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PubMed1989

Effects of massive ascites on measurement of cardiac ejection fraction via multi-gated acquisition (MUGA) scanning.

A patient with massive ascites secondary to ovarian carcinoma was found to have a low cardiac ejection fraction as measured by multi-gated acquisition (MUGA) scanning. Because of this low measurement, she was not treated with Adriamycin for fear of cardiac toxicity. Because the MUGA was felt to be incorrect, we performed simultaneous echocardiography and then repeated the MUGA scan after removal of 9000 cc of ascites fluid. The echocardiogram showed an ejection fraction in excess of 50% and the MUGA performed after paracentesis revealed an ejection fraction of 63% (an increase of 133%). We conclude that the MUGA is an inaccurate way to assess cardiac ejection fraction in the presence of massive ascites and that other ways to assess cardiac function should be used when there is need to determine such function in patients with massive ascites.

Adult↗
PubMed1992

Analysis of ascites from patients with ovarian carcinoma by cell flow cytometry.

Cell flow cytometry offers the opportunity to analyze cytopathological samples with regards to DNA content and proliferative activity. To investigate whether this modality can quantitate certain aspects of ovarian carcinoma by analyzing ascites, 43 samples from patients with advanced papillary serous adenocarcinoma of the ovary were studied. In 28 samples (65%) ploidy and the percentage of cells in S phase (%S phase) could be analyzed. Fifteen samples could not be analyzed because of overlapping cell populations distorting distinct cell cycle phases. Of the 28 samples studied, 8 (29%) were diploid and 20 (71%) were aneuploid. The DNA in aneuploid samples ranged from 1.23 to 2.65. The %S phase for aneuploid was greater than that for diploid samples. Patients with diploid samples survived longer. Cytometric analysis of cells from ascites in 4 patients in whom disease progressed after they received chemotherapy showed that the percentage of cells in S phase increased. Cells from ascites established in vitro showed that ploidy and proliferative activity changed as cells were passed in culture. In conclusion, the analysis of ascites by cell flow cytometry may be a prognosticator in patients with advanced ovarian carcinoma. In addition, conclusions extrapolated from in vitro data to the in vivo situation should be done cautiously since late-passaged cells may not always be representative of the initial tumor sample.

Aneuploidy↗
PubMed1992

Intraperitoneal therapy of malignant ascites associated with carcinoma of ovary and breast using radioiodinated monoclonal antibody 2G3.

A phase I/II study of intraperitoneal (ip) radioimmunotherapy was conducted in ovarian or breast cancer patients with symptomatic chemotherapy-resistant ascites using a novel anti-mucin monoclonal antibody (mAb) 2G3 labeled with 131I. Tracer doses of 2 mCi [131I]2G3 were given by ip injection to 11 patients, followed by increasing therapeutic doses up to 150 mCi (cumulative) in 9 patients. There was no serious toxicity. Temporary palliation of ascites was observed in 3 of 4 patients who received doses greater than 50 mCi. Total body elimination half-life of the radiolabeled antibody assessed by gamma scintigraphy ranged from 95 to 250 hr, longer than data previously reported in patients without ascites treated with ip administered radiolabeled antibodies. However, uptake of radiolabel by tumor nodules was small and variable (2 x 10(-4) - 2 x 10(-2) % ID/g), and preferential uptake by tumor compared to normal peritoneum was observed in only 2 of 5 patients in whom biopsies were obtained. These results suggest that the observed palliation of ascites is due to prolonged retention of radiolabeled antibody in the peritoneal cavity even in the absence of specific targeting.

Adult↗
PubMed1992

Transvaginal color Doppler sonography and CA-125 elevation in a patient with ovarian thecoma and ascites.

A postmenopausal patient presented with a pelvic mass and ascites. The CA-125 level was 329 U/ml, and transvaginal color Doppler sonography of the tumor vasculature suggested malignancy. At laparotomy, a luteinized thecoma and cytologically benign ascites were found. On rare occasions ovarian thecoma may be associated with ascites without hydrothorax. Preoperative evaluation of the patient with ascites and a pelvic mass may suggest malignancy, but histologic confirmation is necessary to exclude this rare association.

Aged↗
PubMed1991

Chemoattractant and opsonic activity in ascitic fluid. A study in 47 patients with cirrhosis or malignant peritonitis.

We studied prospectively the ascitic fluid of 47 patients. Thirty-five were cirrhotics (group A) and 12 had malignant peritonitis (group B). All ascitic fluid samples were initially uninfected. We measured opsonic activity by a chemiluminescent assay, and chemoattractant activity by the under agarose technique. We also measured ascitic concentrations of C3, C4, fibronectin, C-reactive protein, immunoglobulins G, A and M and total proteins. All patients were followed throughout the presence of ascites. None of the group B patients developed peritoneal infection, nor did 23 of the group A patients (group A2). Twelve group A patients (group A1) developed spontaneous bacterial peritonitis (SBP), four of them with recurrence. All indices except immunoglobulins A and M were significantly different between group A and group B patients. Comparing group A1 and group A2, only chemoattractant activity and concentrations of total proteins and C3 were significantly lower in group A1. Using a multivariate analysis with Cox's model, only C3 concentration had an independent predictive value for occurrence of SBP in cirrhotic patients.

Aged↗
PubMed1991

Malignant ascites: sonographic signs of peritoneal carcinomatosis.

This study was performed in 65 patients with cytologically proved malignant ascites to describe and classify direct and indirect sonographic signs of peritoneal carcinomatosis. Abdominal sonography revealed tumour-associated abnormalities which account for malignant ascites in 60 cases (92%). This includes visualisation of peritoneal metastases (n = 16, 25%); matting together of bowel loops (17, 26%); distribution of fluid (19, 29%); echoes within the fluid space (3, 5%); omental matting (8, 12%); associated masses (21, 32%); lymphoadenopathy (31, 48%); and hepatic metastases (26, 40%). Sonography enables the physician to demonstrate direct and indirect signs of peritoneal carcinomatosis in almost all tumour patients with ascites and is therefore useful in determining whether the cause of ascites is malignant or benign disease.

Abdomen↗
PubMed1995

Effects of creatine and beta-guanidinopropionic acid on the growth of Ehrlich ascites tumor cells: i.p. injection and culture study.

Growth of Ehrlich ascites tumor (EAT) cells in the abdominal space of mice or in cell culture was studied in response to i.p. injection or addition, respectively, of creatine or creatine analogue beta-guanidinopropionic acid (beta-GPA). The increase in body weight of the mice due to cancer growth was less in the beta-GPA-injected than in the creatine- or sham-injected group. The volume of abdominal ascites and total cell counts at 11th day after implantation of EAT cells was significantly less in the beta-GPA than in the other groups. The proliferation rate of EAT cells in the beta-GPA group was 27% and 35% of the creatine- and sham-injected groups, respectively. Supplementation of creatine tended to enhance the growth of EAT cells. The creatine concentration in ascites fluid was approximately 4-times greater than in blood plasma of sham-injected control mice. But the creatine content in EAT cells was significantly reduced to approximately 50% in response to beta-GPA injection. Cell culture without creatine caused a significant decrease in viability. The viability was improved, however, by addition of either creatine or serum into the medium. By contrast, it was not significantly increased by addition of serum alone which caused only a minor elevation of the creatine level (23 microM). It is suggested that EAT cell growth is inhibited by lowering the availability of creatine in association with some unknown factors in serum or ascites fluid.

Abdomen↗
PubMed2006

Malignant ascites: systematic review and guideline for treatment.

A guideline on the management of symptomatic malignant ascites by abdominal paracentesis, diuretics and peritoneovenous shunting, based on a systematic review of the literature is presented. Thirty-two relevant studies were identified. None were randomized control trials, one was a non-randomized open controlled trial, five were cohort studies or prospective uncontrolled trials, 26 studies were non-analytic studies like case series. Although paracentesis, diuretics and shunting are commonly used procedures, the evidence is weak. Available data show good, although temporary effect of paracentesis on symptom relief. Fluid withdrawal speed and concurrent intravenous hydration is not sufficiently studied. Peritoneovenous shunts can control ascites in patients with malignant ascites, but have to be balanced by the potential risks of this procedure. The available data about diuretics in treatment of malignant ascites are controversial. The use of diuretics therefore should be considered in all patients, but has to be evaluated individually.

Ascites↗
PubMed2006

Laparoscopic intraperitoneal hyperthermic chemotherapy for palliation of debilitating malignant ascites.

AIM: To report the use of laparoscopic Intraperitoneal Hyperthermic Chemotherapy (LIPHC) in the treatment of malignant ascites. METHODS: From September 2001 to December 2003, 14 patients between the age of 56 and 78years were treated. Ascites was from gastric cancer (5 cases), colorectal cancer (3 cases), ovarian cancer (3 cases), breast cancer (2 cases) and peritoneal mesothelioma (1 case). The LIPHC was carried out at 42 degrees C for 90 min with 1.5% dextrose solution as a carrier. Chemotherapy was cisplatin and doxorubicin or mitomycin depending on the type of primary tumor. The drains were left in situ after surgery and removed when perfuse drainage ceased. RESULTS: Ascites was controlled in all the treated cases. A CT scan performed in follow-up showed a small, clinically undetectable, fluid accumulation in the pelvis of one patient. CONCLUSIONS: This method resulted in benefit for those peritoneal carcinomatosis patients with debilitating malignant ascites who were excluded from cytoreductive surgery. Proficiency in laparoscopic staging procedures and experience in the management of carcinomatosis and intraperitoneal hyperthermic chemotherapy (IPHC) are required for the success of the procedure.

Aged↗
PubMed2000

Perturbation of hyaluronan interactions by soluble CD44 inhibits growth of murine mammary carcinoma cells in ascites.

Hyaluronan accumulates in ascites during intraperitoneal proliferation of TA3/St murine mammary carcinoma cells and at sites of their invasion of the peritoneal wall. To determine whether hyaluronan is functionally involved in these events, ascites tumor formation was compared in mice injected intraperitoneally with stable transfectants of TA3/St cells that overexpress soluble CD44, a hyaluronan-binding protein, versus in mice injected with transfectants expressing mutated soluble CD44 that does not bind hyaluronan. The soluble CD44 transfectants temporarily grew at a reduced rate within the peritoneal cavity, then went into G(1) arrest and were subsequently cleared from the peritoneum. However, transfectants overexpressing mutant soluble CD44 that does not bind hyaluronan exhibited similar ascites accumulation, growth rates, and cell-cycle profiles in vivo to wild-type and vector-transfected TA3/St cells, all of which continued to grow until the tumors became fatal. The soluble CD44-transfected TA3/St cells also failed to attach to and form tumors in the peritoneal wall. When grown in vitro in soft agar, the soluble CD44 transfectants exhibited a dramatic reduction in colony formation compared to wild-type, vector-transfected, and mutant soluble CD44-transfected TA3/St cells. Thus, perturbation of hyaluronan interactions by soluble CD44 has a direct effect on the growth characteristics of these tumor cells, leading to inhibition of anchorage-independent growth in vitro and ascites growth in vivo.

Animals↗
PubMed2001

Management of medically refractory ascites.

BACKGROUND: Medically refractory ascites is a clinical entity for which there exists few effective therapeutic options. Available treatment modalities include diuresis and sodium restriction, peritoneovenous shunt, liver transplant, transjugular intrahepatic portosystemic shunts and surgical shunts, and large-volume paracentesis. Herein we review the current therapeutic options for medically refractory ascites focusing on indications, benefits, and drawbacks of each specific therapy. DATA SOURCES: Data and recommendations are based on the authors' cumulative experience with complicated cirrhotic and cancer patients and on past and current literature addressing intractable ascites. CONCLUSIONS: The absence of a single, effective therapy in the management of refractory ascites speaks to the complex nature of this complication. Although most patients will respond to medical management, thoughtful application of available therapeutic options in patients who fail, as described herein, not only makes decisions regarding their care easier but also provides the best palliation in a vexing clinical scenario.

Ascites↗
PubMed2002

[Reoperation for refractory postoperative chylous ascites: value of peritoneovenous shunt combined with closure of lympho-peritoneal fistula].

Postoperative chylous ascites is a rare but serious complication resulting in denutrition, lymphopenia and infection. The first-intent treatment is usually conservative. We report a case of chylous ascites after retroperitoneal lymphadenectomy for testicular cancer, persisting despite conservative treatment then successfully treated by lymphostasis combined with peritoneovenous shunt. In case of high-output postoperative chylous ascites in low-risk patients with presumed localization of fistula, reoperation is indicated for lymphostasis. We advise to associate a peritoneovenous shunt in case of incomplete closure of the lymphoperitoneal fistula to avoid the morbidity of prolonged ascites.

Adult↗
PubMedDate not supplied

A consideration of comparative metabolic aspects of the aetiology of sudden death syndrome and ascites in broilers.

There is some evidence to suggest that the aetiology of 'Sudden Death Syndrome' (SDS) and ascites in broilers are closely related and that they may be the result of different degrees of the same metabolic condition. Many of the clinical findings, such as cardiac involvement and oedema are common to both conditions. Males are more affected than females and rapid growth, if a factor, is more related to increased oxygen demand rather than growth per se. Dietary, environmental or other factors which disrupt the balance of electrolytes, metabolites or pH may affect cardiopulmonary function and lead to SDS or ascites. The conditions can be either acute or chronic in nature and, whereas if acute, the end result is SDS, when chronic, ascites is the end result. Dietary or environmental factors that may either help to stabilize or adversely affect acid base balance may be useful avenues for future research into the aetiology of SDS and ascites. Factors that would increase the bird's capacity for supplying adequate oxygen to the tissues may also help to alleviate these two conditions which are of considerable annual cost to the poultry industry.

Animals↗
PubMed2001

Serum and ascitic fluid nitrate levels in patients with cirrhosis.

BACKGROUND: Increased nitric oxide level may play a critical role in the hemodynamic disturbances in patients with cirrhosis. There are few reports investigating the factors related to this increase and their results are controversial. The purpose of this study was to reveal the clinical importance of nitric oxide levels and the possible factors related to this increase in patients with cirrhosis. METHODS: Serum and ascites nitrate levels were studied in 50 patients with cirrhosis and 10 control subjects. RESULTS: All cirrhotic patients (groups 2, 3, 4, 5, 6) showed significant increase in serum nitrate levels in comparison with that in control subjects (group 1) (p<0.001). Serum nitrate levels were significantly higher (282.4+/-111.3 micromol/l; p<0.05) in patients with spontaneous bacterial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (186.4+/-87.6 micromol/l). Ascitic fluid nitrate levels were significantly higher (302.4+/-66 micromol/l; p<0.001) in patients with spontaneous bacterial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (135.4+/-65.8 micromol/l). Serum nitrate levels were significantly lower in cirrhotic patients without ascites (group 5) when compared with those in cirrhotic patients with ascites (group 3) (98.8+/-52.6 vs. 186.4+/-87.6 micromol/l; p<0.05). No significant differences were found among patients with severe anemia (groups 4, 6) and other cirrhotic patients (group 3) (174.5+/-54.5, 168.8+/-63.8 vs. 186.4+/-87.6 micromol/l; p>0.05). Cirrhotic patients with Child--Pugh B and C scores showed higher serum nitrate levels (179.4+/-81.1, 222.5+/-101.7 micromol/l; p<0.001) than did cirrhotic patients with Child--Pugh A score (85.8+/-59.7 micromol/l). CONCLUSION: Our findings suggest that overproduction of nitric oxide in cirrhotic patients may be related to the severity of liver damage and spontaneous bacterial peritonitis but not related to their anemia.

Ascites↗
PubMed1993

Elevated levels of interleukin-6 in ascites and serum from women with ovarian hyperstimulation syndrome.

OBJECTIVE: To examine the role of pro-inflammatory cytokines in ovarian hyperstimulation syndrome (OHSS). DESIGN: In vitro laboratory study of serum, peritoneal cells isolated and fluid obtained from ascites removed in the therapeutic management of four patients with OHSS. SETTING: Tertiary care referral teaching hospital. PATIENTS: Four patients with OHSS comprised the study population. Five healthy women at the time of elective laparoscopic tubal ligation served as controls. Control serum was also obtained from healthy adult volunteers, and control peritoneal fluid (PF) was obtained from patients on peritoneal dialysis. INTERVENTIONS: Therapeutic paracentesis was performed on four patients with OHSS. RESULTS: Peritoneal cells were isolated and fluid obtained from ascites removed in the therapeutic management of the women with OHSS. Peritoneal cells were obtained by intraoperative lavage from the control women. The cells were incubated with various concentrations of Escherichia coli lipopolysaccharide (LPS) for 20 and 48 hours. Interleukin-1 beta (IL-1 beta), tumor necrosis factor (TNF), interleukin-6 (IL-6), and prostaglandin E2 (PGE2) were assayed in the incubation supernatants. The release of the three cytokines and PGE2 in response to LPS by peritoneal cells from women with OHSS was not different from the controls. However, both serum and ascitic fluid from women with OHSS contained significantly greater levels of IL-6 than control serum and PF. No significant differences in TNF levels in serum, ascitic fluid, or PF could be found by ELISA or bioassay. CONCLUSIONS: Increased production of IL-6, released into the peritoneal cavity and the circulation, may mediate OHSS.

Adult↗
PubMed1995

Chest tube drainage of pleural effusion correcting abdominal ascites in a patient with severe ovarian hyperstimulation syndrome: a case report.

OBJECTIVE: To describe a patient with severe ovarian hyperstimulation syndrome (OHSS) demonstrating a beneficial result of reduction in abdominal ascites with a chest tube placed for bilateral pleural effusions. DESIGN: Case report. SETTING: Academic hospital. PATIENT: A 28-year-old white female with primary infertility on hMG (Pergonal; Serono Laboratories, Randolph, MA) therapy. INTERVENTIONS: Intravenous fluids, lasix, and albumin were administered for correction of laboratory abnormalities, including hemoconcentration, hypoalbuminemia, and leukocytosis. A chest tube was placed for treatment of pleural effusions. MAIN OUTCOME MEASURES: Laboratory values of hematologic measures and electrolytes. Resolution of pleural effusions and abdominal ascites as determined by chest roentgenogram and physical examination. RESULTS: Treatment of OHSS with intravenous fluids, lasix, and albumin corrected the hemoconcentration, hypoalbuminemia, and leukocytosis associated with OHSS. Placement of a chest tube corrected the pleural effusions and abdominal ascites. CONCLUSION: This case report demonstrates a beneficial result of reduction in abdominal ascites by a chest tube placed for pleural effusions.

Adult↗
PubMed1999

A case of ovarian hyperstimulation syndrome in which antithrombin III deficiency occurred because of its loss into ascites.

OBJECTIVE: To present a case of ovarian hyperstimulation syndrome in which antithrombin III activity in plasma was decreased and in ascites was increased. DESIGN: Case report. SETTING: Hospital-based clinic for reproductive medicine. PATIENT(S): A 27-year-old woman who was transferred to our hospital because of ovarian hyperstimulation syndrome. INTERVENTION(S): Induced abortion. MAIN OUTCOME MEASURE(S): Antithrombin III activity in plasma and ascites. RESULT(S): Antithrombin III activity in ascites was slightly lower than that in plasma. CONCLUSION(S): The loss of antithrombin III into ascites probably caused its deficiency in this case.

Adult↗
PubMed1998

Altered biosynthesis of leukotrienes and lipoxins and host defense disorders in patients with cirrhosis and ascites.

BACKGROUND & AIMS: Advanced cirrhosis is associated with impaired leukocyte function, but the mechanism underlying this host defense alteration is unknown. The aim of this study was to investigate the lipoxygenase pathway of arachidonic acid metabolism and its influence in leukocyte trafficking in patients with cirrhosis and ascites. METHODS: Neutrophils (polymorphonuclear leukocytes [PMN]) were isolated from patients with cirrhosis and ascites and healthy subjects, and 5-lipoxygenase (5-LO) messenger RNA levels and 5-LO-derived products were measured. The effect of leukotrienes (LT) and lipoxins (LX) on PMN adhesion and migration was also assessed. RESULTS: PMN from patients with cirrhosis showed increased 5-LO messenger RNA expression. However, in vitro generation of LTB4, cysteinyl-containing LT and LX was significantly decreased in cirrhotic patients. Interestingly, a close relationship between the activity of the renin-angiotensin system and LXA4 biosynthesis was observed both in vitro and in vivo. PMN isolated from cirrhotic patients with ascites showed significantly decreased adhesion and migration in response to LTB4. LXA4 did not provoke PMN adhesion and migration, but rather abrogated the differences between control and cirrhotic PMN. Cirrhotic monocytes showed marked impairment in adherence to laminin when stimulated with either LTB4 or LXA4. CONCLUSIONS: These results show the existence of altered biosynthesis of LT and LX and defective response to these lipoxygenase products in leukocytes from patients with cirrhosis and ascites. This abnormality may be relevant to the pathogenesis of host defense disorders in chronic liver disease.

Angiotensin II↗