Ascites

Ascites can be defined as the abnormal accumulation of fluid inside the peritoneal cavity. Earlier ascites was classified as transudative and exudative based on the total protein concentration of the ascitic fluid. The traditional concept of high pro-tein ascites(> 2.5 g/dl) as exudate ...

OBJECTIVES: Peritoneal carcinomatosis is the second major cause of ascites. Because of its frequency and poor prognosis, it is important to establish an accurate diagnosis. The aim of this study was to analyze the use of a DNA index, detemined by flow cytometry in the differential diagnosis of ascites, and to compare it to the cytopathological examination. METHODS: A prospective analysis was carried out on 67 patients (39 female, 28 male; mean age, 53 Ϯ 14 yr [range, 5-82]) with ascites of various etiologies. Peritoneal carcinomatosis was detected in 21 patients, whereas in 46 the ascites was of noncarcinomatosis origin. RESULTS: The sensitivity of the cytopathological examination for the diagnosis of peritoneal carcinomatosis was 42.9%, and the specificity was 100%. The mean DNA index determined by flow cytometry was similar for peritoneal carcinomatosis and noncarcinomatosis patients, being 1.28 versus 1.01, respectively, in the preparations without control lymphocytes and 1.28 versus 1.04, respectively, when control lymphocytes were added. The sensitivity of DNA index cytometry was 57.1% and specificity, 93.5%. The combined use of the DNA index and cytopathological examination did not show an advantage over the use of any of the tests individually, although the DNA index was able to detect half of the cases of peritoneal carcinomatosis in which cytopathological examination was negative. Although the sensitivity was higher when the parameters were associated, the DNA index did not offer a statistically significant advantage over the use of cytopathological examination alone, which in turn had higher specificity. CONCLUSION: The DNA index presented lower sensitivity for the diagnosis of peritoneal carcinomatosis when used alone, showing no advantage over conventional cytopathological examination. However, the DNA index was able to detect 50.0% of peritoneal carcinomatosis cases whose conventional cytopathological examinations were negative, and could be valuable in these situations.

Analyses of genome orthologs in cancer on the background of tumor heterogeneity, coupled with the recent identification that the tumor propagating capacity resides within a very small fraction of cells (the tumor stem cells-TSCs), has not been achieved. Here, we describe a strategy to explore genetic drift in the mitochondrial genome accompanying varying stem cell dynamics in epithelial ovarian cancer. A major and novel outcome is the identification of a specific mutant mitochondrial DNA profile associated with the TSC lineage that is drastically different from the germ line profile. This profile, however, is often camouflaged in the primary tumor, and sometimes may not be detected even after metastases, questioning the validity of whole tumor profiling towards determining individual prognosis. Continuing mutagenesis in subsets with a mutant mitochondrial genome could result in transformation through a cooperative effect with nuclear genes - a representative example in our study is a tumor suppressor gene viz. cAMP responsive element binding binding protein. This specific profile could be a critical predisposing step undertaken by a normal stem cell to overcome a tightly regulated mutation rate and DNA repair in its evolution towards tumorigenesis. Our findings suggest that varying stem cell dynamics and mutagenesis define TSC progression that may clinically translate into increasing tumor aggression with serious implications for prognosis.

Objetivo: presentar el cuadro clínico y de laboratorio de una paciente con tuberculosis peritoneal. La tuberculosis puede afectar diferentes órganos con presentaciones clínicas que simulan otras patologías.1Presentamos el caso de una paciente con ascitis y masa anexial diagnosticada por tomografía y con CA 125 elevado. Se realizó laparotomía exploradora con la impresión diagnóstica de tumor de ovario, encontrando adherencias y siembras peritoneales. La patología informó inflamación granulomatosa crónica compatible con tuberculosis.

The association of pulmonary sequestration and nonimmune fetal hydrops reportedly carries a very poor prognosis for survival. We describe three newborns with good outcomes despite the diagnosis of pulmonary sequestration; two cases were associated with hydrops fetalis and one with isolated fetal ascites. Two neonates with severe hydrops fetalis had pulmonary sequestration diagnosed postnatally. A third infant presented early in gestation with marked fetal ascites that regressed spontaneously before delivery; this infant also had pulmonary sequestration. Despite severe respiratory insufficiency requiring aggressive management, all three infants survived after surgical resection of the sequestered lung mass. These cases demonstrate the difficulties associated with antenatal counseling regarding long-term prognosis for infants with nonimmune hydrops and pulmonary sequestration. With optimal care in a tertiary perinatal center, a less pessimistic outlook than previously described in the literature may be appropriate.

A 51-year-old woman presented with acute ascites and hydrothorax is reported. Pelvic ultrasound showed two pelvic solid masses and serum CA125 level was elevated (577 IU / ml). Pathology revealed bilateral ovarian fibromas. We present this case of Meigs' syndrome and discuss its diagnostic problems and a review of the literature.

Hemorrhagic ascites in patients with cirrhosis is described as a RBC (Red Blood cell) >50,000/mm³ and leads to increased morbidity and mortality. Positive red blood cells at a level of less than 50,000/mm³ (10,000-50,000) may be encountered in the ascites but it is not known whether this is clinically significant or not. This study aimed to examine the outcome of hemorrhagic ascites in patients with advanced cirrhosis. Data from 329 cirrhotic patients with ascites who received paracentesis at least once due to ascites was retrospectively analyzed from the period of 2007-2013 from the Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology. Patients were divided according to the number of RBC, with greater than 10,000/mm³ being described as hemorrhagic ascites, and less than 10,000 / mm³ described as the normal or control group. Patient data included: number of accepted intensive unit service stays, acute kidney injury (AKI), hepatic encephalopathy (HES), model for end-liv...

Background and Aim: Refractory ascites in liver-cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritionalsupport could improve outcomes in cirrhotic patients. Methods: Cirrhotic patients undergoing serial large-volume paracentesis for refractoryascites were enrolled and randomized into three groups. Group A received postparacentesis intravenous nutritional-support in addition to a balanced oral diet and a late-evening protein snack, group B received the same oral nutritional-protocol as the first group but without parenteral support, and group C (the control group) received a lowsodium or sodium-free diet. Clinical, anthropometric and laboratory nutritional parameters and biochemical tests of liver and renal function were reported for 12 months of follow-up. Results: We enrolled 120 patients, who were randomized into three groups of equal size. Patients on the nutritional-protocol showed better preservation of clinical, anthropometric and laboratory nutritional parameters that were associated with decreased deterioration of liver function compared with patients on the low-sodium or sodium-free diet (group C). Groups A and B had lower morbidity and mortality rates than the control group (C). Mortality rates were significantly better in patients who were treated with parenteralnutritional-support than for the other two groups. In patients who were on the nutritionalprotocol, there was a reduction in the requirement of taps for the treatment of refractory ascites. Conclusions: Post-paracentesis parenteral-nutritional-support with a balanced oral diet and an evening protein snack appears to be the best care protocol for patients with liver-cirrhosis that has been complicated by refractory-ascites.

The journal is pleased to debut a new feature, a debate. This one is on the use of albumin colloid replacement after large-volume paracentesis. Whether or not such a practice is warranted is argued vigorously and informatively by three experts in the field, Drs Cárdenas and Ginès for the 'pro' side and Runyon for the 'con' side. Topics for future debates will be controversial issues in research or clinical hepatology. Debates are generally commissioned, but if you have an interesting suggestion for a debate, please contact the editor.

We present a case of isolated fetal ascites diagnosed by ultrasonography at 29 weeks' gestation. Cordocentesis revealed a normal karyotype and negative viral titers. Postnatally, the diagnosis of primary lymphangiectasia was made by intestinal biopsy. To our knowledge this is the first description of prenatal manifestation of primary lymphangiectasia. (Am J Obstet Gynecol 2001;184:227-8.)

A two-year-old labrador retriever was examined after a year's history of persistent ascites and exercise intolerance that began shortly after the dog was struck by an automobile. Contrast venography showed tortuosity of the intrathoracic caudal vena cava with partial obstruction caused by kinking of the vessel. Surgical resection of a fibrous connective band that was found to be tethering the intrathoracic vena cava ventrally, creating a partial obstruction, was performed. A hypothesis of the aetiology of this phenomenon is presented.

The gradient between wedged and free hepatic venous pressures was measured in 10 unselected adult patients suffering from fulminant viral hepatitis. The gradient was increased in all the studied patients, ranging from 0.9 to 2. 1 kPa; this finding indicates that portal hypertension was present in all these cases. Ascites was present in all the five patients having a gradient above 1.5 kPa and affected only two of the five patients having a gradient below 1.5 kPa; this observation suggests that portal hypertension plays a role in the mechanism of ascites in fulminant viral hepatitis. Portal hypertension in fulminant viral hepatitis is likely to be the consequence of an intrahepatic block due to massive necrosis of the liver cells.

Ascitic fluid total protein, albumin, cholesterol, their asciteslserum ratios, serum-ascites albumin and cholesterol gradients were measured for their ability to differentiate cirrhotic, malignant and tuberculous ascites in 76 patients. The mean f s.d. ascitic fluid total protein, albumin, cholesterol, their respective ascitic fluid/serum ratios in cirrhotic ascites were lower than malignant and tuberculous groups (P < 0.001 for each).

Background Lymphangiectasia results from acquired dilation of lymphatic vessels. Areas of skin affected by obstruction or destruction of lymphatic drainage are said to be prone to the development of lymphangiectasia. Cirrhosis is a cause of alterations of lymph flow.

e Abstract-Background: Ascites is a common complication of liver cirrhosis, malignancy, cardiac failure, pancreatitis, and tuberculosis, with cirrhosis of the liver being the most common cause. Onset of ascites in cirrhosis of the liver is associated with worsened quality of life, increased risk of spontaneous bacterial peritonitis, and renal failure. Management of ascites caused by cirrhosis requires sodium restriction in diet, sodium excretion with diuretics and, in refractory cases, large volume paracentesis. Technique: We describe a simple adjustment to the standard paracentesis technique that does not require additional equipment or manpower. Conclusion: Removing over 5 L of ascitic fluid can become a timeconsuming and labor-intensive process. We describe a setup that makes this commonly performed procedure fast, convenient, and safe.

Alcoholic liver disease (ALD) is a serious and potentially fatal consequence of alcohol use. The diagnosis of ALD is based on drinking history, physical signs and symptoms, and laboratory tests. Treatment strategies for ALD include lifestyle changes to reduce alcohol consumption, cigarette smoking, and obesity; nutrition therapy; and pharmacological therapy. The diagnosis and management of the complications of ALD are important for alleviating the symptoms of the disease, improving quality of life, and decreasing mortality.

ᴥ Asites pada penyakit ginjal kronik (Nefrogenik Asites) adalah suatu kondisi yang ditandai dengan adanya asites masif, analisis cairan dengan protein yang tinggi, albumin serum rendah dan jumlah neutrofil rendah. Kasusnya termasuk jarang ditemukan dan data yang ada minimal didapatkan.
ᴥ Mekanisme patogenesis nefrogenik asites
1. Peningkatan tekanan hidrostatik vena hepatica.
2. Kelebihan intake cairan.
3. Naiknya permeabilitas membrane peritoneal; uremic toxin, penggunaan larutan dialisat jangka panjang, kompleks imun, aktivitas sistem renin-angiotensin-aldosterone, hemosiderosis.
4. Terganggunya drainasi limfatik peritoneal.
ᴥ Data IRR tahun 2015 asites nefrogenik belum dicantumkan.
ᴥ Pilihan terapi asites nefrogenik yang dianjurkan adalah transplantasi ginjal, CAPD, pilihan lain adalah hemodialisis terus-menerus. Sedangkan terapi yang paling merugikan adalah parasentesis berulang.

Background: Ovarian cancer ascites fluid (OCAF), contains malignant cells, is usually present in women with an advanced stage disease and currently has no effective therapy. Hence, we developed a new therapy strategy to target the expression of diphtheria toxin gene under the control of H19 regulatory sequences in ovarian tumor cells. H19 RNA is present at high levels in human cancer tissues (including ovarian cancer), while existing at a nearly undetectable level in the surrounding normal tissue. Methods: H19 gene expression was tested in cells from OCAF by the in-situ hybridization technique (ISH) using an H19 RNA probe. The therapeutic potential of the toxin vector DTA-H19 was tested in ovarian carcinoma cell lines and in a heterotopic animal model for ovarian cancer. Results: H19 RNA was detected in 90% of patients with OCAF as determined by ISH. Intratumoral injection of DTA-H19 into ectopically developed tumors caused 40% inhibition of tumor growth. Conclusion: These observations may be the first step towards a major breakthrough in the treatment of human OCAF, while the effect in solid tumors required further investigation. It should enable us to identify likely non-responders in advance, and to treat patients who are resistant to all known therapies, thereby avoiding treatment failure.

Lysophosphatidic acid (LPA) is enriched in ascites of ovarian cancer patients and is involved in growth and invasion of ovarian cancer cells. Accumulating evidence suggests cancer-associated myofibroblasts play a pivotal role in tumorigenesis through secreting stromal cell-derived factor-1 (SDF-1). In the present study, we demonstrate that LPA induces expression of alpha-smooth muscle actin (alpha-SMA), a marker for myofibroblasts, in human adipose tissue-derived mesenchymal stem cells (hADSCs). The LPA-induced expression of alpha-SMA was completely abrogated by pretreatment of the cells with Ki16425, an antagonist of LPA receptors, or by silencing LPA(1) or LPA(2) isoform expression with small interference RNA (siRNA). LPA elicited phosphorylation of Smad2/3, and siRNA-mediated depletion of endogenous Smad2/3 or adenoviral expression of Smad7, an inhibitory Smad, abrogated the LPA induced expression of alpha-SMA and phosphorylation of Smad2/3. LPA-induced secretion of transforming growth factor (TGF)-beta1 in hADSCs, and pretreatment of the cells with SB431542, a TGF-beta type I receptor kinase inhibitor, or anti-TGF-beta1 neutralizing antibody inhibited the LPA-induced expression of alpha-SMA and phosphorylation of Smad2. Furthermore, ascites from ovarian cancer patients or conditioned medium from ovarian cancer cells induced expression of alpha-SMA and phosphorylation of Smad2, and pretreatment of the cells with Ki16425 or SB431542 abrogated the expression of alpha-SMA and phosphorylation of Smad2. In addition, LPA increased the expression of SDF-1 in hADSCs, and pretreatment of the cells with Ki16425 or SB431562 attenuated the LPA-stimulated expression of SDF-1. These results suggest that cancer-derived LPA stimulates differentiation of hADSCs to myofibroblast-like cells and increases SDF-1 expression through activating autocrine TGF-beta1-Smad signaling pathway.

Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. Results Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. Conclusion Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.

Splanchnic and systemic arteriolar vasodilationplays an important role in ascites formation incirrhosis. Octreotide produces splanchnicvasoconstriction, but the effects on systemichemodynamics and renal function are controversial. This studyevaluated the effect of subcutaneous octreotideadministration on systemic hemodynamics, endogenousvasoactive systems, and renal function in cirrhoticpatients with ascites. Twenty patients were included: 10received octreotide 250 μg/12 hr subcutaneously (forfive days), and 10 did not. No statistically significantchanges were found in mean arterial pressure and cardiac rate. Octreotide induced astatistically significant decrease in plasma reninactivity (P < 0.01), plasma aldosterone (P = 0.01)and plasma glucagon (P < 0.05). No significantvariations were observed in other systemic vasoactivesubstances (nitric oxide and prostacyclin). Renalfunction was not modified in either group. Inconclusion, in cirrhotic patients with ascites,subcutaneous octreotide administration decreases plasma glucagon, reninactivity, and aldosterone without changing in systemichemodynamics or renal function.

Nephrogenic ascites is a complex problem with a poorly understood pathophysiology. We report the case of a patient with nephrogenic ascites and concomitant secondary hyperparathyroidism who was resistant to the usual treatment but had a complete resolution after subtotal parathyroidectomy. We believe that secondary hyperparathyroidism might be implicated in the pathogenesis of nephrogenic ascites.

Imperforate hymen is most commonly an isolated finding and usually remains asymptomatic until puberty. Rarely, symptoms of imperforate hymen manifest antenatally as well as in the neonatal period, requiring surgical correction for life-threatening consequences. We report a 5-day-old infant with a large hydrometrocolpos causing severe renal compromise and abdominal ascites, successfully surgically treated in the neonatal period. Associated polydactyly suggested McKusick-Kaufman syndrome.

We report a posterior urethral valves case diagnosed at 33 week&#39;s gestation on a fetus presenting with anamnios and urinary ascites. In this fetus, the serum beta2 microglobuline rate was high, suggesting a very poor renal prognosis. At 1-year-old, the creatinine rate is nearly normal. In case of urinary ascites, the serum beta2 microglobuline rate could be improved in relation with the transperitoneal reabsorption of this protein.

Ascites in patients with end-stage renal disease (ESRD) poses a challenging management scenario for nephrologists. We present two patients with ascites refractory to treatment with standard outpatient hemodialysis which resolved upon the initiation of nocturnal home hemodialysis (NHD). NHD is a form of intensive renal replacement therapy whereby patients receive up to 8 hours of continuous hemodialysis and ultrafiltration, five to seven times per week. In both cases, the ascites resolved within weeks of changing hemodialysis modalities. NHD allowed a significant reduction in ultrafiltration rates, which likely underlies the procedural tolerability and contributed to the successful outcomes. This option could be considered in the management of the patient with ESRD and refractory ascites.

RESUMEN
En el mundo prehispánico la ascitis era un signo
frecuente, resultado de la presencia epidemiológicamente
significativa de alteraciones hepáticas
y cardiacas. Así mismo, era importante su relación
con Tláloc y los dioses y diosas de la lluvia y
el agua. El cuerpo ascítico era entendido simbólicamente
como un recipiente lleno de agua y se le
atribuía la función específica de servir a Tláloc al
ser portador de ésta. En el presente artículo analizamos
el papel de Tláloc y sus deidades asociadas,
como proveedores de agua y alimento.
Describimos cinco diferentes tipos de representaciones
plásticas de cuerpos llenos de agua, todos
claramente asociados con Tláloc.


SUMMARY
Ascites has been a common pathological sign
among prehispanic Mexican people, as a result
from hepatic and cardiac ailments. In this sense it
represents a significant epidemiological problem.
But it also is important because is related to Tlaloc
and the rain gods and goddesses. The hidropic body
is a symbolic water container and have a special
function: serve as a Tlaloc and related gods vehicle
to transport the precious liquid. In this paper
we analyze the Tlaloc role as water and alimentary
substances provider and his capital importance for
people survival. We also describe five different plastic
ways to represent water in the body, all of them
with clear relationship to Tlaloc.

Background. Ascites in patients with hepatocellular carcinoma (HCC) is a poorly characterized subgroup of malignancy-related ascites. Not only the underlying liver disease, but also the tumor growth and spread contributes to the ascites formation. The authors differentiated ascites in HCC from other types of ascites.

Evidence is scarce on the efficacy of long-term human albumin (HA) administration in patients with decompensated cirrhosis. The human Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis (ANSWER) study was designed to clarify this issue. We did an investigator-initiated multicentre randomised, parallel, open-label, pragmatic trial in 33 academic and non-academic Italian hospitals. We randomly assigned patients with cirrhosis and uncomplicated ascites who were treated with anti-aldosteronic drugs (≥200 mg/day) and furosemide (≥25 mg/day) to receive either standard medical treatment (SMT) or SMT plus HA (40 g twice weekly for 2 weeks, and then 40 g weekly) for up to 18 months. The primary endpoint was 18-month mortality, evaluated as difference of events and analysis of survival time in patients included in the modified intention-to-treat and per-protocol populations. This study is registered with EudraCT, number 2008-000625-19, and ClinicalTrials.gov, number NCT012...

Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of pediatric patients with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to its diagnostic and ...