Objective:This study aims to systematically evaluate the clinical efficacy and safety of diuretic therapy in patients with liver cirrhosis ascites.Method:60 patients with liver cirrhosis ascites diagnosed from January...Objective:This study aims to systematically evaluate the clinical efficacy and safety of diuretic therapy in patients with liver cirrhosis ascites.Method:60 patients with liver cirrhosis ascites diagnosed from January 2024 to May 2025 were prospectively included and randomly divided into a furosemide monotherapy group(20 cases),a spironolactone monotherapy group(20 cases),and a combination therapy group(20 cases).The intervention period is 28 days,and the main observation indicators include 24-hour urine output,changes in abdominal circumference,weight loss,serum electrolyte levels,renal function indicators,and incidence of adverse reactions.All study subjects received standardized dietary management and sodium restriction intervention(daily sodium intake<5 g).Result:The total effective rate(significant+effective)of the combination therapy group in reducing ascites was 95%(19/20),significantly higher than the 75%(15/20)of the furosemide group and the 70%(14/20)of the spironolactone group(p<0.01).On the 28th day of treatment,the mean urine output in the combination group was 2450±210 mL/d,which was higher than that in the monotherapy group(1850±195 mL/d in the furosemide group);Spironolactone group 1560±180 mL/d.The blood sodium levels of the three groups were maintained at 135-140 mmol/L,but the incidence of hypokalemia in the combination group(10%)was significantly lower than that in the furosemide group(35%).Conclusion:The combination of furosemide and spironolactone has a synergistic effect in the treatment of ascites in cirrhosis,with a 39.2%increase in diuretic effect and a reduction in the risk of electrolyte imbalance;Individualized dose adjustment combined with strict sodium restriction is the core strategy to ensure treatment safety.展开更多
BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains u...BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.展开更多
BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic f...BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.展开更多
BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced rad...BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced radiological and endoscopic methods and serological,cytological,and microbiological examinations and,therefore,underwent diag-nostic laparoscopy.METHODS This retrospective analysis evaluated 82 patients who underwent diagnostic laparoscopy due to unexplained ascites.Patients’medical records were obtained from the hospital database.Their age,sex,complaints at admission,laboratory results,radiological imaging results,diagnostic laparoscopy reports,and pa-thology reports were analyzed.RESULTS The serum-ascites albumin gradient was<1.1 in 96.3%of the patients(n=79).Among patients,22(26.8%)had benign diagnoses and 60(73.2%)had malignant diagnoses.In addition,55(67.1%)were deceased,and the median follow-up time from diagnosis to death was four months.The overall follow-up time ranged from 1 to 142 months,with a median of 14 months.Patients’diagnoses were significantly associated with their survival(P<0.05,χ2 test).The mortality rate was 86.7%among patients with malignant diagnoses and 13.6%among patients with benign diagnoses.CONCLUSION Diagnostic laparoscopy is minimally invasive,has a low complication rate,and requires a short hospital stay.It can be safely performed to diagnose and treat ascites that remain unexplained after advanced radiological and endoscopic examinations.展开更多
Background:Laparoscopic pancreaticoduodenectomy(LPD)has gained growing acceptance for the resection of periampullary carcinoma.However,postoperative ascites(POA)frequently occurs after LPD,yet little is known about th...Background:Laparoscopic pancreaticoduodenectomy(LPD)has gained growing acceptance for the resection of periampullary carcinoma.However,postoperative ascites(POA)frequently occurs after LPD,yet little is known about the underlying factors that promote POA under this laparoscopic approach.This study aimed to explore the clinical influence of POA after LPD and its potential predictors.Methods:Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed.Patients were assigned to the two groups by whether daily abdominal drainage>500 mL for at least three consecutive days,followed by subgroup analysis of pancreatic fistula(PF)-POA and non-PF-POA.Variables,including preoperative laboratory tests,past history,surgery-related factors,and incidence of complications,were compared.In addition,logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.Results:A total of 38 patients(17.4%)developed POA,with 17 having PF-POA and 21 having non-PF-POA.Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection,and a longer hospital stay compared with other groups.Multivariate analysis demonstrated that prothrombin time>14 s and main pancreatic duct diameter<3 mm were independent risk factors for PF-POA.Moreover,male sex,total bilirubin>34.2μmol/L and platelet count<100×10^(9)/L were independent risk factors for non-PF-POA.The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA,respectively.Conclusions:LPD recovery and postoperative complications are impacted by POA,where PF-POA is the most clinically relevant POA.Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA;male sex,elevated total bilirubin level,and decreased platelet count were independent risk factors for non-PF-POA.展开更多
Acute pancreatitis(AP)is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course,ranging from mild,selflimiting episodes to severe necrotizing forms.Among its common co...Acute pancreatitis(AP)is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course,ranging from mild,selflimiting episodes to severe necrotizing forms.Among its common complications ascites has traditionally been viewed as a passive byproduct of peritoneal inflammation and enzymatic leakage with limited diagnostic or prognostic utility.However,growing evidence challenges this perspective,suggesting that ascitic fluid in AP represents a dynamic and clinically meaningful component of disease progression.In this editorial we reflected on the findings presented by Rao et al,who highlighted the diagnostic,prognostic,and therapeutic significance of ascitic fluid in AP.Easily accessible markers such as lactate dehydrogenase may provide early prognostic insight while emerging molecular biomarkers and cytokine pro-files offer promise for more precise risk stratification and individualized therapy.We argue that the systematic evaluation of ascitic fluid should be integrated into the clinical management of moderate to severe AP.Incorporating ascites analysis into standard diagnostic protocols may enhance early risk assessment,inform therapeutic decisions,and ultimately improve patient outcomes.Ascitic fluid should be recognized as a clinically valuable marker and an important source of information in the evolving landscape of AP care.展开更多
BACKGROUND Ascites is the most common complication of cirrhosis.Current pharmacological interventions,such as diuretics,often become ineffective in advanced stages due to diuretic resistance.Sodium-glucose co-transpor...BACKGROUND Ascites is the most common complication of cirrhosis.Current pharmacological interventions,such as diuretics,often become ineffective in advanced stages due to diuretic resistance.Sodium-glucose co-transporter 2(SGLT2)inhibitors have demonstrated potential in enhancing urinary sodium excretion and mitigating sodium-fluid retention.This study aims to evaluate the effects of SGLT2 inhibitors on the fractional excretion of sodium(FENa)in patients with cirrhotic ascites.AIM To determine whether adjunctive therapy with the SGLT2 inhibitor empagliflozin increases FENa compared with standard care alone in patients with cirrhosis and refractory ascites,and to evaluate its short-term safety profile.METHODS The effect of SGLT2 inhibitor empagliflozin on FENa in patients with cirrhosis and refractory ascites is a multicenter,open-label,randomized controlled trial.A total of 70 patients with refractory ascites secondary to cirrhosis will be enrolled and randomly assigned to receive either empagliflozin 10 mg daily plus standard care or standard care alone for 14 consecutive days.The primary outcome is the change in FENa from baseline to day 14.Secondary outcomes include 24-hour urinary sodium excretion,urine volume,ascites volume(assessed by ultrasound),body weight,and safety indicators.Exploratory outcomes include changes in components of the reninangiotensin-aldosterone system.RESULTS This article reports the study protocol only.No participant data have been collected or analyzed for this manuscript.CONCLUSION This protocol evaluates whether empagliflozin,added to standard therapy,increases sodium excretion and reduces fluid overload in refractory ascites.展开更多
BACKGROUND Chylous ascites(CA),which is characterized by lymphatic leakage into the peritoneal cavity,is a rare but significant complication of liver transplantation.Although dietary and pharmacological strategies hav...BACKGROUND Chylous ascites(CA),which is characterized by lymphatic leakage into the peritoneal cavity,is a rare but significant complication of liver transplantation.Although dietary and pharmacological strategies have shown effectiveness in managing CA,standardized treatment protocols have yet to be established.AIMTo evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs)vs octreotide therapy in managing post-liver transplantation CA.METHODSA comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotidetherapy. The key parameters examined included resolution rates, treatment duration, and recurrence.RESULTSA comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospectivecohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%.The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementationwas used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolutionrates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietarymanagement alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotidecontainingregimens than with dietary management alone (median, 7 days vs 14 days;P = 0.03).CONCLUSIONA stepwise approach to CA management is recommended, initiating dietary interventions and escalating tooctreotide when necessary. Further research through well-designed randomized controlled trials is essential toestablish standardized treatment protocols for optimizing patient outcomes.展开更多
Ovarian cancer remains a leading cause of gynecological cancer mortality1,and patients with advanced stage ovarian cancer frequently develop malignant ascites that foster immunosuppressive microenvironments and therap...Ovarian cancer remains a leading cause of gynecological cancer mortality1,and patients with advanced stage ovarian cancer frequently develop malignant ascites that foster immunosuppressive microenvironments and therapeutic resistance2,3.Although ascites have traditionally been considered detrimental,we report a paradoxical role in which they enhance the cytotoxicity ofγδT cells—a unique T cell subset that can be allogenically transferred for cancer treatment4,5—toward ovarian cancer.展开更多
Objective: To study the value of combined determination of carcinoembryonic antigen (CEA), total cholesterol (Tch) and adenosine deaminase (ADA) in the differential diagnosis of ascites due to different causes. Method...Objective: To study the value of combined determination of carcinoembryonic antigen (CEA), total cholesterol (Tch) and adenosine deaminase (ADA) in the differential diagnosis of ascites due to different causes. Methods: Sixty-eight cases with ascites were divided into 3 groups based on their etiology, namely malignant ascites, tubercular ascites and non-tubercular benign ascites. CEA, Tch, and ADA were measured and analyzed in different ascites. Results: CEA was significantly higher in malignant ascites than in benign ascites, the sensitivity and specificity for malignant ascites being 50% and 100% respectively. Tch is higher or equal to 1.54 mmol/L in tubercular ascites and lower or equal to 1.18 mmol/L in non-tubercular benign ascites, and Tch level in malignant ascites was frequently between that in tubercular acites and non-tubercular benign ascites. Ascitic fluid ADA activity was higher than 30 U/L in 80% of tubercular ascites, while none of non-tubercular benign ascites reached to such level. Conclusion: CEA, Tch and ADA are valuable for the diagnosis and differential diagnosis of ascitic etiology and combine measurements of these indices can increase the diagnostic efficiency.展开更多
Ascites is a pathologic accumulation of peritoneal fluidcommonly observed in decompensated cirrhotic states. Its causes are multi-factorial, but principally involve significant volume and hormonal dysregulation in the...Ascites is a pathologic accumulation of peritoneal fluidcommonly observed in decompensated cirrhotic states. Its causes are multi-factorial, but principally involve significant volume and hormonal dysregulation in the setting of portal hypertension. The diagnosis of ascites is considered in cirrhotic patients given a constellation of clinical and laboratory findings, and ultimately confirmed, with insight into etiology, by imaging and paracentesis procedures. Treatment for ascites is multimodal including dietary sodium restriction, pharmacologic therapies, diagnostic and therapeutic paracentesis, and in certain cases transjugular intra-hepatic portosystemic shunt. Ascites is associated with numerous complications including spontaneous bacterial peritonitis, hepato-hydrothorax and hepatorenal syndrome. Given the complex nature of ascites and associatedcomplications, it is not surprising that it heralds increased morbidity and mortality in cirrhotic patients and increased cost-utilization upon the health-care system. This review will detail the pathophysiology of cirrhotic ascites, common complications derived from it, and pertinent treatment modalities.展开更多
IM To study the effect of intraperitoneal hyperthermic double distilled water and cisdiaminodichloroplatinum (DDP) perfusion in treatment of cancerous ascites and radical gastrectomy.METHODS H22 cancer cells (2×...IM To study the effect of intraperitoneal hyperthermic double distilled water and cisdiaminodichloroplatinum (DDP) perfusion in treatment of cancerous ascites and radical gastrectomy.METHODS H22 cancer cells (2×107 tumor cells each mouse) were injected into the peritoneal cavity of LACA mice. Five days after the injection, intraperitoneal perfusion of 37℃ isotonic fluid (Group Ⅰ), simple hyperthermic (43℃) double distilled water (Group Ⅱ), isotonic fluid (group Ⅲ), DDP (group Ⅳ) and hyperthermic double distilled water perfusion combined with DDP (group Ⅴ) were performed. Based on the experiment from September 1991 through September 1993, intraperitoneal hyperthermic double distilled water perfusion with DDP was used to treat 32 advanced gastric cancer patients after radical gastrectomy.RESULTS In comparison with the control group, the cancer cells in the peritoneal cavity of LACA mice were almost completely destroyied, the ascites was markedly inhibited and the survival time was prolonged, the growth of peritoneal cancerous nodes was reduced in all groups, except the control group.Clinically, after oneyear followup, all 32 patients with advanced carcinoma got satisfactory results, but the 2year followup was not satisfactory.CONCLUSION The intraperitoneal hyperthermic double distilled water perfusion with DDP inhibited the occurrence of ascites in LACA mice, and prolonged the lifetime of gastric cancer patients after radical gastrectomy.展开更多
Gastric adenocarcinoma is quite rare in children and as a result very little experience has been reported on with regards to clinical presentation,treatment and outcome.We describe the case of a 16-year-old boy presen...Gastric adenocarcinoma is quite rare in children and as a result very little experience has been reported on with regards to clinical presentation,treatment and outcome.We describe the case of a 16-year-old boy presenting with abdominal fullness and poor appetite for 7 d.Sonography showed massive ascites and computed tomography imaging revealed the presence of gastric mucosa thickness with omentum caking.The diagnosis of gastric adenocarcinoma was biopsyproven endoscopically.Despite gastric adenocarcinoma being quite rare in the pediatric patient population,we should not overlook the possibility of gastric adenocarcinoma when a child presents with distended abdomen and massive ascites.展开更多
AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled...AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0software and P＜0.05 was considered statistically significant.RESULTS: Of the 148 patients enrolled in the study, 72(48.6%) were males and 76 (51.4%) were females with a mean age of 59.03±13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%),ovarian and gastric cancers were found in 14 (22.5%)and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68±0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P＜0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P＜0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P＜0.0001).CONCLUSION: Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.展开更多
AIM: To measure plasma D-dimer levels in cirrhotic patients with and without ascites, assessing the effect of ascites resolution in D-dimer concentration. METHODS: Seventy consecutive cirrhotic patients (M = 44, F = 2...AIM: To measure plasma D-dimer levels in cirrhotic patients with and without ascites, assessing the effect of ascites resolution in D-dimer concentration. METHODS: Seventy consecutive cirrhotic patients (M = 44, F = 26, mean age 65 years, SD ± 13), observed from October 2005 to March 2006 were enrolled. Circulating D-dimer levels were measured using a latex-enhanced, immunoturbidimetric test. In patients with ascites (n = 42) the test was repeated after ascites resolution. RESULTS: Ascites was present in 42 patients (group A) and absent in 28 (group B). Group A patients had more advanced liver disease. Hepatocellular carcinoma (HCC) was diagnosed in 14 patients and was more frequent in group B. Above normal range D-dimers were found in 45/70 patients. High D-dimers were more frequent in group A than in group B (P = 0.001). High D-dimers were associated with presence of HCC (P = 0.048) only in group B. After ascites resolution, obtained in all patients, mean D-dimer values decreased in those 34 patients with high basal levels (P = 0.007), returning to normal in 17. CONCLUSION: In patients with liver cirrhosis, ascites and HCC are the main factors associated with increased fibrinolytic activity.展开更多
AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites. METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhos...AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites. METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhosis and 12 tuberculosis）. Control serum samples were obtained from 20 healthy subjects. Leptin and TNFα levels were measured by EUSA. Body mass index （BMI） and percentage of body fat （BFM） by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. RESULTS： In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFα levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. CONCLUSION： In patients with malignant ascites, levels of leptin and TNFα were significantly lower than in patients with tuberculous ascites.展开更多
AIM:To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis(SBP). METHODS: A total of 57 consecutive...AIM:To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis(SBP). METHODS: A total of 57 consecutive patients with ascites requiring a large volume paracentesis were studied. Their age, gender, specific underlying disease conditions were recorded after a review of their clinical records. Each underwent a routine assessment prior to their paracentesis consisting of a complete blood count, complete metabolic profile and prothrombin time/international normalized ratio(INR) determination. The ascitic fluid was cultured and a complete cellcount and albumin determination was obtained on the fluid. In addition, blood and ascitic fluid was assessed for the levels of interleukin interleukin(IL)-1A, IL-1B, IL-2, IL-4, IL-8, IL-10, monocyte chemotactic protein(MCP)-1, tumor necrosis factor(TNF)-α, interferon(IFN)-γ, vascular endothelial growth factor(VEGF) and epidermal growth factor(EGF) utilizing the Randox Biochip platforms(Boston, MA). A serum-ascites gradient, for each cytokine and growth factor was calculated. The results are reported as mean ± SEM between disease groups with statistical analysis consisting of the student t-test(two tailed) with a P value of 0.05 defining significance. RESULTS: No clinically important demographic or biochemical differences between the 4 groups studied were evident. In contrast, marked difference in the cytokine and growth factors levels and pattern were evident between the 4 disease groups. Individuals with alcoholic cirrhosis had the highest levels of IL-1A, IL-1B, IL-4, IFNγ. Those with malignant disease had the highest levels of IL-2. Those with hepatitis C virus(HCV) associated cirrhosis had the highest value for IL-6, IL-8, IL-10, MCP-1 and VEGF. Those with cardiac disease had the highest level of TNF-α and EGF. The calculated serum- ascites gradients for the cardiac and malignant disease groups had a greater frequency of negative values signifying greater levels of IL-8, IL-10 and MCP-1 in ascites than did those with alcohol or HCV disease. CONCLUSION: These data document important differences in the cytokine and growth factor levels in plasma, ascitic fluid and the calculated plasma- ascites fluid gradients in cirrhotics requiring a large volume paracentesis. These differences may be important in determining the risk for bacterial peritonitis.展开更多
Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with nonc...Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.展开更多
AIM: To explore the efficacy and mechanism of a novel therapeutic method of traditional Chinese medicine in patients with refractory cirrhotic ascites complicated with azotemia. METHODS: Seventy-five cases of refracto...AIM: To explore the efficacy and mechanism of a novel therapeutic method of traditional Chinese medicine in patients with refractory cirrhotic ascites complicated with azotemia. METHODS: Seventy-five cases of refractory cirrhotic ascites complicated with azotemia were randomly divided into 3 groups: comprehensive treatment (n = 29), simple treatment (n = 24), and control (n = 22). The basic treatment methods were the same in all groups, including liver protecting medicines, diuretics and supportive drugs. The control group underwent only the basic treatment. Shehuang Paste (SHP) was applied to the navels of the two treatment groups once a day for 30 d. Colon dialysis with Chinese herbs was administered to the comprehensive treatment group once every two days. Before and after treatment, we measured abdominal circumference, BUN, Cr, serum Na+, urine Na+/K+, liver function, endotoxin content, NO, and ET-1. Color Doppler ultrasonography was conducted to measure the portal vein blood flow. RESULTS: The total effective rate for ascites was 72.4% in the comprehensive treatment group, 45.8% in the simple treatment, contrasting with 18.2% in the controls. Between the two treatment groups and the controls, there were significant differences in the effective rates (P < 0.01, and P < 0.05). There was also a significant difference (P < 0.05) between the two treatment groups. Measurements of Cr and BUN showed higher values for the treatment groups, with the comprehensive better than the simple group (P < 0.05). Sera Na, urineNa/K were different, P < 0.01 between pre- and post- treatment in the comprehensive group, and P < 0.05 in the simple group. The treatment groups’ endotoxin content was also significantly reduced (P < 0.01, and P < 0.05), with the comprehensive group better than the simple group (P < 0.05). Portal vein blood flow and NO content significantly reduced (P < 0.05), as did ET-1 content (P < 0.01). There were no significant changes in the control group (P > 0.05). The comprehensive treatment group’s pre- and post-treatment portal vein and splenic vein blood flows showed a positive correlation to NO, ET-1 and endotoxin contents.CONCLUSION: When treating refractory cirrhotic ascites complicated with azotemia, Shehuang Paste combined with Chinese herbal dialysis is better than Shehuang Paste alone for ascites resolution, azotemia, and endotoxin elimination. However, both methods on their own were also effective for reducing portal and splenic vein blood flow, and lowering the contents of NO, ET-1 in the two treatment groups.展开更多
We describe a patient with sudden onset of abdominal pain and ascites,leading to the diagnosis of autosomal dominant polycystic kidney disease(ADPKD).Her presentation was consistent with acute liver cyst rupture as th...We describe a patient with sudden onset of abdominal pain and ascites,leading to the diagnosis of autosomal dominant polycystic kidney disease(ADPKD).Her presentation was consistent with acute liver cyst rupture as the cause of her acute illness.A review of literature on polycystic liver disease in patients with ADPKD and current management strategies are presented.This case alerts physicians that ADPKD could occasionally present as an acute abdomen;cyst rupture related to ADPKD may be considered in the differential diagnoses of acute abdomen.展开更多
文摘Objective:This study aims to systematically evaluate the clinical efficacy and safety of diuretic therapy in patients with liver cirrhosis ascites.Method:60 patients with liver cirrhosis ascites diagnosed from January 2024 to May 2025 were prospectively included and randomly divided into a furosemide monotherapy group(20 cases),a spironolactone monotherapy group(20 cases),and a combination therapy group(20 cases).The intervention period is 28 days,and the main observation indicators include 24-hour urine output,changes in abdominal circumference,weight loss,serum electrolyte levels,renal function indicators,and incidence of adverse reactions.All study subjects received standardized dietary management and sodium restriction intervention(daily sodium intake<5 g).Result:The total effective rate(significant+effective)of the combination therapy group in reducing ascites was 95%(19/20),significantly higher than the 75%(15/20)of the furosemide group and the 70%(14/20)of the spironolactone group(p<0.01).On the 28th day of treatment,the mean urine output in the combination group was 2450±210 mL/d,which was higher than that in the monotherapy group(1850±195 mL/d in the furosemide group);Spironolactone group 1560±180 mL/d.The blood sodium levels of the three groups were maintained at 135-140 mmol/L,but the incidence of hypokalemia in the combination group(10%)was significantly lower than that in the furosemide group(35%).Conclusion:The combination of furosemide and spironolactone has a synergistic effect in the treatment of ascites in cirrhosis,with a 39.2%increase in diuretic effect and a reduction in the risk of electrolyte imbalance;Individualized dose adjustment combined with strict sodium restriction is the core strategy to ensure treatment safety.
基金Supported by National Natural Science Foundation of China,No.82360136Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
文摘BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.
文摘BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced radiological and endoscopic methods and serological,cytological,and microbiological examinations and,therefore,underwent diag-nostic laparoscopy.METHODS This retrospective analysis evaluated 82 patients who underwent diagnostic laparoscopy due to unexplained ascites.Patients’medical records were obtained from the hospital database.Their age,sex,complaints at admission,laboratory results,radiological imaging results,diagnostic laparoscopy reports,and pa-thology reports were analyzed.RESULTS The serum-ascites albumin gradient was<1.1 in 96.3%of the patients(n=79).Among patients,22(26.8%)had benign diagnoses and 60(73.2%)had malignant diagnoses.In addition,55(67.1%)were deceased,and the median follow-up time from diagnosis to death was four months.The overall follow-up time ranged from 1 to 142 months,with a median of 14 months.Patients’diagnoses were significantly associated with their survival(P<0.05,χ2 test).The mortality rate was 86.7%among patients with malignant diagnoses and 13.6%among patients with benign diagnoses.CONCLUSION Diagnostic laparoscopy is minimally invasive,has a low complication rate,and requires a short hospital stay.It can be safely performed to diagnose and treat ascites that remain unexplained after advanced radiological and endoscopic examinations.
文摘Background:Laparoscopic pancreaticoduodenectomy(LPD)has gained growing acceptance for the resection of periampullary carcinoma.However,postoperative ascites(POA)frequently occurs after LPD,yet little is known about the underlying factors that promote POA under this laparoscopic approach.This study aimed to explore the clinical influence of POA after LPD and its potential predictors.Methods:Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed.Patients were assigned to the two groups by whether daily abdominal drainage>500 mL for at least three consecutive days,followed by subgroup analysis of pancreatic fistula(PF)-POA and non-PF-POA.Variables,including preoperative laboratory tests,past history,surgery-related factors,and incidence of complications,were compared.In addition,logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.Results:A total of 38 patients(17.4%)developed POA,with 17 having PF-POA and 21 having non-PF-POA.Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection,and a longer hospital stay compared with other groups.Multivariate analysis demonstrated that prothrombin time>14 s and main pancreatic duct diameter<3 mm were independent risk factors for PF-POA.Moreover,male sex,total bilirubin>34.2μmol/L and platelet count<100×10^(9)/L were independent risk factors for non-PF-POA.The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA,respectively.Conclusions:LPD recovery and postoperative complications are impacted by POA,where PF-POA is the most clinically relevant POA.Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA;male sex,elevated total bilirubin level,and decreased platelet count were independent risk factors for non-PF-POA.
文摘Acute pancreatitis(AP)is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course,ranging from mild,selflimiting episodes to severe necrotizing forms.Among its common complications ascites has traditionally been viewed as a passive byproduct of peritoneal inflammation and enzymatic leakage with limited diagnostic or prognostic utility.However,growing evidence challenges this perspective,suggesting that ascitic fluid in AP represents a dynamic and clinically meaningful component of disease progression.In this editorial we reflected on the findings presented by Rao et al,who highlighted the diagnostic,prognostic,and therapeutic significance of ascitic fluid in AP.Easily accessible markers such as lactate dehydrogenase may provide early prognostic insight while emerging molecular biomarkers and cytokine pro-files offer promise for more precise risk stratification and individualized therapy.We argue that the systematic evaluation of ascitic fluid should be integrated into the clinical management of moderate to severe AP.Incorporating ascites analysis into standard diagnostic protocols may enhance early risk assessment,inform therapeutic decisions,and ultimately improve patient outcomes.Ascitic fluid should be recognized as a clinically valuable marker and an important source of information in the evolving landscape of AP care.
基金Supported by Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support,No.ZLRK202533High-Level Public Health Technology Talent Project,No.2022-2-005the Scientific Research Project of Beijing You’an Hospital,2024,No.BJYAYY-YN2022-20.
文摘BACKGROUND Ascites is the most common complication of cirrhosis.Current pharmacological interventions,such as diuretics,often become ineffective in advanced stages due to diuretic resistance.Sodium-glucose co-transporter 2(SGLT2)inhibitors have demonstrated potential in enhancing urinary sodium excretion and mitigating sodium-fluid retention.This study aims to evaluate the effects of SGLT2 inhibitors on the fractional excretion of sodium(FENa)in patients with cirrhotic ascites.AIM To determine whether adjunctive therapy with the SGLT2 inhibitor empagliflozin increases FENa compared with standard care alone in patients with cirrhosis and refractory ascites,and to evaluate its short-term safety profile.METHODS The effect of SGLT2 inhibitor empagliflozin on FENa in patients with cirrhosis and refractory ascites is a multicenter,open-label,randomized controlled trial.A total of 70 patients with refractory ascites secondary to cirrhosis will be enrolled and randomly assigned to receive either empagliflozin 10 mg daily plus standard care or standard care alone for 14 consecutive days.The primary outcome is the change in FENa from baseline to day 14.Secondary outcomes include 24-hour urinary sodium excretion,urine volume,ascites volume(assessed by ultrasound),body weight,and safety indicators.Exploratory outcomes include changes in components of the reninangiotensin-aldosterone system.RESULTS This article reports the study protocol only.No participant data have been collected or analyzed for this manuscript.CONCLUSION This protocol evaluates whether empagliflozin,added to standard therapy,increases sodium excretion and reduces fluid overload in refractory ascites.
文摘BACKGROUND Chylous ascites(CA),which is characterized by lymphatic leakage into the peritoneal cavity,is a rare but significant complication of liver transplantation.Although dietary and pharmacological strategies have shown effectiveness in managing CA,standardized treatment protocols have yet to be established.AIMTo evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs)vs octreotide therapy in managing post-liver transplantation CA.METHODSA comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotidetherapy. The key parameters examined included resolution rates, treatment duration, and recurrence.RESULTSA comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospectivecohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%.The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementationwas used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolutionrates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietarymanagement alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotidecontainingregimens than with dietary management alone (median, 7 days vs 14 days;P = 0.03).CONCLUSIONA stepwise approach to CA management is recommended, initiating dietary interventions and escalating tooctreotide when necessary. Further research through well-designed randomized controlled trials is essential toestablish standardized treatment protocols for optimizing patient outcomes.
基金supported by the National Natural Science Foundation of China(Grant No.82274034)the Peking University Medicine plus X Pilot Program-Platform Construction Project(Grant No.2024YXXLHPT004).
文摘Ovarian cancer remains a leading cause of gynecological cancer mortality1,and patients with advanced stage ovarian cancer frequently develop malignant ascites that foster immunosuppressive microenvironments and therapeutic resistance2,3.Although ascites have traditionally been considered detrimental,we report a paradoxical role in which they enhance the cytotoxicity ofγδT cells—a unique T cell subset that can be allogenically transferred for cancer treatment4,5—toward ovarian cancer.
文摘Objective: To study the value of combined determination of carcinoembryonic antigen (CEA), total cholesterol (Tch) and adenosine deaminase (ADA) in the differential diagnosis of ascites due to different causes. Methods: Sixty-eight cases with ascites were divided into 3 groups based on their etiology, namely malignant ascites, tubercular ascites and non-tubercular benign ascites. CEA, Tch, and ADA were measured and analyzed in different ascites. Results: CEA was significantly higher in malignant ascites than in benign ascites, the sensitivity and specificity for malignant ascites being 50% and 100% respectively. Tch is higher or equal to 1.54 mmol/L in tubercular ascites and lower or equal to 1.18 mmol/L in non-tubercular benign ascites, and Tch level in malignant ascites was frequently between that in tubercular acites and non-tubercular benign ascites. Ascitic fluid ADA activity was higher than 30 U/L in 80% of tubercular ascites, while none of non-tubercular benign ascites reached to such level. Conclusion: CEA, Tch and ADA are valuable for the diagnosis and differential diagnosis of ascitic etiology and combine measurements of these indices can increase the diagnostic efficiency.
文摘Ascites is a pathologic accumulation of peritoneal fluidcommonly observed in decompensated cirrhotic states. Its causes are multi-factorial, but principally involve significant volume and hormonal dysregulation in the setting of portal hypertension. The diagnosis of ascites is considered in cirrhotic patients given a constellation of clinical and laboratory findings, and ultimately confirmed, with insight into etiology, by imaging and paracentesis procedures. Treatment for ascites is multimodal including dietary sodium restriction, pharmacologic therapies, diagnostic and therapeutic paracentesis, and in certain cases transjugular intra-hepatic portosystemic shunt. Ascites is associated with numerous complications including spontaneous bacterial peritonitis, hepato-hydrothorax and hepatorenal syndrome. Given the complex nature of ascites and associatedcomplications, it is not surprising that it heralds increased morbidity and mortality in cirrhotic patients and increased cost-utilization upon the health-care system. This review will detail the pathophysiology of cirrhotic ascites, common complications derived from it, and pertinent treatment modalities.
文摘IM To study the effect of intraperitoneal hyperthermic double distilled water and cisdiaminodichloroplatinum (DDP) perfusion in treatment of cancerous ascites and radical gastrectomy.METHODS H22 cancer cells (2×107 tumor cells each mouse) were injected into the peritoneal cavity of LACA mice. Five days after the injection, intraperitoneal perfusion of 37℃ isotonic fluid (Group Ⅰ), simple hyperthermic (43℃) double distilled water (Group Ⅱ), isotonic fluid (group Ⅲ), DDP (group Ⅳ) and hyperthermic double distilled water perfusion combined with DDP (group Ⅴ) were performed. Based on the experiment from September 1991 through September 1993, intraperitoneal hyperthermic double distilled water perfusion with DDP was used to treat 32 advanced gastric cancer patients after radical gastrectomy.RESULTS In comparison with the control group, the cancer cells in the peritoneal cavity of LACA mice were almost completely destroyied, the ascites was markedly inhibited and the survival time was prolonged, the growth of peritoneal cancerous nodes was reduced in all groups, except the control group.Clinically, after oneyear followup, all 32 patients with advanced carcinoma got satisfactory results, but the 2year followup was not satisfactory.CONCLUSION The intraperitoneal hyperthermic double distilled water perfusion with DDP inhibited the occurrence of ascites in LACA mice, and prolonged the lifetime of gastric cancer patients after radical gastrectomy.
基金Supported by grants from the Research laboratory of pediatrics,Children’s Hospital of China Medical UniversityChina Medical University Hospital,No.DMR-101-042
文摘Gastric adenocarcinoma is quite rare in children and as a result very little experience has been reported on with regards to clinical presentation,treatment and outcome.We describe the case of a 16-year-old boy presenting with abdominal fullness and poor appetite for 7 d.Sonography showed massive ascites and computed tomography imaging revealed the presence of gastric mucosa thickness with omentum caking.The diagnosis of gastric adenocarcinoma was biopsyproven endoscopically.Despite gastric adenocarcinoma being quite rare in the pediatric patient population,we should not overlook the possibility of gastric adenocarcinoma when a child presents with distended abdomen and massive ascites.
文摘AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0software and P＜0.05 was considered statistically significant.RESULTS: Of the 148 patients enrolled in the study, 72(48.6%) were males and 76 (51.4%) were females with a mean age of 59.03±13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%),ovarian and gastric cancers were found in 14 (22.5%)and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68±0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P＜0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P＜0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P＜0.0001).CONCLUSION: Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.
文摘AIM: To measure plasma D-dimer levels in cirrhotic patients with and without ascites, assessing the effect of ascites resolution in D-dimer concentration. METHODS: Seventy consecutive cirrhotic patients (M = 44, F = 26, mean age 65 years, SD ± 13), observed from October 2005 to March 2006 were enrolled. Circulating D-dimer levels were measured using a latex-enhanced, immunoturbidimetric test. In patients with ascites (n = 42) the test was repeated after ascites resolution. RESULTS: Ascites was present in 42 patients (group A) and absent in 28 (group B). Group A patients had more advanced liver disease. Hepatocellular carcinoma (HCC) was diagnosed in 14 patients and was more frequent in group B. Above normal range D-dimers were found in 45/70 patients. High D-dimers were more frequent in group A than in group B (P = 0.001). High D-dimers were associated with presence of HCC (P = 0.048) only in group B. After ascites resolution, obtained in all patients, mean D-dimer values decreased in those 34 patients with high basal levels (P = 0.007), returning to normal in 17. CONCLUSION: In patients with liver cirrhosis, ascites and HCC are the main factors associated with increased fibrinolytic activity.
文摘AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites. METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhosis and 12 tuberculosis）. Control serum samples were obtained from 20 healthy subjects. Leptin and TNFα levels were measured by EUSA. Body mass index （BMI） and percentage of body fat （BFM） by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. RESULTS： In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFα levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. CONCLUSION： In patients with malignant ascites, levels of leptin and TNFα were significantly lower than in patients with tuberculous ascites.
文摘AIM:To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis(SBP). METHODS: A total of 57 consecutive patients with ascites requiring a large volume paracentesis were studied. Their age, gender, specific underlying disease conditions were recorded after a review of their clinical records. Each underwent a routine assessment prior to their paracentesis consisting of a complete blood count, complete metabolic profile and prothrombin time/international normalized ratio(INR) determination. The ascitic fluid was cultured and a complete cellcount and albumin determination was obtained on the fluid. In addition, blood and ascitic fluid was assessed for the levels of interleukin interleukin(IL)-1A, IL-1B, IL-2, IL-4, IL-8, IL-10, monocyte chemotactic protein(MCP)-1, tumor necrosis factor(TNF)-α, interferon(IFN)-γ, vascular endothelial growth factor(VEGF) and epidermal growth factor(EGF) utilizing the Randox Biochip platforms(Boston, MA). A serum-ascites gradient, for each cytokine and growth factor was calculated. The results are reported as mean ± SEM between disease groups with statistical analysis consisting of the student t-test(two tailed) with a P value of 0.05 defining significance. RESULTS: No clinically important demographic or biochemical differences between the 4 groups studied were evident. In contrast, marked difference in the cytokine and growth factors levels and pattern were evident between the 4 disease groups. Individuals with alcoholic cirrhosis had the highest levels of IL-1A, IL-1B, IL-4, IFNγ. Those with malignant disease had the highest levels of IL-2. Those with hepatitis C virus(HCV) associated cirrhosis had the highest value for IL-6, IL-8, IL-10, MCP-1 and VEGF. Those with cardiac disease had the highest level of TNF-α and EGF. The calculated serum- ascites gradients for the cardiac and malignant disease groups had a greater frequency of negative values signifying greater levels of IL-8, IL-10 and MCP-1 in ascites than did those with alcohol or HCV disease. CONCLUSION: These data document important differences in the cytokine and growth factor levels in plasma, ascitic fluid and the calculated plasma- ascites fluid gradients in cirrhotics requiring a large volume paracentesis. These differences may be important in determining the risk for bacterial peritonitis.
文摘Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.
基金Supported by the National Traditional Chinese Medicine Administration Bureau, No. 02-03LP40
文摘AIM: To explore the efficacy and mechanism of a novel therapeutic method of traditional Chinese medicine in patients with refractory cirrhotic ascites complicated with azotemia. METHODS: Seventy-five cases of refractory cirrhotic ascites complicated with azotemia were randomly divided into 3 groups: comprehensive treatment (n = 29), simple treatment (n = 24), and control (n = 22). The basic treatment methods were the same in all groups, including liver protecting medicines, diuretics and supportive drugs. The control group underwent only the basic treatment. Shehuang Paste (SHP) was applied to the navels of the two treatment groups once a day for 30 d. Colon dialysis with Chinese herbs was administered to the comprehensive treatment group once every two days. Before and after treatment, we measured abdominal circumference, BUN, Cr, serum Na+, urine Na+/K+, liver function, endotoxin content, NO, and ET-1. Color Doppler ultrasonography was conducted to measure the portal vein blood flow. RESULTS: The total effective rate for ascites was 72.4% in the comprehensive treatment group, 45.8% in the simple treatment, contrasting with 18.2% in the controls. Between the two treatment groups and the controls, there were significant differences in the effective rates (P < 0.01, and P < 0.05). There was also a significant difference (P < 0.05) between the two treatment groups. Measurements of Cr and BUN showed higher values for the treatment groups, with the comprehensive better than the simple group (P < 0.05). Sera Na, urineNa/K were different, P < 0.01 between pre- and post- treatment in the comprehensive group, and P < 0.05 in the simple group. The treatment groups’ endotoxin content was also significantly reduced (P < 0.01, and P < 0.05), with the comprehensive group better than the simple group (P < 0.05). Portal vein blood flow and NO content significantly reduced (P < 0.05), as did ET-1 content (P < 0.01). There were no significant changes in the control group (P > 0.05). The comprehensive treatment group’s pre- and post-treatment portal vein and splenic vein blood flows showed a positive correlation to NO, ET-1 and endotoxin contents.CONCLUSION: When treating refractory cirrhotic ascites complicated with azotemia, Shehuang Paste combined with Chinese herbal dialysis is better than Shehuang Paste alone for ascites resolution, azotemia, and endotoxin elimination. However, both methods on their own were also effective for reducing portal and splenic vein blood flow, and lowering the contents of NO, ET-1 in the two treatment groups.
文摘We describe a patient with sudden onset of abdominal pain and ascites,leading to the diagnosis of autosomal dominant polycystic kidney disease(ADPKD).Her presentation was consistent with acute liver cyst rupture as the cause of her acute illness.A review of literature on polycystic liver disease in patients with ADPKD and current management strategies are presented.This case alerts physicians that ADPKD could occasionally present as an acute abdomen;cyst rupture related to ADPKD may be considered in the differential diagnoses of acute abdomen.
