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At least 1,621 records · Page 90Linked to original sources
PubMed2005

[Diagnosis of spontaneous ascites infection in patients with cirrhosis: reagent strips].

AIM: To evaluate the sensitivity, specificity, and predictive values of dipstick testing (DT) for detecting spontaneous bacterial peritonitis (SBP), defined by an ascites neutrophil polymorphonuclear cell count > or = 250/mm3, in patients with cirrhosis. METHODS: The study includes all patients with cirrhosis and ascites admitted to our general hospital on the southern outskirts of the Paris metropolitan area (France) from June 2003 to May 2004 (n = 47:27 men and 20 women). Diagnostic abdominal paracentesis was performed on admission, and a Multistix SG (Bayer Pharma) reagent strip was immersed in one ascitic sample from each patient. Readings after 120 s were either negative (DT-) or positive (DT+, with 4 levels of positivity: trace, +, ++, or +++). In case of cytologically-proven SBP, patients were treated with cefotaxime, and subsequent paracentesis with DT and cytologic testing took place every 48 hours, until recovery. RESULTS: Six of the 47 patients had proven SBP, all with clinical signs of SBP (fever and/or abdominal pain); five of these patients were DT+ and one was DT-. In the five patients initially DT+, the DT became negative at the same time as the cytologic criteria for SBP disappeared. Forty-one patients did not meet the cytologic criteria for SBP: 34 were DT- and 7 were DT+ (traces: 4, ++: 2, +++:1); two of these had clinical signs suggestive of SBP. CONCLUSION: Although the sensitivity (83%), specificity (83%) and negative predictive value (97%) of DTwere satisfactory, its positive predictive value (42%) was low. Dipstick testing of ascitic fluid is easy to perform and inexpensive and may be recommended for diagnosis and follow-up of SBP, especially in emergency settings.

Aged↗
PubMedDate not supplied

Opsonic activity of ascitic fluids from Plasmodium falciparum-infected Saimiri monkey: positive correlation with protection in passive transfer assay.

An investigation into the protective activity of ascitic fluids from Saimiri monkeys infected with Plasmodium falciparum and the role played by opsonins in that activity was undertaken. P. falciparum-parasitized blood was collected from splenectomized Saimiri (when parasitaemia reached at least 20% or more) and used in an in vitro phagocytic assay including ascitic fluid and cultures of peripheral blood monocytes from normal Saimiri. Under the conditions of this in vitro assay, we found that ascitic fluid phagocytosis-promoting factors were opsonic rather than cytophilic. The opsonic activity was highly specific for parasitized red blood cells and was effective against all stages of development of the parasite. A highly positive relationship between in vitro opsonizing activity and in vivo protective capacity of immune ascitic fluid was found.

Animals↗
PubMed2001

Pharmacokinetics of fluoroquinolones in uncompensated cirrhosis: the significance of penetration in the ascitic fluid.

In order to study the penetration of routinely used fluoroquinolones in the ascitic fluid of patients with uncompensated cirrhosis the following doses were given. Three patients received three consecutive iv doses of 200 mg of ciprofloxacin, six patients, three consecutive iv doses of 300 mg of ciprofloxacin, seven others, three consecutive iv doses of 400 mg of pefloxacin and six, three consecutive iv doses of 400 mg of ofloxacin. Drug levels in serum and the ascitic fluid were monitored at regular time intervals. Peak levels of the 200 mg dose of ciprofloxacin, of the 300 mg dose of ciprofloxacin, of pefloxacin and of ofloxacin in serum were 2.11,2.45,9.21 and 8.86 microg/ml, respectively and in the ascitic fluid 0.67, 0.45, 6.09 and 5.83 microg/ml, respectively T(1/2) was 3.19+/-0.73, 3.55+/-1.68, 15.60+/-12.40 and 9.45+/-3.14 h, respectively with AUC of 3.62+/-4.02, 7.39+/-4.70, 137.85+/-63.96 and 119.8+/-16.83 mg/l h. Urinary excretion of ciprofloxacin and of ofloxacin was similar to healthy individuals but pefloxacin showed a mean urinary excretion of 30.11%. It is concluded that pefloxacin and ofloxacin at the administered iv doses result in serum and ascitic fluid levels above the MICs of the common pathogens causing spontaneous bacterial peritonitis and that they should be administered to cirrhotic patients in dosing regimens similar to those in patients with normal hepatic function. The use of ciprofloxacin requires further studies to define the appropriate dose.

Aged↗
PubMed1997

Ascites and renal functional abnormalities in cirrhosis. Pathogenesis and treatment.

In the past few years, there have been important advances in the field of pathogenesis and management of ascites and hepatorenal syndrome in cirrhosis. A new pathogenic theory of ascites and renal dysfunction in cirrhosis has been presented and previously ill-defined conditions, such as refractory ascites and hepatorenal syndrome, have been defined precisely. The link between the diseased liver and the disturbances in renal function and vasoactive systems is not completely known, but a large body of evidence indicates that it consists of a circulatory dysfunction that affects mainly the arterial circulation and is characterized by an inability to maintain an effective arterial blood volume within normal limits. The research on the mechanisms of this circulatory dysfunction will give valuable information in the design of more pathophysiologically oriented therapeutic approaches to the management of ascites.

Ascites↗
PubMed2006

Chylous ascites after anterior resection for rectal carcinoma: a rare but significant incident.

Chylous ascites specifically after anterior resection for rectal cancer has not been documented in the literature thus far. All previously reported postoperative chylous ascites developed in other types of malignancies and were diagnosed within a few days of surgery. However, the patient we report had symptoms 2 years after surgery. Intraoperatively, chylous ascites was found with multiple lymph node metastasis in the small bowel mesentery and retroperitoneal region. The rarity of chylous ascites after anterior resection in rectal carcinoma is documented and discussed.

Adenocarcinoma↗
PubMed2001

Pleurx tunneled catheter in the management of malignant ascites.

The authors report their experience with the Pleurx tunneled catheter in patients with end-stage abdominal carcinomatosis and intractable ascites. Ten patients with intractable ascites and abdominal carcinomatosis underwent placement of tunneled Pleurx catheters. The catheters were placed with combined US and fluoroscopic guidance. Patients' charts were reviewed for procedural complications, serum albumin levels, infection, efficacy of catheters in providing effective drainage of ascites, and duration of catheter patency. There were no procedural complications. The serum albumin level decreased from 2.7 g/L to 2.3 at 3 weeks and 2.4 g/L at 6 weeks. There were no catheter infections. Some patients required continuous drainage, whereas others were successfully treated by drainage once per week. Mean catheter survival was 70 days. In patients with end-stage abdominal carcinomatosis complicated by malignant ascites, the Pleurx tunneled catheter can provide effective palliation and alleviated the need for repeated percutaneous paracentesis.

Abdominal Neoplasms↗
PubMed2000

Mechanisms of ascites formation.

Ascites is the most common complication of cirrhosis. It is associated with profound changes in the splanchnic and systemic circulation and with renal abnormalities. The development of ascites is related to the existence of severe sinusoidal portal hypertension that causes marked splanchnic arterial vasodilation and a forward increase in the splanchnic production of lymph. Splanchnic arterial vasodilation also produces arterial vascular underfilling, arterial hypotension, compensatory activation of the RAAS, SNS, and AVP, and a continuous sodium and water retention, leading to ascites formation. Now, therefore, the splanchnic arterial circulation, rather than the venous portal system, is believed to be involved in the pathogenesis of ascites formation.

Ascites↗
PubMed1997

Pathophysiology, complications, and treatment of ascites.

In the past few years, there have been important advances in the field of pathogenesis and management of ascites and spontaneous bacterial peritonitis in cirrhosis. A new pathogenic theory of ascites and renal dysfunction in cirrhosis has been presented, and previously ill-defined conditions, such as refractory ascites and hepatorenal syndrome, have been defined precisely. The reintroduction of therapeutic paracentesis has modified markedly the way in which patients hospitalized for ascites are treated. The use of potent and safe antibiotics has improved the resolution rate and survival of patients with spontaneous bacterial peritonitis, and the use of oral antibiotics will simplify the management of this condition in the near future. Finally, prophylactic antibiotic regimens represent a major step forward in the prevention of spontaneous bacterial peritonitis in subsets of cirrhotic patients with a great risk of developing this complication.

Ascites↗
PubMed2003

Mechanisms of water and sodium retention in cirrhosis and the pathogenesis of ascites.

Patients with advanced cirrhosis and portal hypertension often show an abnormal regulation of extracellular fluid volume, resulting in the accumulation of fluid as ascites, pleural effusion or oedema. The mechanisms responsible for ascites formation include alterations in the splanchnic circulation as well as renal functional abnormalities that favour sodium and water retention. Renal abnormalities occur in the setting of a hyperdynamic state characterized by an increase cardiac output, a reduction in total vascular resistance and an activation of neurohormonal vasoactive systems. This circulatory dysfunction, due mainly to intense arterial vasodilation in the splanchnic circulation, is considered to be a primary feature in the pathogenesis of ascites. A major factor involved in the development of splanchnic arterial vasodilation is nitric oxide (NO), a potent vasodilator that is elevated in the splanchnic circulation of patients with cirrhosis. This event decreases effective arterial blood volume and leads to fluid accumulation and renal function abnormalities which are a consequence of the homeostatic activation of vasoconstrictor and antinatriuretic factors triggered to compensate for a relative arterial underfilling. The net effect is avid retention of sodium and water as well as renal vasoconstriction. The mechanisms of sodium and water retention and ascites formation in patients with cirrhosis are discussed in this review.

Ascites↗
PubMed2002

Pancreatic cancer with chylous ascites demonstrated by lymphoscintigraphy: successful treatment with peritoneovenous shunting.

A 60-year-old woman was admitted to our hospital because of abdominal distension caused by massive chylous ascites. Six months earlier, she was diagnosed with inoperative pancreatic head cancer and biliary tract stenting and radiation therapy were performed due to obstructive jaundice. The chylous ascites was observed by lymphoscintigraphy with 99mTc-labeled human serum albumin. It showed upper abdomen accumulation and leakage into the abdominal cavity, and a diagnosis of chylous ascites caused by obstruction or rupture of lymphocele due to pancreatic cancer was made. Chylous ascites did not improve with a conservative therapy, including low-fat diet and administration of flousemide, but was successfully treated with a peritoneovenous shunt using a Denver shunting tube. In association with the placement of the shunt, she lived for 15 months after the first diagnose of pancreatic cancer without pancreatoduodenectomy.

Chylous Ascites↗
PubMed1998

A folate binding protein in ascitic fluid, serum and ovarian tissue of patients with ovarian adenocarcinoma immunoreacts with antibodies against human milk folate binding protein.

The presence of a folate binding protein which immunoreacts with antibodies against human milk folate binding protein was demonstrated in ascitic fluids from seven patients with ovarian adenocarcinoma. Ascitic fluids collected from two patients with other malignancies contained non-immunoreactive FBP. Tumor tissue specimens from five patients with ovarian carcinoma contained immunoreactive FBP. By contrast to normal ovaries ovarian carcinoma tissue showed positive immunostaining on immunohistochemistry. Ascitic fluids from two patients with ovarian carcinoma exhibited single distinct bands on SDS-PAGE immunoblotting. The gel filtration profile of ovarian carcinoma tissue homogenate from two patients contained 25 and 1OOkDa peaks of radioligand-bound and immunoreactive folate binding protein, while ascitic fluid from one of the patients exhibited a large 100 kDa immunoreactive peak with no radioligand binding activity. The immunoreactive non-functional 100 kDa FBP could represent unprocessed precursor FBP. Future studies are necessary to evaluate whether determination of immunoreactive FBP in ovarian adenocarcinomatosis is of any diagnostic value.

Adenocarcinoma↗
PubMed1996

Therapeutic effect of the matrix metalloproteinase inhibitor, batimastat, in a human colorectal cancer ascites model.

The matrix metalloproteinase inhibitor batimastat was administered to a human colorectal cancer ascites model, which was initiated by injection of C170HM2 cells into the peritoneal cavity of SCID mice and resulted in solid tumour deposits and ascites formation. The cell line expressed both the 72 and 92 kDa forms of gelatinase by zymography. Batimastat administered from day 0 (40 mg kg-1) reduced the volume of ascites to 21% of control in mice treated from day 0 (P < 0.002) but not day 10. Formation of solid peritoneal deposits was significantly reduced to 77% of vehicle control when batimastat was administered from day 0 (P < 0.01) and 69% of control when administered from day 10 (P < 0.05). Thus, batimastat has the ability to reduce the volume of ascites forming in SCID mice injected intraperitoneally with the human colorectal cell line, C170HM2, when administered from day 0 but not from day 10. Solid peritoneal tumour deposits were significantly reduced in both treatment groups, highlighting the therapeutic potential of batimastat in this clinical condition.

Animals↗
PubMed1979

Analysis of genetic control of chylous ascites in ragged mice.

Chylous ascites is a disorder visible as a white fluid in the peritoneal cavity of suckling mice. It is due to inadequate lymphatic drainage from the small intestine. An initial genetic study showed it to be a pleiotropic effect of ragged, Ra. There were four main studies. These involved seven major mutants segregating with ragged. Four of the mutants had no effect on chylous ascites, but two mutants linked with ragged, and one unlinked, showed a complex situation involving enhancement, inhibition, epistacy and other interactions. The overall phenotypic effects which these mutants are known to have do not explain how they produce their interaction with ragged in terms of chylous ascites. The studies also indicate the existence of a single major modifier controlling penetrance and expression, and there is evidence for cumulatively acting minor modifiers. In neonates the male sex is more liable to chylous ascites, and in adults this condition affects fertility and fecundity.

Animals↗
PubMed2002

Angiopoietin-1 inhibits tumour growth and ascites formation in a murine model of peritoneal carcinomatosis.

Angiopoietin-1 is an important regulator of endothelial cell survival. Angiopoietin-1 also reduces vascular permeability mediated by vascular endothelial growth factor. The effects of angiopoietin-1 on tumour growth and angiogenesis are controversial. We hypothesised that angiopoietin-1 would decrease tumour growth and ascites formation in peritoneal carcinomatosis. Human colon cancer cells (KM12L4) were transfected with vector (pcDNA) alone (control) or vector containing angiopoietin-1 and injected into the peritoneal cavities of mice. After 30 days, the following parameters were measured: number of peritoneal nodules, ascites volume, and diameter of the largest tumour. Effects of angiopoietin-1 on vascular permeability were investigated using an intradermal Miles assay with conditioned media from transfected cells. Seven of the nine mice in the pcDNA group developed ascites (1.3+/-0.5 ml (mean+/-s.e.m.)), whereas no ascites was detectable in the angiopoietin-1 group (0 out of 10) (P<0.01). Number of peritoneal metastases (P<0.05), tumour volume, (P<0.05), vessel counts (P<0.01), and tumour cell proliferation (P<0.01) were significantly reduced in angiopoietin-1-expressing tumours. Conditioned medium from angiopoietin-1-transfected cells decreased vascular permeability more than did conditioned medium from control cells (P<0.05). Our results suggest that angiopoietin-1 is an important mediator of angiogenesis and vascular permeability and thus could theoretically serve as an anti-neoplastic agent for patients with carcinomatosis from colorectal cancer.

Angiogenesis Inducing Agents↗
PubMed1999

Massive myelomatous ascites responsive to VAD chemotherapy and autologous stem cell transplantation.

Plasmacytic ascites is an infrequent complication of multiple myeloma. To date, only few cases have been reported with a very rapidly fatal course unresponsive to therapy. We describe a patient with plasmacytic ascites and quiescent multiple myeloma of 8 years of duration. Disease progression became apparent due to myelomatous ascites, unexplained fever, pancytopenia and bone marrow infiltration. This case showed a complete and long-lasting response after VAD chemotherapy followed by autologous PBSC transplantation. Ascites in association with MM may respond for lengthy periods to high-dose chemotherapy and ASCT.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Saphenoperitoneal shunts for patients with intractable ascites associated with chronic liver disease.

BACKGROUND: Ascites is a common complication in patients with chronic liver disease. Some patients are resistant to diuretics and need therapeutic paracentesis on a regular basis. This is inconvenient in the long term and also has resource implications. Alternatively, these patients may be treated by peritoneovenous shunts, which require insertion of a foreign body into a central vein and are prone to occlusion. A new technique for peritoneovenous shunting without the use of foreign material is described. METHODS: Eight patients with chronic liver disease and diuretic-resistant ascites underwent this procedure. During operation, the long saphenous vein was divided at the mid-thigh level and inverted towards the inguinal canal, where it was anastomosed directly to the peritoneum at the internal inguinal ring using non-absorbable suture material. RESULTS: Seven patients had successful shunt formation; the remaining patient had to have the shunt removed because of ascitic leakage. In those who underwent successful shunt formation, the need for paracentesis and the dose of diuretic was significantly reduced over a median follow-up of 8 months. Hospital stay in the month after discharge was significantly less than that in the month before operation. Three patients died during follow-up from causes unrelated to the operation. One patient underwent successful liver transplantation. CONCLUSION: This study suggests that saphenoperitoneal shunting is potentially a safe and effective therapy for patients with diuretic-resistant ascites. It retains the benefits of peritoneovenous shunting without the adverse effects of insertion of foreign material.

Ascites↗
PubMed2000

Expression of costimulatory molecules CD80 and CD86 and their receptors CD28, CTLA-4 on malignant ascites CD3+ tumour-infiltrating lymphocytes (TIL) from patients with ovarian and other types of peritoneal carcinomatosis.

Costimulation of T lymphocytes by the leucocyte surface molecules CD80 and CD86 expressed on antigen-presenting cells (APC) is required for the development of T cell responses. The CD28 and CTLA-4 molecules on T cells serve as receptors for the CD80 and CD86 costimulatory antigens. We have examined the frequency of expression of CD80 (B7.1), CD86 (B7.2), CD28 and CTLA-4 surface antigens on TIL isolated from malignant ascites or peritoneal washings of 26 patients with ovarian carcinoma and five patients with non-ovarian peritoneal carcinomatosis. Expression of CD80 and CD86 antigen was detected by reverse transcription-polymerase chain reaction (RT-PCR), and by FACS analysis. Significantly higher proportions of intraperitoneal CD3+ cells expressed CD86 antigen than the CD80 antigen (14 +/- 9% versus 3 +/- 3%, P < 0.05). Moreover, CD3+CD86+ cells were significantly more frequent in the peritoneal fluid (14 +/- 9%) than in the peripheral blood (3 +/- 0.4%, P < 0.05) of ovarian patients or normal controls (3 +/- 1%). CTLA-4 and CD28 antigen were expressed, respectively, on 9 +/- 4% and 86 +/- 14% of ascitic CD3+ cells of ovarian cancer patients. Both CD80 and CD86 antigens were expressed primarily on HLA-DR+ ascites TIL and were present in a very low proportion of HLA-DR- ascites TIL. These HLA-DR+ cells may represent a population of lymphocytes that have been activated in vivo, and function as APC. An anti-CD86 MoAb or a combination of anti-CD86 and anti-CD80 MoAbs significantly inhibited the proliferation of cultured intraperitoneal TIL. We have shown that in addition to CD28 and CTLA-4, CD3+ intraperitoneal TIL express the costimulatory molecules CD80 and CD86. The expression of these molecules on T cells could be dependent upon certain factors in the tumour microenvironment that could determine the outcome of in vivo immune responses.

Abatacept↗
PubMedDate not supplied

Lymphatic ascites following lymphadenectomy for gynecological malignancy.

Seven patients seen between January 1995 and December 1998 developed symptomatic lymphatic ascites following either pelvic or para-aortic lymph node dissection. The incidence of symptomatic lymphatic ascites during this 4-year period was 2.7% (7 of 263 cases). The accumulation of ascites postoperatively was associated with a prolonged postoperative ileus, abdominal pain, and extended postoperative hospitalization. Once the condition was recognized, abdominal paracentesis resulted in rapid improvement of symptoms in two patients but repeated paracenteses were required for a further two patients who had significant complications as a result of these procedures. Two patients improved following spontaneous drainage of a large amount of ascites per vagina and did not require further intervention. The final patient settled with observation only. This condition can be difficult to recognize and is a potential cause of significant postoperative morbidity.

Ascites↗