion (n = 17). Ascites was eliminated in 88% of patients in Group B compared to 57% of patients in Group A (p < 0.05). Complications developed in 4 patients in Group A and 2 patients in Group B. Paracentesis was associated to a mild and transient reduction in mean arterial pressure and a significant rise in urinary output. Duration of hospital stay was 5 +/- 3 days in Group B and 22 +/- 6 in Group A (p < 0.001). Survival and likelihood of readmission for ascites was similar in both groups. Our results suggest that paracentesis plus intravenous albumin infusion is a fast, safe and effective therapy for tense ascites in cirrhotic patients.

Albumins↗
PubMed1988

Reverse cascade filtration of ascitic fluid--preliminary results.

Refractory ascites is an infrequent complication of cirrhosis. Paracentesis and ultrafiltration of the ascitic fluid with intravenous or intraperitoneal reinfusion of the concentrated ascites has been used as therapy for this condition since 1971. The technique is cumbersome and has high morbidity and mortality rates, even if effective. In this paper we describe a new technique that couples secondary filtration for the removal of macromolecules, with ultrafiltration of ascitic fluid. In its very first application 6 patients underwent 8 treatments. No adverse effect was observed and clinical efficacy was good. Up to 60 g of albumin can be saved in a single session lasting less than 2 hours.

Aged↗