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Sample records for complicating refractory ascites

  1. [Treatment of refractory ascites].

    PubMed

    Martínez, Javier; Albillos, Agustín

    2014-07-01

    Ascites is a common complication of hepatic cirrhosis and portal hypertension. Patients present systemic and splanchnic circulation disorders, which cause central hypovolemia and arterial hypotension, with the subsequent activation of vasoconstrictor systems and increased renal reabsorption of sodium and water. Approximately 5%-10% of patients present refractory ascites. Refractory ascites is considered when it is not controllable with standard dietary (sodium restriction) and diuretic (furosemide up to 160 mg a day and spironolactone up to 400mg a day) treatment or when patients present adverse effects due to diuretics that impede their administration at optimum dosages. The current therapeutic options for these patients are repeated evacuative paracentesis and the percutaneous intrahepatic portosystemic shunt. Despite these treatments, refractory ascites has a poor prognosis; patients should therefore be assessed for liver transplantation. PMID:25087715

  2. [Early complications and long-term results of the LeVeen peritoneo-venous shunt in the treatment of refractory ascites].

    PubMed

    Arciero, G; Di Blasio, V; Botta, V; Rossi, M; Pigna, F; Di Tora, A

    1996-11-01

    Results concerning 14 cirrhotic patients who underwent LeVeen peritoneo-venous shunt for refractory or complicated ascites are discussed. The most relevant early complications regard coagulation disorders (35.7%) with a 14.3% postoperative mortality. The functional result appears largely satisfactory, also in terms of long-term efficiency. Utility of a wide evacuation of ascitic fluid during the operation is underlined. Ascites drainage at operation doesn't compromise shunt function or renal resumption, furthermore it may prevent some life-threatening complications like DIC, esophageal varices rupture and congestive heart failure. PMID:9072716

  3. Reinfusion of ascites during hemodialysis as a treatment of massive refractory ascites and acute renal failure

    PubMed Central

    Hsu, Ta-Wei; Chen, Yi-Chuan; Wu, Meei-Ju; Li, Anna Fen-Yau; Yang, Wu-Chang; Ng, Yee-Yung

    2011-01-01

    Refractory ascites can occur in patients with various conditions. Although several procedures based on the reinfusion of ascitic fluid have been reported after the failure of bed rest, salt and water restriction, diuretics, intravenous administration of albumin, and repeated paracentesis, these procedures are performed for ascitic fluid removal without dialytic effect. In this study, a flow control reinfusion of ascites during hemodialysis (HD) was performed to demonstrate the efficacy of this method in a lupus patient with massive refractory ascites and respiratory and acute renal failure (ARF). The alleviation of ascites and ARF attests to the success of the flow control reinfusion of ascites during HD. This procedure can control the rate of ascites and body fluid removal simultaneously during HD using the roller pump. In conclusion, with a normal coagulation profile, the procedure of flow control reinfusion of ascites during HD is an effective alternative treatment for the alleviation of refractory ascites with renal failure. PMID:21694946

  4. [Role of surgical therapy in the treatment of refractory ascites].

    PubMed

    Pisani Ceretti, A; Intra, M; Borzio, M; Santambrogio, R; Opocher, E; Ballarini, C; Cordovana, A; Motta, R; Spina, G P

    1997-11-01

    In 5-10% of cases ascites is not controlled by medical therapy and is defined refractory. These patients may be submitted to one of the four following surgical options: portal-systemic shunt, peritoneo-venous shunt, transjugular intrahepatic portal-systemic shunt, orthotopic liver transplantation. Although the portal-systemic shunt is efficient in clearing ascites, it does not improve the survival, which depends on liver function, and it is complicated by an important incidence of encephalopathy. Since the patients with refractory ascites and good hepatic risk are not usually many, it is possible to understand why derivative surgery has been disappointing with this indication. Although the peritoneo-venous shunt is associated with a significant rate of valve obstruction, it is an easy, effective and not expensive treatment. So, till now, it has been considered the first choice procedure of refractory ascites, if any situations, determinating the onset of postoperative complications, are not present. Recently a new method has been introduced in the therapy of portal hypertension, the transjugular intrahepatic portal-systemic shunt. This is a bloodless portal-systemic derivation and so it has caused great enthusiasm even if the available data are insufficient to give a definitive opinion on its role in management of ascites. Certainly the liver transplantation, which presents the great advantage to treat both the cirrhosis and its complications, seems to be the most rational therapy for these patients. However, at least for this moment, the well-known absence of organ donors makes still actual the palliative surgical measures. PMID:9489332

  5. Evaluation and management of patients with refractory ascites

    PubMed Central

    Senousy, Bahaa Eldeen; Draganov, Peter V

    2009-01-01

    Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LVP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician. PMID:19115470

  6. Chylous ascites as a complication of laparoscopic donor nephrectomy.

    PubMed

    Caumartin, Yves; Pouliot, Frédéric; Sabbagh, Robert; Dujardin, Thierry

    2005-12-01

    Laparoscopic living donor nephrectomy (LLDN) is a minimally invasive technique for kidney procurement and was developed with the hope of reducing the disincentives associated with live renal donation. Compared with open donor nephrectomy (ODN), this alternative has many advantages including less postoperative pain and earlier return to work. Unfortunately, these benefits are sometimes negated by postoperative complications. Among these, chylous ascites (CA) is a rare but serious problem that is usually managed conservatively. We report the case of a living donor who developed CA refractory to initial conservative management and surgical treatment. We also discuss the role of surgery in the treatment of CA following LLDN. PMID:16297058

  7. Radiological Insertion of Denver Peritoneovenous Shunts for Malignant Refractory Ascites: A Retrospective Multicenter Study (JIVROSG-0809)

    SciTech Connect

    Sugawara, Shunsuke; Sone, Miyuki; Arai, Yasuaki; Sakamoto, Noriaki; Aramaki, Takeshi; Sato, Yozo; Inaba, Yoshitaka; Takeuchi, Yoshito; Ueno, Teruko; Matsueda, Kiyoshi; Moriguchi, Michihisa; Tsushima, Takahiro

    2011-10-15

    Purpose: Peritoneal venous shunts (PVSs) are widely used for palliating symptoms of refractory malignant ascites and are recognized as one of the practical methods. However, reliable clinical data are insufficient because most previous reports have been small studies from single centers. We conducted a retrospective, multicenter study to evaluate the safety and efficacy of radiologically placed PVSs in patients with malignant refractory ascites. Methods: A total of 133 patients with malignant ascites refractory to medical therapies were evaluated for patient characteristics, technical success, efficacy, survival times, adverse events, and changes in laboratory data. Results: PVSs were successfully placed in all patients and were effective (i.e., improvement of ascites symptoms lasting 7 days or more) in 110 (82.7%). The median duration of symptom palliation was 26 days and median survival time was 41 days. The most frequent adverse event was PVS dysfunction, which occurred in 60 (45.1%) patients, among whom function was recovered with an additional minimally invasive procedure in 9. Abnormalities in coagulation (subclinical disseminated intravascular coagulation) occurred in 37 (27.8%) patients, although only 7 (5.3%) developed clinical disseminated intravascular coagulation. Other major adverse events were gastrointestinal bleeding (9.8%), sepsis (3.8%), and acute heart failure (3.0%). PVS was least effective in patients with elevated serum creatinine, bloody ascites, or gynecologic tumor. Conclusions: Radiological PVS is a technically feasible and effective method for palliating the symptoms from refractory malignant ascites, but preoperative evaluation and monitoring the postprocedural complications are mandatory to preclude severe adverse events after PVS.

  8. Do vasopressin V2 receptor antagonists benefit cirrhotics with refractory ascites?

    PubMed Central

    Fukui, Hiroshi

    2015-01-01

    Hyponatremia is a frequent complication of advanced cirrhosis with ascites associated with increased morbidity and mortality. It is caused by an impairment in the renal capacity to eliminate solute-free water and is considered to be related to persistent secretion of vasopressin despite low serum osmolality. This nonosmotic release of vasopressin is mediated by the autonomic nervous system, which senses the underfilling of arterial vascular component. This reduction of effective arterial blood volume is closely related to the development of ascites. Although the short-time effects of vasopressin V2 receptor antagonists (vaptans) on hyponatremia and ascites have been repeatedly reported, their effects on the long-term management of cirrhotic ascites have not been established yet. Considering that their effects on water diuresis and their safety are limited by severe underfilling state of patients, cautious approaches with adequate monitoring are needed to advanced cirrhosis. Proper indication, adequate doses and new possibility of combination therapy should be explored in the future controlled study. As hyponatremia is frequent obstacle to ascites management, judicious combination with low-dose diuretics may decrease the incidence of refractory ascites. Although vaptans show much promise in the treatment of advanced cirrhosis, the problem of high cost should be solved for the future. PMID:26556988

  9. Splanchnic and Systemic Hemodynamics in Cirrhotic Patients With Refractory Ascites. Effect of Peritoneovenous Shunting

    PubMed Central

    Vons, Corinne; Hadengue, Antoine; Lee, Samuel S.; Smadja, Claude; Franco, Dominique

    1991-01-01

    The splanchnic and systemic hemodynamics of 14 patients with refractory ascites were studied and were compared to those of 15 patients with ascites responding to medical treatment. Among the 14 patients, 10 were grade B and 4 C, according to the Pugh classification. Of the 15 patients, 5 were Pugh B and 10 C. In patients with refractory ascites, free hepatic venous pressure was significantly higher and hepatic venous pressure gradient was significantly lower than in patients with responsive ascites. Hepatic and azygos blood flows were not significantly different between the two groups. Cardiac output was lower in patients with refractory ascites (p < 0.05) than in those with responsive ascites. In patients with refractory ascites, six months after peritoneovenous shunting, there was a significant reduction of wedged and free hepatic venous pressures and azygos blood flow. Cardiac output increased by 20% (p < 0.02). This study shows that hemodynamic alterations in patients with refractory ascites is the consequence of increased intraabdominal pressure due to chronic ascites. Six months after peritoneovenous shunting splanchnic and systemic hemodynamics became similar to those observed in patients without ascites. PMID:1842670

  10. Two Unusual but Treatable Causes of Refractory Ascites After Liver Transplantation.

    PubMed

    Novelli, P M; Shields, J; Krishnamurthy, V; Cho, K

    2015-12-01

    Refractory ascites (RA) is thought to complicate the postoperative course of 5-7% (Nishida et al. in Am J Transplant. 6: 140-149, 2006; Gotthardt et al. in Ann Transplant. 18: 378-383, 2013) of liver transplant recipients. RA after liver transplantation is often a frustrating diagnostic dilemma with few good management options unless an obvious mechanical factor is identified. Supportive therapies often fail until a treatable precipitating cause is identified and removed. We describe two patients who developed RA following liver transplantation for primary sclerosing cholangitis, and hepatitis C and alcoholic liver disease, respectively. The cause for RA was hyperkinetic portal hypertension secondary to splenomegaly in the first case and a pancreatic AVM in the 2nd case. After failure of other interventions, surgical splenectomy resulted in immediate and durable resolution of the previously intractable ascites. PMID:26017456

  11. Current management of the complications of portal hypertension: variceal bleeding and ascites

    PubMed Central

    Dib, Nina; Oberti, Frédéric; Calès, Paul

    2006-01-01

    Portal hypertension is one of the main consequences of cirrhosis. It results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. The condition leads to the formation of portosystemic collateral veins. Esophagogastric varices have the greatest clinical impact, with a risk of bleeding as high as 30% within 2 years of medium or large varices developing. Ascites, another important complication of advanced cirrhosis and severe portal hypertension, is sometimes refractory to treatment and is complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. We describe the pathophysiology of portal hypertension and the current management of its complications, with emphasis on the prophylaxis and treatment of variceal bleeding and ascites. PMID:16682712

  12. [Surgical treatment of refractory ascites with peritoneovenous shunt].

    PubMed

    Massari, R; Fulgente, R; Marinelli, S; Romessis, M

    1995-01-01

    Leveen and associates described a peritoneo-venous shunt which proved to be useful in patients with intractable ascites. Medical therapy, paracentesis and peritoneovenous shunt have been compared, but there is uncertainty about their relative merits. Therefore, the leveen device has be placed in last years in an increasing number of patients: it has not been shown by prospective trials to prolong survival significantly, although it may shorten hospitalization and improve the quality of life. A number of early and late complications were described but they do not influence the general results: origin and features of such complications are discussed as well as their prevention and treatment and personal cases are presented. Selection of patients and careful surgical procedure seems to be mandatory for better results. PMID:8706187

  13. Ascites

    MedlinePlus

    ... Liver failure - ascites; Alcohol use - ascites; End-stage liver disease - ascites; ESLD - ascites ... can do to help take care of your liver disease are: Get vaccinated for diseases such as influenza, ...

  14. Indigenous cost-effective peritoneo-venous shunt for refractory ascites.

    PubMed

    Marimuthu, K; Kumar, A Suresh; Sabanathan, S; Gowrishankar, A; Kumar, P Sasi; Rajkumar, J S

    2004-01-01

    About 5% of patients with chronic liver disease develop massive refractory ascites. These patients cease to respond to diuretic therapy and may develop prerenal azotemia. There is a small but definite role for the peritoneo-venous shunt in these patients. In our study of 36 patients, managed with locally made, single-valved peritoneo-venous shunts (GSAIMS shunts), shunt failure and complication rates were assessed postoperatively. There is a definite improvement in quality of life with this cost-effective locally made shunt if patients are selected carefully. Long-term follow-up of these patients is not possible because most of these patients succumb to advanced liver disease. PMID:15285240

  15. Predictors of Refractory Ascites Development in Patients with Hepatitis B Virus-Related Cirrhosis Hospitalized to Control Ascitic Decompensation

    PubMed Central

    Seo, Ju Hee; Kim, Seung Up; Park, Jun Yong; Kim, Do Young; Han, Kwang-Hyub; Chon, Chae Yoon

    2013-01-01

    Purpose Refractory ascites (RA) is closely related to a high morbidity and mortality. In this study, we investigated predictors of RA development in patients with hepatitis B virus (HBV)-related cirrhosis who were hospitalized to control ascitic decompensation, and determined predictors for survival in patients who experienced RA. Materials and Methods We analyzed 199 consecutive patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation between January 1996 and December 2008. Results Multivariate analyses showed that only serum potassium at admission predicted RA development independently [p=0.013; hazard ratio (HR), 2.800; 95% confidence interval (CI), 1.166-6.722]. During the follow-up period, 16 (8.0%) patients experienced RA within 4.2 (range, 1.0-39.2) months after admission for controlling ascitic decompensation, and they survived a median of 8.7 (range, 3.9-51.3) months. Child-Pugh class and RA type were identified as independent prognostic factors affecting the survival in patients with RA (p=0.045; HR, 8.079; 95% CI, 1.231-67.984 and p=0.013; HR, 14.510; 95% CI, 1.771-118.874, respectively). Conclusion Serum potassium was an independent predictor of RA development in patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation. After RA development, Child-Pugh class and RA type were independent predictors for survival. PMID:23225811

  16. Postoperative Chylous Ascites: A Rare Complication of Laparoscopic Nissen Fundoplication

    PubMed Central

    Bacelar, Tércio Souto; de Arruda, Pedro Carlos Loureiro; Ferraz, Álvaro Antonio Bandeira; Ferraz, Edmundo Machado

    2003-01-01

    The accumulation of chylous fluid in the abdominal cavity is an infrequent, yet alarming, complication in abdominal surgery. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux disease and is significantly altering the balance of therapy toward more common and earlier surgical intervention. We report the case of a 67-year-old woman with gastroesophageal reflux disease and intense esophagitis who underwent a laparoscopic Nissen fundoplication in February 2000. The procedure was performed without apparent complications. Twenty days later, the patient complained of abdominal pain and distension. Ultrasonography showed ascites, whereas endoscopic and radiological exploration of the fundoplication demonstrated no abnormalities. A paracentesis was performed, which showed a milky fluid with high concentrations of triglycerides (1024 ng/dL) and cholesterol (241 ng/dL). The patient was treated successfully with total parenteral nutrition for 3 weeks, followed by a low-fat diet. To our knowledge, this is the third reported case of chylous ascites after a Nissen fundoplication and the second case after laparoscopic fundoplication. The development of chylous ascites seems to be related to the injury of lymphatic vessels, including the thoracic duct, during the retroesophageal window dissection. The careful dissection and judicious use of diathermy is proposed to prevent this rare complication. PMID:14558719

  17. [Refractory ascites: a fifteen-year experience with the peritoneovenous shunt].

    PubMed

    Cattaneo, U; Enrico, S; Serra, G C; Bergoglio, D; Corno, F; Fronda, G R

    1993-09-01

    The authors consider the various causes of ascites and they also develop the concept of refractory ascites. They consider the various possibilities of medical and dietary therapy whose failure constitutes the basis for a surgical approach. In the latter case it is being considered the Peritoneo Venous Shunt (PVS) that employs different types of valves. In the light of their personal experience, matured over a period of 15 years, in which 75 valves were positioned in 64 patients and precisely: 55 valves of Le Veen, 15 Hakim and 5 Denver, it is emphasized that the best results, as for as mortality and morbidity goes, were obtained through careful attention in the preoperative stage and during surgery itself with the privileged use of a Le Veen's valve. For such motives, since in a high percentage of these patients there persists a poor prognosis a year away from the onset of refractory ascites, a PVS seems proposable anyway and even though this will not alter the pathological outcome, there's a clear improvement in the quality of life without precluding any other surgical approach. Finally, the authors outline the possibilities offered by the Transjugular Intrahepatic Portosystemic Shunt (TIPS), as a new original approach for the resolution of refractory ascites. PMID:8286483

  18. [Massive endocardial thrombosis in a patient with a peritoneo-jugular shunt for refractory ascites: the therapeutic success of tissue plasminogen activator and defibrotide].

    PubMed

    Sacchetti, C; Pederzoli, S; Tamborrino, E; Grandi, M

    1994-01-01

    The authors report a case of a patient with a refractory ascites due to extrahepatic portal thrombosis in course of idiopathic thrombocythemia. A peritoneovenous shunt was applied and as a late complication a massive thrombosis of the intracardiac portion of the duct developed. Thrombolysis was obtained with tissue plasminogen activator at doses usually administered for acute myocardial infarction. Prophylaxis of recurrence was pursued with pictomide and defibrotide. PMID:8079040

  19. Refractory Ascites with Liver Fibrosis Developed in Late Phase Allogeneic Hematopoietic Stem Cell Transplantation: Report of Three Patients

    PubMed Central

    Hosoi, Hiroki; Warigaya, Kenji; Murata, Shogo; Mushino, Toshiki; Kuriyama, Kodai; Nishikawa, Akinori; Tamura, Shinobu; Hatanaka, Kazuo; Hanaoka, Nobuyoshi; Muragaki, Yasuteru; Murata, Shinichi; Nakakuma, Hideki; Sonoki, Takashi

    2016-01-01

    We report cases of three patients of refractory ascites without other fluid retention that occurred around five months after allogeneic hematopoietic stem cell transplantation (allo-HSCT). All three patients expired and postmortem examinations revealed unexpected liver fibrosis lacking histological evidences of graft-versus-host-disease (GVHD). The three patients showed normal hepatic function and size before transplantation. During their clinical courses, serum biochemistry test showed no elevation of hepatic enzymes and bilirubin; however, imaging studies demonstrated hepatic atrophy at the onset of ascites. One of the liver specimens showed bile obstruction, which could be seen in hepatic damage by GVHD. Although ascites resulting from venoocclusive disease in early phase allo-HSCT is well documented, ascites associated with hepatic fibrosis in late phase allo-HCST has not been reported. Further clinico-pathological studies on similar patients should be required to ascertain refractory ascites associated with liver fibrosis after allo-HSCT. PMID:27499838

  20. Chylous Ascites: A Rare Complication of Thoracic Duct Embolization for Chylothorax

    SciTech Connect

    Gaba, Ron C. Owens, Charles A.; Bui, James T.; Carrillo, Tami C.; Knuttinen, M. Grace

    2011-02-15

    Thoracic duct embolization represents a safe and effective method to treat postsurgical chylothorax. Complications of this procedure are rare despite transabdominal puncture of lymphatic channels for thoracic duct access, and chylous ascites is unreported. Herein, we describe a case of chylous ascites formation after lymphatic puncture and attempted cannulation. Our management approach is also discussed.

  1. Management of ascites in cirrhosis.

    PubMed

    Wong, Florence

    2012-01-01

    Ascites is a common complication of liver cirrhosis associated with a poor prognosis. The treatment of ascites requires dietary sodium restriction and the judicious use of distal and loop diuretics, sequential at an earlier stage of ascites, and a combination at a later stage of ascites. The diagnosis of refractory ascites requires the demonstration of diuretic non-responsiveness, despite dietary sodium restriction, or the presence of diuretic-related complications. Patients with refractory ascites require second-line treatments of repeat large-volume paracentesis (LVP) or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and assessment for liver transplantation. Careful patient selection is paramount for TIPS to be successful as a treatment for ascites. Patients not suitable for TIPS insertion should receive LVP. The use of albumin as a volume expander is recommended for LVP of >5-6 L to prevent the development of circulatory dysfunction, although the clinical significance of post-paracentesis circulatory dysfunction is still debated. Significant mortality is still being observed in cirrhotic patients with ascites and relatively preserved liver and renal function, as indicated by a lower Model for End-Stage Liver Disease (MELD) score. It is proposed that patients with lower MELD scores and ascites should receive additional points in calculating their priority for liver transplantation. Potential new treatment options for ascites include the use of various vasoconstrictors, vasopressin V(2) receptor antagonists, or the insertion of a peritoneo-vesical shunt, all of which could possibly improve the management of ascites. PMID:21916992

  2. Efficacy of tolvaptan in patients with refractory ascites in a clinical setting

    PubMed Central

    Ohki, Takamasa; Sato, Koki; Yamada, Tomoharu; Yamagami, Mari; Ito, Daisaku; Kawanishi, Koki; Kojima, Kentaro; Seki, Michiharu; Toda, Nobuo; Tagawa, Kazumi

    2015-01-01

    AIM: To elucidate the efficacies of tolvaptan (TLV) as a treatment for refractory ascites compared with conventional treatment. METHODS: We retrospectively enrolled 120 refractory ascites patients between January 1, 2009 and September 31, 2014. Sixty patients were treated with oral TLV at a starting dose of 3.75 mg/d in addition to sodium restriction (> 7 g/d), albumin infusion (10-20 g/wk), and standard diuretic therapy (20-60 mg/d furosemide and 25-50 mg/d spironolactone) and 60 patients with large volume paracentesis in addition to sodium restriction (less than 7 g/d), albumin infusion (10-20 g/wk), and standard diuretic therapy (20-120 mg/d furosemide and 25-150 mg/d spironolactone). Patient demographics and laboratory data, including liver function, were not matched due to the small number of patients. Continuous variables were analyzed by unpaired t-test or paired t-test. Fisher’s exact test was applied in cases comparing two nominal variables. We analyzed factors affecting clinical outcomes using receiver operating characteristic curves and multivariate regression analysis. We also used multivariate Cox’s proportional hazard regression analysis to elucidate the risk factors that contributed to the increased incidence of ascites. RESULTS: TLV was effective in 38 (63.3%) patients. The best cut-off values for urine output and reduced urine osmolality as measures of refractory ascites improvement were > 1800 mL within the first 24 h and > 30%, respectively. Multivariate regression analysis indicated that > 25% reduced urine osmolality [odds ratio (OR) = 20.7; P < 0.01] and positive hepatitis C viral antibodies (OR = 5.93; P = 0.05) were positively correlated with an improvement of refractory ascites, while the total bilirubin level per 1.0 mg/dL (OR = 0.57; P = 0.02) was negatively correlated with improvement. In comparing the TLV group and controls, only the serum sodium level was significantly lower in the TLV group (133 mEq/L vs 136 mEq/L; P = 0

  3. TIPSS Procedure in the Treatment of a Single Patient After Recent Heart Transplantation Because of Refractory Ascites Due to Cardiac Cirrhosis

    SciTech Connect

    Fava, Mario; Meneses, Luis Loyola, Soledad; Castro, Pablo; Barahona, Fernando

    2008-07-15

    We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient's respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support.

  4. Postoperative Ascites of Unknown Origin following Laparoscopic Appendicectomy: An Unusual Complication of Laparoscopic Surgery

    PubMed Central

    Feretis, M.; Boyd-Carson, H.; Karim, A.

    2014-01-01

    Postoperative ascites is a very rare complication of laparoscopic surgery. Significant iatrogenic injuries to the bowel, the urinary tract, and the lymphatic system should be excluded promptly to avoid devastating results for the patient. In some cases, in spite of investigating patients extensively, no definitive causative factor for the accumulation of fluid can be identified. In such cases, idiopathic allergic or inflammatory reaction of the peritoneum may be responsible for the development of ascites. We present a case of ascites of an unknown origin in a young female patient following a laparoscopic appendicectomy. PMID:24822146

  5. Efficacy of peritoneovenous shunt for treating tolvaptan-resistant refractory ascites in a cirrhotic patient with portal vein thrombosis: A case report

    PubMed Central

    SHIGETO, KOTA; KAWAGUCHI, TAKUMI; NIIZEKI, TAKASHI; KUNITAKE, YASUSHI; TAKEDATSU, HIDETOSHI; TONAN, TATSUYUKI; FUJIMOTO, KIMINORI; TANAKA, MASATOSHI; ABE, TOSHI; NAITO, HISANORI; TORIMURA, TAKUJI

    2016-01-01

    Peritoneovenous shunt is normally used for the treatment of refractory ascites. However, its efficacy in treating tolvaptan-resistant refractory ascites has not been reported thus far. In addition, the impact of peritoneovenous shunt on the prognosis of cirrhotic patients remains controversial. In the present report, a case of tolvaptan-resistant refractory ascites associated with liver cirrhosis and portal vein thrombosis is described. The male patient was diagnosed with hepatitis C virus-related liver cirrhosis at the age of 51 years. At the age of 56 years, the patient developed portal vein thrombosis, resulting in the development of refractory ascites. Since the ascites was resistant to treatment with a low-sodium diet and diuretics such as tolvaptan, a peritoneovenous shunt was implanted upon obtaining consent. The shunt immediately increased the urine volume, and the ascites was markedly decreased. The patient's body weight decreased from 62.7 to 57.1 kg in 2 days, and his ascites symptom inventory-7 score decreased from 23 to 0 points in 31 days. Although the patient succumbed to sepsis on day 486 following the shunt implant, his activities of daily living were preserved until 8 days prior to mortality. Thus, the present case supports the efficacy of peritoneovenous shunt for the treatment of tolvaptan-resistant refractory ascites associated with liver cirrhosis and portal vein thrombosis. Furthermore, the present case suggests that peritoneovenous shunt may prolong the survival of cirrhotic patents with refractory ascites. PMID:27123091

  6. Acute pancreatitis, ascites, and acute renal failure in Plasmodium vivax malaria infection, a rare complication.

    PubMed

    Lakhotia, Manoj; Pahadiya, Hans Raj; Kumar, Harish; Singh, Jagdish; Sangappa, Jainapur Ravi; Choudhary, Prakash Kumar

    2015-01-01

    A 22-year-old male presented with 6 days history of intermittent fever with chills, 2 days history of upper abdomen pain, distension of abdomen, and decreased urine output. He was diagnosed to have Plasmodium vivax malaria, acute pancreatitis, ascites, and acute renal failure. These constellations of complications in P. vivax infection have never been reported in the past. The patient responded to intravenous chloroquine and supportive treatment. For renal failure, he required hemodialysis. Acute pancreatitis, ascites, and acute renal failure form an unusual combination in P. vivax infection. PMID:26629455

  7. TIPSS procedure in the treatment of a single patient after recent heart transplantation because of refractory ascites due to cardiac cirrhosis.

    PubMed

    Fava, Mario; Meneses, Luis; Loyola, Soledad; Castro, Pablo; Barahona, Fernando

    2008-07-01

    We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient's respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support. PMID:18071789

  8. The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX© Catheter

    PubMed Central

    Reinglas, Jason; Amjadi, Kayvan; Petrcich, Bill; Momoli, Franco; Shaw-Stiffel, Thomas

    2016-01-01

    Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA. Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic. Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP) from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics. Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

  9. Transjugular intrahepatic portosystemic shunt creation as treatment for refractory chylous ascites and chylothorax in a patient with cirrhosis.

    PubMed

    Kinney, Thomas B; Ferrara, Stephen L; Miller, Franklin J; Roberts, Anne C; Hassanein, Tarek

    2004-01-01

    The etiology of chylothorax is usually considered to consist of four major categories: tumors, trauma, idiopathic conditions, and miscellaneous conditions. It appears that chylothorax is a rare and underreported manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. This condition can be debilitating as a result of respiratory compromise from a large volume of pleural fluid, as well as metabolic derangements, malnutrition, and immunologic impairment from loss of vital lymphatic constituents. Herein the authors present a case of a 46-year-old male patient with cirrhosis and complications of high-volume chylous ascites and chylothorax who was successfully treated with creation of a transjugular intrahepatic portosystemic shunt. PMID:14709693

  10. Chylous Ascites Following Open Abdominal Aortic Aneurysm Repair: An Unusual Complication

    PubMed Central

    Galanopoulos, Georgios; Konstantopoulos, Theofanis; Theodorou, Stavros; Tsoutsas, Ioannis; Xanthopoulos, Dimitrios; Kaperonis, Elias; Papavassiliou, Vassilios

    2016-01-01

    Chylous ascites is a rare complication after abdominal aortic aneurysm repair. Accumulation of chyle within the close space of the peritoneal cavity may cause severe discomfort to the patient, complicating the postoperative course. Prompt diagnosis is needed to adopt measures for reducing lymph leakage and contributing to lymphatic fistula closure. Fortunately, conservative treatment is successful in the majority of cases. In the rare cases that do not respond to conservative treatment, surgery becomes mandatory. Accurate preoperative localization of lymph leakage is a prerequisite for a successful outcome. Postoperative chyloperitoneum has a benign course and an excellent prognosis. PMID:27486496

  11. Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review.

    PubMed

    Fleming, Nicole D; Alvarez-Secord, Angeles; Von Gruenigen, Vivian; Miller, Michael J; Abernethy, Amy P

    2009-09-01

    The safety and efficacy of indwelling intraperitoneal (IP) catheters for the management of refractory malignant ascites is unclear. A systematic literature overview and retrospective chart review of patients with malignant refractory ascites who underwent indwelling IP catheter placement was performed. Standardized literature abstraction and chart review templates were used to ensure that consistent information was collected. Fifteen publications met literature search criteria, representing 221 patients. Tenckhoff (Quinton Instrument Company, Seattle, WA, USA), Pleurex (Denver Biomedical Inc., Golden, CO, USA), and peritoneal catheters were used, along with IP ports. A median 5.9% of cases (range: 2.5%-34%) had documented peritonitis. In the literature, untunneled catheters were most commonly associated with infections. Our chart review added 19 cases from two academic institutions to this literature (median age: 60 years [range: 31-85]; females: 17 [89%]; gynecological malignancies: 14 [73%]). Palliative management before catheter placement included diuretics (n=4 [21%]) and multiple paracenteses (n=11 [58%] had two or more taps [range: 2-8]). Median time from diagnosis to catheter placement was 25 months (range: 1-77). Interventions were: French pigtail catheters (n=16 [84%]), Tenckhoff catheter (n=1 [5%]), and Port-A-Caths (Smith Medical MD, St. Paul, MN, USA) (n=2; 11%). Four (21%) catheters were tunneled. Prophylactic antibiotics were prescribed in six cases (32%). Two cases (11%) had documented infections, seven catheters (37%) became occluded, and two leaked (11%). The median time from catheter until death was 36 days (range: 4-660). Nine patients (47%) were admitted to hospice. In these retrospective studies, indwelling IP catheters appear to be a safe and effective palliative strategy to manage refractory malignant ascites, without overwhelming infection rates. PMID:19328648

  12. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts.

    PubMed

    Bercu, Zachary L; Fischman, Aaron M; Kim, Edward; Nowakowski, F Scott; Patel, Rahul S; Schiano, Thomas D; Chang, Charissa Y; Lookstein, Robert A

    2015-03-01

    OBJECTIVE. This single-center study evaluated the use of expanded polytetrafluoroethylene (ePTFE)-covered stent-grafts for transjugular intrahepatic portosystemic shunt (TIPS) placement to manage portal hypertension-related refractory ascites. MATERIALS AND METHODS. One hundred patients at a single tertiary care center in a major metropolitan hospital underwent TIPS placement with an ePTFE-covered stent-graft (Viatorr TIPS Endoprosthesis). Patients with portal hypertension-related ascites and preexisting hepatocellular carcinoma or liver transplant were excluded from the analysis. Records were reviewed for demographic characteristics, technical success of the TIPS procedures, and stent follow-up findings. Clinical results were assessed at 90- and 180-day intervals. RESULTS. Immediate technical success of the TIPS procedure was 100%. Of the 61 patients with documented follow-up, 55 (90.2%) had a partial or complete ascites response to TIPS creation. Of these 55 patients, nine experienced severe encephalopathy. Six of 61 patients (9.8%) did not experience a significant ascites response. Overall survival was 78.7% at 365-day follow-up. The 365-day survival was 84.2% for patients with a model for end-stage liver disease (MELD) score of less than 15, 67.0% for those with a score of 15-18, and 53.8% for those with a score of greater than 18 (p = 0.01). For patients with a MELD score of less than 18, the 365-day survival was 88.0% for those with an albumin value of 3 mg/dL or greater and 72.8% for those with an albumin value of less than 3 mg/dL (p = 0.04). CONCLUSION. TIPS placement using an ePTFE-covered stent-graft is an efficacious therapy for refractory ascites. Patients with preserved liver function-characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/dL or greater-experience the greatest survival benefit. PMID:25714299

  13. [Current ascites therapy].

    PubMed

    Ochs, A

    1997-01-21

    Ultrasonography detects ascites easily even in trace amounts. 80% of the cases are caused by hepatic disease, in the remaining 20% cancer, inflammation, pancreatic, renal, or cardiac disease can be found. The underlying disease should be investigated by few inexpensive laboratory test from serum, urine and ascites and by abdominal sonography. Hepatic ascites is caused by portal hypertension and disturbances of humoral factors. Sodium retention, peripheral, vasodilation, hyperdynamic circulation and progressive renal vasoconstriction lead to a stepwise deterioration of patients condition. Treatment with diuretics (furosemide, torsemide, or xipamide and spironolactone) and sodium-restriction (< 60 mval per day) control 85-90% of the cases with hepatic ascites. If this regimen fails, non-compliance, spontaneous bacterial peritonitis, hyponatremia or additional complications such as renal failure, Budd-Chiari syndrome or tumor should be considered. Ten to 15% of the patients develop refractory ascites and finally hepatorenal syndrome and have a poor prognosis. Early liver transplantation should be considered. Large volume paracentesis with albumin substitution is a therapeutic option in these patients. The transjugular intrahepatic portosystemic stent-shunt (TIPS) may be superior for patients with concurrent esophageal varices or hepatorenal syndrome. If TIPS is considered the patient should be referred to an experienced center. The peritoneo-venous shunt is restricted to rare indications. In the future, new drugs such as antagonists of endothelins or of the antidiuretic hormone may offer new therapeutic options. PMID:9064726

  14. Chylous ascites after radical nephrectomy and inferior vena cava thrombectomy. Successful conservative management with somatostatin analogue.

    PubMed

    Leibovitch, Ilan; Mor, Yoram; Golomb, Jacob; Ramon, Jacob

    2002-02-01

    Postoperative chylous ascites is a rare complication of retroperitoneal surgery. The treatment of postoperative chylous ascites is primarily conservative, consisting of repeated paraceteses, medium chain triglyceride (MCT) diet, salt restriction, diuretics and bowel rest with total parenteral nutrition. Occasionally, chylous ascites may take a protracted course which may necessitate insertion of peritoneo-venous shunts or direct surgical lymphostasis. Recently, Somatostatin was shown to be highly effective in closure of refractory lymphatic fistulas. We present a case of refractory chylous ascites following radical nephrectomy with inferior vena caval thrombectomy that failed to respond to conventional conservative measures and resolved rapidly following the administration of Somatostatin. PMID:12074412

  15. Diagnosis and therapy of ascites in liver cirrhosis

    PubMed Central

    Biecker, Erwin

    2011-01-01

    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. PMID:21455322

  16. Pregnancy complicated by haemorrhagic ascites in a woman with newly diagnosed HIV.

    PubMed

    Morgan, Catrin; Nicholls, Kate; Gangat, Nusraat; Sansome, Stafford

    2016-01-01

    A young pregnant Zambian woman was referred from a district hospital in South Zambia to the university teaching hospital, Lusaka with severe anaemia and ascites. The ascites had developed over a month and the woman was currently 15 weeks pregnant. Further workup revealed that the patient was HIV-positive and the ascitic tap showed haemorrhagic fluid. After being reviewed by multiple doctors, the cause of the haemorrhagic ascites remained unclear; therefore, the decision was made to do a laparotomy. The laparotomy revealed haemoperitoneum and a large cyst attached to the liver containing 5 L of bloodstained fluid. The histopathology report revealed features consistent with a giant haemangioma. There were many barriers to accessing optimum healthcare in this case. These included limited access to blood, poor communication resulting in the patient being unaware of her HIV status and lack of patient education about HIV. PMID:27473033

  17. Management of cirrhotic ascites

    PubMed Central

    Pedersen, Julie Steen; Bendtsen, Flemming

    2015-01-01

    The most common complication to chronic liver failure is ascites. The formation of ascites in the cirrhotic patient is caused by a complex chain of pathophysiological events involving portal hypertension and progressive vascular dysfunction. Since ascites formation represents a hallmark in the natural history of chronic liver failure it predicts a poor outcome with a 50% mortality rate within 3 years. Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis, hyponatremia and progressive renal impairment. Adequate management of cirrhotic ascites and its complications betters quality of life and increases survival. This paper summarizes the pathophysiology behind cirrhotic ascites and the diagnostic approaches, as well as outlining the current treatment options. Despite improved medical treatment of ascites, liver transplantation remains the ultimate treatment and early referral of the patient to a highly specialized hepatology unit should always be considered. PMID:25954497

  18. Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis.

    PubMed

    Garcia-Tsao, Guadalupe

    2016-01-01

    Cirrhosis is not a single entity but represents a disease progression across different prognostic stages, with the compensated and decompensated stages being the most important. Variceal hemorrhage (VH) and ascites are complications of cirrhosis that denote the presence of a decompensated stage. Spontaneous bacterial peritonitis (SBP) is a common bacterial infection unique to patients with cirrhosis that can precipitate the development of recurrent VH and hepatorenal syndrome (HRS), complications that denote the presence of a 'further decompensated' stage of cirrhosis. Main current issues in the management of VH include identification of different prognostic stages that allow for individualized patient care. Management of VH cannot be performed in an isolated manner, and the presence of other complications of cirrhosis (ascites, encephalopathy) should be taken into account both in the management and in the design of clinical trials. Because management of ascites per se has not resulted in significant changes in mortality, main management issues consist of preventing further decompensating events by preventing factors that will lead to worsening vasodilatation and hemodynamic status (infections, vasodilators), preventing volume depletion (overdiuresis, GI hemorrhage) and preventing structural kidney injury (nephrotoxins). Prophylaxis of bacterial infections such as SBP currently consists of the administration of antibiotics. By preventing infections, there is evidence that recurrent VH and HRS can also be prevented. However, response to recommended empirical antibiotics in patients with suspected infection, such as SBP, is currently significantly lower than in the past because of an increase in infections secondary to multidrug resistant (MDR) organisms. One of the main predictors of the development of MDR organisms is antibiotic prophylaxis and unnecessary and prolonged use of antibiotics in hospital. Therefore, appropriate antibiotics should be used in patients

  19. Hypokalaemia and refractory asystole complicating diabetic ketoacidosis, lessons for prevention.

    PubMed

    Abdulaziz, Salman; Dabbagh, Ousama; Al Daker, Mohamed Ousama; Hassan, Imad

    2012-01-01

    We report a unique case of diabetic ketoacidosis in which a relatively low potassium level on admission was associated with consequent life-threatening and refractory arrhythmia secondary to inappropriate use of intravenous insulin and bicarbonate therapy. The latter was reversed by rapid bolus potassium injection. Although we do not advocate this approach in every case, we emphasise that a bolus injection of potassium may be life saving in such cases. The lessons from this case have led to multidisciplinary meetings and modification of the institute's diabetic ketoacidosis clinical pathway. PMID:23220438

  20. Hypokalaemia and refractory asystole complicating diabetic ketoacidosis, lessons for prevention

    PubMed Central

    Abdulaziz, Salman; Dabbagh, Ousama; Al Daker, Mohamed Ousama; Hassan, Imad

    2012-01-01

    Summary We report a unique case of diabetic ketoacidosis in which a relatively low potassium level on admission was associated with consequent life-threatening and refractory arrhythmia secondary to inappropriate use of intravenous insulin and bicarbonate therapy. The latter was reversed by rapid bolus potassium injection. Although we do not advocate this approach in every case, we emphasise that a bolus injection of potassium may be life saving in such cases. The lessons from this case have led to multidisciplinary meetings and modification of the institute's diabetic ketoacidosis clinical pathway. PMID:23220438

  1. Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report

    PubMed Central

    2013-01-01

    Introduction Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn. PMID:23302289

  2. Treatment and management of ascites and hepatorenal syndrome: an update

    PubMed Central

    Buder, Robert; Kapun, Lisbeth; Voglmayr, Martin

    2015-01-01

    Ascites and renal dysfunction are frequent complications experienced by patients with cirrhosis of the liver. Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and is one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves assessment of its granulocyte count and protein concentration to exclude complications such as infection or malignoma and to allow risk stratification for the development of spontaneous peritonitis. Although sodium restriction and diuretics remain the cornerstone of the management of ascites, many patients require additional therapy when they become refractory to this treatment. In this situation, the treatment of choice is repeated large-volume paracentesis. Alteration in splanchnic hemodynamics is one of the most important changes underlying the development of ascites. Further splanchnic dilation leads to changes in systemic hemodynamics, activating vasopressor agents and leading to decreased renal perfusion. Small alterations in renal function influence the prognosis, which depends on the cause of renal failure. Prerenal failure is evident in about 70% of patients, whereas in about 30% of patients the cause is hepatorenal syndrome (HRS), which is associated with a worse prognosis. Therefore, effective therapy is of great clinical importance. Recent data indicate that use of the new definition of acute kidney injury facilitates the identification and treatment of patients with renal insufficiency more rapidly than use of the current criteria for HRS. In this review article, we evaluate approaches to the management of patients with ascites and HRS. PMID:25729433

  3. Complications associated with the implantation of peritoneo-venous valves and possibilities of prevention.

    PubMed

    Vincze, K

    1994-01-01

    The author describes the complications associated with the implantation of peritoneo-venous valves in the therapy of refractory ascites. They survey the various complications (disorders in the healing of the wound, valve occlusion, ascites induced coagulation disorders) observed during the treatment of 71 patients and give full account of their work performed while observing these complications, their prevention and avoidance. They stress the importance of haematologic examinations and postoperative haemostasis parameters of patients having undergone valve implantation. PMID:7618386

  4. [Treatment of ascites in cirrhotic patients].

    PubMed

    Elizalde, I; Zozaya, J M

    2001-09-01

    Ascites is the most frequent complication of hepatic cirrhosis and its appearance brings a reduction of survival. The treatment aims to mobilise the intraperitoneal liquid and to prevent its reaccumulation. The first step of treatment includes rest in bed, a hyposodic and spironolactone diet, alone or in combination with furosemide or torasemide. However, 10-20% of patients do not respond to treatment or develop adverse effects that limit its use, which is termed refractory ascites. These patients must be considered as possible candidates for a liver transplant and, when this is not possible, the chosen treatment is total paracentesis with an intravenous infusion of albumin. In patients who do not tolerate paracentesis, or who require its realisation with great frequency, other therapeutic options can be evaluated, such as surgical anastomoses, intrahepatic portosystemic percutaneous derivation and, in the final instance, peritoneo-venous shunt. PMID:12876580

  5. Effect of plasma exchange on refractory hemophagocytic syndrome complicated with myelodysplastic syndrome.

    PubMed

    Satomi, A; Nagai, S; Nagai, T; Niikura, K; Ideura, T; Ogata, H; Akizawa, T

    1999-11-01

    A case of hemophagocytic syndrome (HPS) refractory to corticosteroid therapy was successfully treated by plasma exchange. The patient was a 56-year-old woman who had undergone regular hemodialysis for 10 years for complicated myelodysplastic syndrome (MDS) and then had had lung tuberculosis. After the onset of tuberculosis, she suffered from HPS and was treated by antituberculosis agents and high dose corticosteroid administration without any effect on the HPS. After adding a series of plasma exchanges, the HPS improved gradually, and her MDS began to respond to corticosteroid therapy. Plasma hypercytokinemia due to HPS was corrected by plasma exchange, and the correction of a high level of plasma inflammatory cytokine was considered to be one of the contributing factors for the improvement of HPS. These results suggest that therapeutic plasma exchange should be considered as a therapeutic tool for HPS refractory to conventional therapy. PMID:10608726

  6. A Complex Multiherbal Regimen Based on Ayurveda Medicine for the Management of Hepatic Cirrhosis Complicated by Ascites: Nonrandomized, Uncontrolled, Single Group, Open-Label Observational Clinical Study

    PubMed Central

    Patel, Manish V.; Patel, Kalapi B.; Gupta, Shivenarain; Michalsen, Andreas; Stapelfeldt, Elmar; Kessler, Christian S.

    2015-01-01

    Hepatic cirrhosis is one of the leading causes of death worldwide, especially if complicated by ascites. This chronic condition can be related to the classical disease entity jalodara in Traditional Indian Medicine (Ayurveda). The present paper aims to evaluate the general potential of Ayurvedic therapy for overall clinical outcomes in hepatic cirrhosis complicated by ascites (HCcA). In form of a nonrandomized, uncontrolled, single group, open-label observational clinical study, 56 patients fulfilling standardized diagnostic criteria for HCcA were observed during their treatment at the P. D. Patel Ayurveda Hospital, Nadiad, India. Based on Ayurvedic tradition, a standardized treatment protocol was developed and implemented, consisting of oral administration of single and compound herbal preparations combined with purificatory measures as well as dietary and lifestyle regimens. The outcomes were assessed by measuring liver functions through specific clinical features and laboratory parameters and by evaluating the Child-Pugh prognostic grade score. After 6 weeks of treatment and a follow-up period of 18 weeks, the outcomes showed statistically significant and clinically relevant improvements. Further larger and randomized trials on effectiveness, safety, and quality of the Ayurvedic approach in the treatment of HCcA are warranted to support these preliminary findings. PMID:26339267

  7. [Ascites and acute kidney injury].

    PubMed

    Piano, Salvatore; Tonon, Marta; Angeli, Paolo

    2016-07-01

    Ascites is the most common complication of cirrhosis. Ascites develops as a consequence of an abnormal splanchnic vasodilation with reduction of effecting circulating volume and activation of endogenous vasoconstrictors system causing salt and water retention. Patients with ascites have a high risk to develop further complications of cirrhosis such as hyponatremia, spontaneous bacterial peritonitis and acute kidney injury resulting in a poor survival. In recent years, new studies helped a better understanding of the pathophysiology of ascites and acute kidney injury in cirrhosis. Furthermore, new diagnostic criteria have been proposed for acute kidney injury and hepatorenal syndrome and a new algorithm for their management has been recommended with the aim of an early diagnosis and treatment. Herein we will review the current knowledge on the pathophysiology, diagnosis and treatment of ascites and acute kidney injury in patients with cirrhosis and we will identify the unmet needs that should be clarified in the next years. PMID:27571467

  8. Iatrogenic colorectal Kaposi sarcoma complicating a refractory ulcerative colitis in a human immunodeficiency negative-virus patient.

    PubMed

    Hamzaoui, Lamine; Kilani, Houda; Bouassida, Mahdi; Mahmoudi, Moufida; Chalbi, Emna; Siai, Karima; Ezzine, Heykel; Touinsi, Hassen; Azzouz, Mohamed M'saddak; Sassi, Sadok

    2013-01-01

    Kaposi sarcoma is a mesenchymal tumor associated to a human herpes virus-8. It often occurs in human immunodeficiency virus-positive subjects. Colorectal localization is rare. We report the case of a colorectal Kaposi sarcoma complicating a refractory ulcerative colitis treated with surgery after the failure of immunomodulator therapy in a human immunodeficiency virus-negative heterosexual man. PMID:24396560

  9. Nephrogenic ascites - Still an intractable problem?

    PubMed

    Nayak-Rao, Shobhana

    2015-01-01

    Nephrogenic ascites or ascites associated with renal failure is seen in end-stage renal disease in-patients on hemodialysis but has been described occasionally in earlier stages of renal failure. The cause can be multifactorial and a combination of inadequate dialysis and ultrafiltration, poor nutrition and increased peritoneal membrane permeability in uremia. Generally, the onset of nephrogenic ascites is insidious and portends a grim long-term prognosis. We describe herein three patients who presented with refractory ascites of nephrogenic origin and review this entity. PMID:26178555

  10. Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome

    PubMed Central

    Indesteege, Inge; Laenen, Annouschka; Verslype, Chris; Vergote, Ignace; Prenen, Hans

    2016-01-01

    Abstract Background To assess the technical and clinical outcome of percutaneous insertion of tunneled peritoneal catheters in the palliative treatment of refractory malignant ascites and to determine the safety and feasibility of intraperitoneal administration of cytotoxic drugs through the tunneled catheter. Materials and methods Consecutive patients palliatively treated with a tunneled peritoneal catheter to drain the malignant ascites were identified. Patients’ medical history, procedural and clinical follow-up data, including complications and estimated survival, were reviewed. Additionally, a sub analysis of the patients with widespread ovarian cancer and refractory ascites treated with or without intraperitoneal administration of cytotoxic drugs was made. Results In all 94 patients it was technically feasible to insert the peritoneal drainage catheter and to drain a median of 3260 cc (range 100 cc – 8500 cc) of malignant ascitic fluid. Post procedural complications included catheter infection (n = 2; 2%), fluid leakage around the entry site (n = 4; 4%), catheter occlusion (n = 2; 2%), sleeve formation around the catheter tip (n = 1; 1%) and accidental loss of the catheter (n = 1; 1%). There was no increase in catheter infection rate in patients treated with or without intraperitoneal administration of cytotoxic drugs. Median overall survival after catheter insertion is 1.7 months. Conclusions Percutaneous insertion of a tunneled Tenckhoff catheter for the palliative drainage of malignant ascites and intraperitoneal infusion of cytotoxic drugs is feasible and associated with a very low complication rate, including catheter infection. These tunneled peritoneal lines are beneficial for symptomatic palliative treatment of refractory ascites and allow safe intraperitoneal chemotherapy. PMID:27247552

  11. Symptomatic treatment of ascites with a peritoneo-vesical automated fluid shunt system in a dog.

    PubMed

    Venzin, C; Kook, P; Jenni, S; Wilhelm, S; Degen, T; Braun, A; Rütten, M; Glaus, T M

    2012-02-01

    A six-year-old Rottweiler with chronic ascites and moderate panhypoproteinaemia that had been treated with large volume paracentesis over several months duration was diagnosed with a large bi-atrial mass and hepatic fibrosis. For palliative treatment, a peritoneo-vesical automated fluid shunt system with an integrated chargeable battery and an integrated computer to control pump function and to transmit data transcutaneously was implanted by coeliotomy. The pump was left in place for 10 weeks, eliminating the need for further paracentesis during this time. At the end of this period, no ascites was discernible and serum protein concentrations had returned to their respective reference intervals. As a complication, decubitus with skin perforation had developed above the pump. Besides palliative treatment of chronic refractory ascites, this pump may have application in other conditions characterised by chronic cavity effusion or in peritoneal dialysis. PMID:22106956

  12. Cirrhotic ascites review: Pathophysiology, diagnosis and management

    PubMed Central

    Moore, Christopher M; Van Thiel, David H

    2013-01-01

    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 multi-modal 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. PMID:23717736

  13. Ayurvedic management of cirrhotic ascites

    PubMed Central

    Aswathy, G.; Dharmarajan, Prasanth; Sharma, Ananth Ram; Sasikumar, V. K.; Vasudevan Nampoothiri, M. R.

    2016-01-01

    Cirrhosis is the final stage of most of the chronic liver diseases and is most invariably complicated by portal hypertension resulting in ascites. A case of chronic liver disease with portal hypertension (cryptogenic cirrhosis), managed at Amrita School of Ayurveda is discussed in this paper. The clinical picture was that of an uncomplicated cirrhotic ascites. Snehapāna (therapeutic oral administration of lipids) followed by virecana (purgation) was done after an initial course of nityavirecana (daily purgation). Later Vardhamāna pippalī rasāyana [administration of single drug - pippalī (piper longum) in a structured dose pattern] was administered with an intention of rejuvenating liver cells. Ascites and lower limb oedema were completely resolved after the therapy. No recurrence of ascites has been reported after a follow up period of one year. PMID:27621523

  14. Use of computed tomography-lymphangiography with direct injection of water-soluble contrast medium to identify the origin of chylous ascites.

    PubMed

    Otake, Kohei; Uchida, Keiichi; Inoue, Mikihiro; Koike, Yuhki; Narushima, Mitsunaga; Kusunoki, Masato

    2015-01-01

    Contrast lymphangiography is a useful technique to determine the site of lymphatic leakage in the patient with chylous ascites. Conventional lymphangiography with lipid-soluble contrast material carries the disadvantage of complications, such as oil emboli and lymphedema. The authors report a successful case of computed tomography (CT)-lymphangiography with direct injection of water-soluble contrast medium into a lower limb lymphatic vessel to determine the site of lymphatic leakage in a pediatric patient with refractory primary chylous ascites. The patient subsequently underwent laparoscopic ligation of the leaking site and recovered well. This novel technique offers superior potential for preoperative assessment and the planning of laparoscopic repair. PMID:26993687

  15. Pseudomembranous colitis: an unusual cause of neutrocytic ascites.

    PubMed

    Spahr, L; de Saussure, P; Felley, C; Pugin, J; Hadengue, A

    1999-07-01

    Severe cases of pseudomembranous colitis (PMC) may be associated with intraperitoneal fluid accumulation. However, the characteristics of the liquid are seldom described. Specifically, neutrocytic ascites has only been reported once. We report a case of a severe PMC complicated by a highly neutrocytic ascites which remained culture-negative. We discuss the possible mechanisms leading to ascites formation in this condition and review ascitic fluid characteristics in patients with PMC. PMID:10445802

  16. Feasibility of externalized peritoneovenous shunt (EPVS) for malignant ascites

    PubMed Central

    2011-01-01

    Purpose To evaluate a new modified peritoneovenous shunt therapy, the externalized peritoneovenous shunt (EPVS) system placement, used to treat patients with malignant ascites. Methods We retrospectively reviewed 10 patients, who were not suited for conventional peritoneovenous shunts (PVS), with malignant ascites, which was refractory to medical therapies. Patient characteristics, technical success, efficacy, duration of EPVS placement, adverse events, and outcome were evaluated. Clinical efficacy of the EPVS was evaluated by the change in subjective symptoms. Results The primary reasons for applying EPVS were severe anasarca in 4 patients, potential PVS dysfunction in 3 patients, poor performance status in 2 patients, and a history of PVS occlusion in 1 patient. EPVS was successfully placed in all patients, and it provided clinical efficacy in 8 patients (80%). Early death occurred within 7 days after EPVS placement in 2 patients because of renal failure. The median duration of EPVS placement was 10.4 days (range, 2-28 days). In 6 patients (60%), the EPVS was exchanged to conventional PVS sequentially, since the initial EPVS placement resulted in an improvement of the subjective symptoms of the patients, without serious complications. Conclusion EPVS placement may be an option for patients with malignant ascites who may not be appropriate for conventional PVS placement. PMID:21777451

  17. Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm.

    PubMed

    Pereira, Keith; Carrion, Andres F; Salsamendi, Jason; Doshi, Mehul; Baker, Reginald; Kably, Issam

    2016-02-01

    Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3-7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a 'bridge' therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE. PMID:26285910

  18. [A Case of Small Intestinal Cancer Repeating an Ileus Symptom Complicated with Refractory Arrhythmia].

    PubMed

    Otsuru, Toru; Iijima, Shohei; Tsujimura, Naoto; Nakao, Eiichiro; Matsumoto, Takashi; Takachi, Kou; Nishioka, Kiyonori; Takemoto, Hiroyoshi; Oshima, Satoshi; Uemura, Yoshio

    2015-11-01

    A 56-year-old man had been treated for hypertrophic cardiomyopathy since childhood. He had been treated for refractory ventricular tachycardia (VT) with interventricular septum cauterization, catheter ablation, and implantation of a defibrillator. He had been treated at home for several years. The ileus that developed in July 2014 was relieved by conservative medical treatment once, but it recurred after oral intake of food a short time later. The obstruction was due to a small intestine cancer that was diagnosed by enteroscopy. After considering the risks of surgery due to the cardiac problem and the quality of life due to ileus caused by the mass, we resected it. This surgery was not a radical resection because of peritoneal dissemination. He started oral food intake postoperatively, and returned to home care. Three months after surgery, oral chemotherapy was administered after considering his stable cardiac function in addition to his coherent mental status. An adverse event of severe watery diarrhea developed, and VT caused by dehydration occurred. After the chemotherapy was discontinued, he recovered in intensive care. He returned to home care at his prior status for 9 months postoperatively. PMID:26805146

  19. Transjugular Intrahepatic Portosystemic Shunt for Treatment of Cirrhosis-related Chylothorax and Chylous Ascites: Single-institution Retrospective Experience

    SciTech Connect

    Kikolski, Steven G. Aryafar, Hamed Rose, Steven C.; Roberts, Anne C.; Kinney, Thomas B.

    2013-08-01

    PurposeTo investigate the efficacy and safety of the use of transjugular intrahepatic portosystemic shunt (TIPS) creation to treat cirrhosis-related chylous collections (chylothorax and chylous ascites).MethodsWe retrospectively reviewed data from four patients treated for refractory cirrhosis-related chylous collections with TIPS at our institution over an 8 year period.ResultsOne patient had chylothorax, and three patients had concomitant chylothorax and chylous ascites. There were no major complications, and the only procedure-related complications occurred in two patients who had mild, treatable hepatic encephalopathy. All patients had improvement as defined by decreased need for thoracentesis or paracentesis, with postprocedure follow-up ranging from 19 to 491 days.ConclusionTIPS is a safe procedure that is effective in the treatment of cirrhosis-related chylous collections.

  20. Urinary Ascites - A Consequence of Intraoperative Injury.

    PubMed

    Ghosh, Sinjon; Chatterjee, Nandini; Mukhopadhyay, Mainak; Brahmachari, Ramkrishna; Maity, Pranab; Das, A K

    2015-09-01

    Patients with complications after surgery often pose enormous challenges to physicians. We report the case of a young lady developing fever, oliguria and intractable ascites refererred to us after undergoing abdominal surgery. She was diagnosed subsequently to have a urinoma with urinary ascites masquerading as a case of sepsis. Percutaneous nephrostomy followed by definitive repair and reimplantation of ureter later led to subsidence of the symptoms. PMID:27608874

  1. Chylous ascites secondary to laparoscopic donor nephrectomy.

    PubMed

    Shafizadeh, Stephen F; Daily, Patrick P; Baliga, Prabhakar; Rogers, Jeffrey; Baillie, G Mark; Rajagopolan, P R; Chavin, Kenneth D

    2002-08-01

    Live donor renal transplantation offers many significant advantages over cadaveric donor transplantation. Yet living donation continues to be underused, accounting for less than 30% of all donor renal transplants. In an attempt to remove the disincentives to live donation, Ratner et al. developed laparoscopic donor nephrectomy (LDN). LDN is gaining acceptance in the transplant community. The overriding concern must always be the safety and welfare of the donor. To this end, potential complications of LDN must be identified and discussed. We present a patient who developed the complication of chylous ascites from LDN. To improve the laparoscopic technique further, a discussion of its successes and complications needs to be encouraged. To this end, we present chylous ascites as a potential complication after LDN. We also offer suggestions to minimize the likelihood of this complication. PMID:12137847

  2. Value of histopathology for predicting the post-operative complications of ileo-anal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis.

    PubMed

    El Demellawy, Dina; El Hallani, Soufiane; de Nanassy, Joseph; Lee, James Young; Chan, Emily; Sullivan, Katrina; Bass, Juan; Mack, David; Nasr, Ahmed

    2016-06-01

    The J-pouch is a surgical procedure offered to children with refractory ulcerative colitis (UC) who have undergone subtotal colectomy to reconstruct a reservoir function with ileo-anal anastomosis. Unfortunately, post-operative complications may occur and can compromise the pouch function. We assessed rectal histopathology to determine whether severity of inflammation in the rectum prior to the creation of the J-Pouch was associated with post-operative complications. We retrospectively reviewed the histopathology of all J-pouch procedure specimens from paediatric patients during the period 2000-2013 using an objective grading system that assesses the chronicity and activity of the UC disease. We analysed the parameters for association with the post-operative complications. A classification tree algorithm was generated to predict the risk of complication based on histopathological parameters. A total of 28 paediatric patients were identified, among whom 10 developed post-operative complications (35%). The activity score at the recto-anal margin was higher among the patients with post-operative complications (mean 7.3±3.1 versus 4.8±3.1; p=0.04). The involvement of more than 5% colonic crypts with epithelial neutrophilic infiltration at the recto-anal margin was found to be an independent parameter that would stratify the patients into low-risk or high-risk group for developing complications (17% versus 64%; p=0.04). An association between UC disease activity at the recto-anal margin and post-operative J-pouch complications was determined. Potentially, this association suggests that a histopathological assessment of the recto-anal transitional zone may have value in guiding the surgeon on the risk of post-operative complications. PMID:27130833

  3. A corny cause of cerebrospinal fluid ascites: A case report and review of literature

    PubMed Central

    Jamal, Hira; Abrams, Gary

    2016-01-01

    Objective: To report a rare cause of cerebrospinal fluid ascites. Methods: A 37-year-old female with history of intracranial hypertension and a ventriculo-peritoneal shunt was referred to liver clinic for evaluation of newly developed ascites. Results: Initially, the cause of ascites was thought to be secondary to a liver etiology. However, this was excluded after a comprehensive evaluation including portal pressure measurements. We determined the ascites to be infected cerebrospinal fluid secondary to a rare commensal organism, Corynebacterium non-Jeikeium, which resolved after removing ventriculo-peritoneal shunt, appropriate antibiotics and conversion to a ventriculo-atrial shunt. Conclusion: Cerebrospinal fluid ascites is a rare complication of VP shunts and since 1976 only 8 cases of Corynebacterium non jk VP shunt infections have been reported in the literature but none associated with ascites. Also this report highlights the beneficial role of transjugular portal pressure measurements in the evaluation of ascites. PMID:27489721

  4. Evaluation and treatment of malignant ascites secondary to gastric cancer

    PubMed Central

    Maeda, Hiromichi; Kobayashi, Michiya; Sakamoto, Junichi

    2015-01-01

    Malignant ascites affects approximately 10% of patients with gastric cancer (GC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in GC patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points (named “five-point method”) on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, “Clinical Benefit Response in GC (CBR-GC)”, was recently introduced to measure the efficacy of chemotherapy for malignant ascites of GC. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for GC patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a

  5. Evaluation and treatment of malignant ascites secondary to gastric cancer.

    PubMed

    Maeda, Hiromichi; Kobayashi, Michiya; Sakamoto, Junichi

    2015-10-21

    Malignant ascites affects approximately 10% of patients with gastric cancer (GC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in GC patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points (named "five-point method") on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, "Clinical Benefit Response in GC (CBR-GC)", was recently introduced to measure the efficacy of chemotherapy for malignant ascites of GC. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for GC patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a

  6. Transjugular intrahepatic porto-systemic shunt in the elderly: Palliation for complications of portal hypertension

    PubMed Central

    Syed, Mubin I; Karsan, Hetal; Ferral, Hector; Shaikh, Azim; Waheed, Uzma; Akhter, Talal; Gabbard, Alan; Morar, Kamal; Tyrrell, Robert

    2012-01-01

    AIM: To present a dedicated series of transjugular intrahepatic porto-systemic shunts (TIPS) in the elderly since data is sparse on this population group. METHODS: A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010. Twenty-five patients were referred for TIPS. We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease. Of the 23 patients suitable for TIPS, the indications for TIPS placement was portal hypertension complicated by refractory ascites alone (n = 9), hepatic hydrothorax alone (n = 2), refractory ascites and hydrothorax (n = 1), gastrointestinal bleeding alone (n = 8), gastrointestinal bleeding and ascites (n = 3). RESULTS: Of these 23 attempted TIPS procedure patients, 21 patients had technically successful TIPS procedures. A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years (range 65-82 years). Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS. Sixteen of 21 patients who underwent successful TIPS (excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo. Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients. Bleeding was controlled following technically successful procedures in 10 out of 11 patients. CONCLUSION: We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients. PMID:22400084

  7. [Sapheno-peritoneal shunt for the treatment of ascites].

    PubMed

    Nagy, Z; Gyurkovics, E; Kaliszky, P; Kupcsulik, P

    2001-08-01

    For the surgical treatment of drug resistant ascites caused by hepatic cirrhosis usually different types of valvular plastic tubes are used, implanted as peritoneo-venous shunts. These shunts drain the ascites into the jugular vein. In the 1st Surgical Department of the Semmelweis University Budapest we have performed 267 peritoneo-venous shunt operations. We introduced a new method using an autolog venous graft with a peritoneo-venous anastomosis, that drains the ascites into the saphenous, then femoral vein. So far we performed 5 such interventions. The early results suggest that sapheno-peritoneal shunt can be successfully used for treatment of ascites. With this operation complications of plastic grafts are avoidable. PMID:11550492

  8. [Concentration and reinfusion of ascitic fluid in liver cirrhosis].

    PubMed

    Mian, G; Triolo, L; Magris, D; de Savorgnani, M N; G'Agnolo, B

    1979-09-29

    46 concentration-reinfusion treatments were performed on 36 patients, suffering from refractory ascites for liver cirrhosis. The procedure was well tolerated, improved the status of the patients and enabled diuretic to be effective again, in some cases for as long as two years. The usefulness of infusing autologous, non-denatured proteins in high dosage is stressed. The Authors belive that hepatorenal syndrome, severe hypokaliemia or hyposodemia and encephalopathy are the elective indications for the treatment. PMID:492554

  9. Vascular endothelial growth factor expression correlates with serum CA125 and represents a useful tool in prediction of refractoriness to platinum-based chemotherapy and ascites formation in epithelial ovarian cancer

    PubMed Central

    Wei, Ai-Qun; Robertson, Gregory; Morris, David L.

    2015-01-01

    There is an increasing need for the identification of novel biological markers and potential therapeutic targets in epithelial ovarian cancer (EOC). Given the critical role of growth factors in the biology of EOC, we aimed in the present study to evaluate the intratumoral expressions of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) proteins and their clinical relevance in a cohort of 100 patients with EOC. All patients received platinum-based chemotherapy after surgery. A comparative immunohistochemical study of normal ovarian and EOC tissues showed that both growth factors were expressed at higher levels in tumor samples. In our statistical analysis, while no association existed between the FGF expression status and the clinicopathological characteristics of patients, intratumoral VEGF was identified as a potential biomarker for the prediction of ascites formation. In addition, the expression status of VEGF appeared to independently predict overall survival and response to chemotherapy. Furthermore, a direct association was demonstrated between the pre-treatment VEGF expression and serum CA125 after three cycles of chemotherapy. In sum, we report for the first time to our knowledge the correlation between intratumoral VEGF and serum CA125 in EOC. Our data also shows the prognostic value of VEGF expression in EOC. These results suggest the potential value of intratumoral VEGF in patient stratification. Dual inhibition of VEGF and CA125 might bring about a better outcome for patients with EOC. PMID:26143638

  10. Fecal Microbiota Transplantation Using Upper Gastrointestinal Tract for the Treatment of Refractory or Severe Complicated Clostridium difficile Infection in Elderly Patients in Poor Medical Condition: The First Study in an Asian Country

    PubMed Central

    Gweon, Tae-Geun; Kim, Jinsu; Lim, Chul-Hyun; Park, Jae Myung; Lee, Dong-Gun; Lee, In Seok; Cho, Young-Seok; Kim, Sang Woo; Choi, Myung-Gyu

    2016-01-01

    Background and Aims. Fecal microbiota transplantation (FMT) is a highly effective treatment option for refractory Clostridium difficile infection (CDI). FMT may be challenging in patients with a low performance status, because of their poor medical condition. The aims of this study were to describe our experience treating patients in poor medical condition with refractory or severe complicated CDI using FMT via the upper GI tract route. Methods. This study was a retrospective review of seven elderly patients with refractory or severe complicated CDI and a poor medical condition who were treated with FMT through the upper GI tract route from May 2012 through August 2013. The outcomes studied included the cure rate of CDI and adverse events. Results. Of these seven patients who received FMT via the upper GI tract route, all patients were cured. During the 11-month follow-up period, CDI recurrence was observed in two patients; rescue FMT was performed in these patients, which led to a full cure. Vomiting was observed in two patients. Conclusions. FMT via the upper gastrointestinal tract route may be effective for the treatment of refractory or severe complicated CDI in patients with a low performance status. Physicians should be aware of adverse events, especially vomiting. PMID:27127501

  11. [Favourable course of persisting malignant ascites].

    PubMed

    Stange, Rainer; Jänsch, Annette; Schrag, Sabine; Pflugbeil, Christine; Schlodder, Dietrich; Pandey-Hoffmann, Ursula; Uehleke, Bernhard

    2009-02-01

    Malignant ascites is a frequent complication in oncological diseases. There are no standard therapies for any primary tumour. We report the case of a woman, aged 49 years at the time of primary diagnosis, who suffered from recurrent ascites resulting from liver metastasis of breast cancer. Based on the literature and former experience of our department, mistletoe extract was repeatedly applied intraperitoneally at the occasion of decompressive punctures. The further course of the disease suggests a significant role of mistletoe in achieved symptom control, which also resulted in a considerable improvement in quality of life. The mistletoe solution was well tolerated. Relevant mechanisms of action in addition to the well-known immunomodulating properties of mistletoe could be direct cytotoxic and adjuvant effects to the concomitantly administered chemotherapy of carboplatin/paclitaxel. PMID:19295230

  12. Chylous ascites: diagnosis, causes and treatment.

    PubMed

    Laterre, P F; Dugernier, T; Reynaert, M S

    2000-01-01

    Chylous ascites is a rare form of ascites and generally associated with a poor outcome since it is often secondary to neoplasms. Its true incidence is not well established in the general medico-surgical population. Any source of lymph vessels obstruction or leakage can potentially cause chylous effusions in the peritoneal or retroperitoneal cavities. Any type of cancer and lymph node involvement may be associated with this uncommon type of ascites. Traumatic, and mainly surgical, vessels leakage is the second most common source of chylous effusions. Other even more rare underlying conditions have been described as leading to chyloperitoneum. Large fluid volume losses together with proteins, and lymphocytes can induce additional morbidity in a previously debilitated population or severely ill patients. This includes organ dysfunction related to volume and electrolytes losses, but mainly secondary infections due to impaired immunity by antibodies and lymphocytes depletion. Even if a vast majority of chylous effusions shall heal spontaneously, early and full treatment has to be initiated in order to reduce morbidity and mortality associated with this condition. Adapted oral diet is to be introduced to reduce lymph flow. Low lipid, high medium-chain triglycerides alimentation is the first measure to implement. Total parenteral nutrition is to be reserved to failures of oral diet. In addition, paracentesis is indicated to improve patient comfort, reduce intra-adbominal pressure and secondary renal dysfunction. Somatostatin analogues have been demonstrated to be effective in reducing lymphorragia and may be proposed prior to consider the surgical approach. Direct lymph vessels ligation can be indicated for large lymph vessels leakage demonstrated by radiologic techniques and when medical treatment has failed. Peritoneo-venous shunt becomes a less common technique in refractory chylous effusion because of its high morbidity. Herein, the other causes of chylous effusions

  13. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications.

    PubMed

    Siramolpiwat, Sith

    2014-12-01

    Portal hypertension (PH) plays an important role in the natural history of cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic portosystemic shunts (TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present, polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents. TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment. Recently, applying TIPS early (within 72 h after admission) has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding. In addition, TIPS is recommended as the second-line treatment for secondary prophylaxis. For bleeding gastric varices, applying TIPS was able to achieve hemostasis in more than 90% of patients. More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities, including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices. TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy. In patients with refractory ascites, there is growing evidence that TIPS not only results in better control of ascites, but also improves long-term survival in appropriately selected candidates. In addition, TIPS is a promising treatment for refractory hepatic hydrothorax. However, the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined. The advantage of TIPS is offset by a risk of developing hepatic encephalopathy, the most relevant post-procedural complication. Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome. This review is aimed at summarizing the published data regarding the application of TIPS in the management of

  14. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications

    PubMed Central

    Siramolpiwat, Sith

    2014-01-01

    Portal hypertension (PH) plays an important role in the natural history of cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic portosystemic shunts (TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present, polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents. TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment. Recently, applying TIPS early (within 72 h after admission) has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding. In addition, TIPS is recommended as the second-line treatment for secondary prophylaxis. For bleeding gastric varices, applying TIPS was able to achieve hemostasis in more than 90% of patients. More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities, including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices. TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy. In patients with refractory ascites, there is growing evidence that TIPS not only results in better control of ascites, but also improves long-term survival in appropriately selected candidates. In addition, TIPS is a promising treatment for refractory hepatic hydrothorax. However, the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined. The advantage of TIPS is offset by a risk of developing hepatic encephalopathy, the most relevant post-procedural complication. Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome. This review is aimed at summarizing the published data regarding the application of TIPS in the management of

  15. [Pulmonary complications of liver cirrhosis: hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax].

    PubMed

    Halank, M; Strassburg, C P; Hoeper, M M

    2010-03-01

    Hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax are typical pulmonary complications in patients with liver cirrhosis. Whereas hepatopulmonary syndrome and portopulmonary hypertension represent pulmonary vascular diseases, the development of hepatic hydrothorax is associated with the presence of ascites and phrenic lesions. For severe hepatopulmonary syndrome and refractory hepatic hydrothorax, liver transplantation is the treatment of choice. In severe portopulmonary hypertension specific medical treatment is indicated. In selected patients, beside intravenous prostanoids, oral endothelin receptor antagonists and phosphodiesterase type-5 inhibitors are possible treatment options. PMID:20098977

  16. Eosinophilic ascites: a diagnostic challenge.

    PubMed

    Khalil, Hesham; Joseph, Moby

    2016-01-01

    Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet. PMID:27600059

  17. Massive ascites of unknown origin

    PubMed Central

    Yuan, Shi-Min

    2014-01-01

    Massive ascites of unknown origin is an uncommon condition, which represent a diagnostic challenge. Patients with delayed diagnosis and treatment may have a poor prognosis. A 22-year-old female was referred to this hospital due to a 4-year progressive abdominal distension with massive ascites of unknown origin. By thorough investigations, she was eventually diagnosed as chronic calcified constrictive pericarditis. She received pericardiectomy and had an uneventful postoperative course. With a few day paracentesis, ascites did not progress any more. She was doing well at 5-month follow-up and has returned to work. Extracardiac manifestations, such as massive ascites and liver cirrhosis, were rare in patients with constrictive pericarditis. Pericardiectomy can be a radical solution for the treatment of chronic constrictive pericarditis. In order to avoid delayed diagnosis and treatment, physicians have to bear in mind this rare manifestation of chronic calcified constrictive pericarditis. PMID:24600502

  18. Ascites and spontaneous bacterial peritonitis: Recommendations from two United States Centers

    PubMed Central

    Sundaram, Vinay; Manne, Vignan; Al-Osaimi, Abdullah MS

    2014-01-01

    Cirrhosis affects millions of people throughout the world. Two of the most serious complications of liver cirrhosis are ascites and spontaneous bacterial peritonitis (SBP). The development of ascites is related to the severity of portal hypertension and is an indicator of increased mortality. Although sodium restriction and diuretic therapy have proven effective, some patients may not respond appropriately or develop adverse reactions to diuretic therapy. In such cases, interventions such as transjugular intrahepatic portosystemic shunt (TIPS) placement are warranted. SBP is a complication of ascites that confers a very high mortality rate. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. Initiation of prophylaxis in SBP remains controversial. Given the burden of liver cirrhosis on the health care system, ascites and SBP will continue to provide challenges for the primary care provider, hospitalist, internist, and gastroenterologist alike. PMID:25253362

  19. Advantages of treatment of ascites without sodium restriction and without complete removal of excess fluid.

    PubMed Central

    Reynolds, T B; Lieberman, F L; Goodman, A R

    1978-01-01

    Two modifications of the standard method of treatment of ascites in chronic liver disease were investigated in three separate randomised trials involving a total of 201 patients. These modifications were (1) an unrestricted sodium intake and (2) limitation of diuresis to partial removal of ascites, to the point of relief of abdominal tension. Mean serum sodium fell significantly in all patient groups receiving the low sodium diet and did not fall in the groups given an unrestricted diet. Mean serum urea nitrogen rose significantly in the patient groups undergoing complete diuresis and did not change in the groups undergoing partial diuresis. Mean serum uric acid rose only in the groups undergoing complete diuresis. We concluded that the advantages of these two modifications of therapy of ascites were increased dietary palatability and decreased likelihood of hyponatraemia and of rise in serum urea nitrogen and uric acid. Disadvantages included dissatisfaction of patients over incomplete clearing of ascites, occasional difficulty in performing diagnostic studies because of prolonged ascites, and unsuitability of a high sodium intake in patients whose ascites is highly refractory to treatment. PMID:680588

  20. ACCURACY OF SERUM - ASCITES ALBUMIN GRADIENT IN THE AETIOLOGICAL DIAGNOSIS OF ASCITES.

    PubMed

    Seth, A K; Rangarao, R; Pakhetra, R; Baskaran, V; Rana, Pvs; Rajamani, S

    2002-04-01

    50 adults with ascites admitted to our hospital were studied. Simultaneous samples of ascitic fluid and blood were collected and subjected to analysis including ascitic fluid total protein and serum ascites albumin gradient The cut off value of serum-ascites albumin gradient for differentiating between high and low gradient was taken as 1.1 gm % and of ascitic fluid protein for differentiating exudate and transudate as 2.5 gm%. The sensitivity, specificity, positive predictive value and negative predictive value of high gradient and transudative ascites in diagnosing portal hypertension were 943%, 60%, 84.6%, 81.8% and 62.9%, 133%, 91.7% and 50% respectively. High gradient ascites is a sensitive test in the diagnosis of portal hypertension as a cause of ascites. The exudate-transudate approach has severe limitations in the differential diagnosis of ascites. PMID:27407357

  1. Outcome of pancreatic ascites in patients with tropical calcific pancreatitis managed using a uniform treatment protocol.

    PubMed

    Kurumboor, Prakash; Varma, Deepak; Rajan, Mahendra; Kamlesh, Naduthottam Palanisami; Paulose, Roshin; Narayanan, Ramesh Ganesh; Philip, Mathew

    2009-01-01

    Pancreatic ascites or internal pancreatic fistula is a known complication of chronic pancreatitis. This condition is associated with considerable morbidity and mortality. The management approach of pancreatic ascites in tropical calcific pancreatitis is infrequently reported owing to the low incidence of this condition. Between December 2005 and June 2007, 11 patients with pancreatic ascites with tropical calcific pancreatitis (male:female 7:4, mean age 29.5 [14.2] years) were treated. A retrospective analysis of patients who underwent endotherapy and surgery for this condition based on an institutional protocol was performed. The end point was resolution of pancreatic ascites and relief of symptoms. All patients had pancreatic ascites, and one patient also had pancreatic pleural effusion. Endoscopic transpapillary stenting was possible in nine patients (81%). Identification of site of leak and placement of an endoscopic stent across the PD disruption was possible in five (45%) patients. All these patients had relief of ascites. Mean number of endotherapy sessions required before control of ascites was 1.8. Among the remaining four (36.6%) patients who had ERCP, placement of stent across the leak was unsuccessful; however stenting helped stabilize the general condition and nutritional status. These four patients and two patients who failed ERP underwent lateral pancreatojejunostomy surgery. Morbidity was observed in three patients who underwent surgery and one patient died due to sepsis and hemorrhage. All patients who had surgical drainage had complete relief of ascites and symptoms. In patients with pancreatic ascites in tropical calcific pancreatitis endotherapy and transpapillary stenting helps in resolution of ascites in nearly half of the patients. In the remaining patients preliminary conservative management followed by surgical pancreatic ductal drainage provides good relief of symptoms. PMID:19907961

  2. Ascites Drainage Leading to Intestinal Adhesions at the Mesentery of the Small Intestine with Fatal Outcome

    PubMed Central

    Kettler, B.; Schrem, H.; Klempnauer, J.; Grannas, G.

    2014-01-01

    A common problem in patients with chronic liver diseases and liver cirrhosis is the development of ascites. First line therapy for ascites is the restriction of sodium intake and a diuretic treatment. Paracentesis is indicated in patients with large compromising volumes of ascites. In selected cases, permanent drainage of ascites over prolonged periods of time may be indicated. In the case presented here, a 66-year-old male patient, who was hospitalized with liver cirrhosis caused by alcoholic abuse, required permanent drainage of ascites. After three weeks of continuous ascites drainage, he developed bacterial peritonitis. Conventional attempts to remove the catheter by transcutaneous pulling failed and we thus decided to perform a median laparotomy to remove the catheter surgically. Intraoperatively an adhesion of the ascites drain (a so called ‘basket catheter’) to the mesentery very close to the small intestine was found, approximately 50 mm distal of the ligament suspensorium duodeni (ligament of Treitz). The basket catheter used for this patient was especially designed to drain infections, not fluids. We solved the adhesion, removed the basket catheter, placed a new surgical drain and finished the operation. The patient developed a rupture of his abdominal fascia suture 12 days later, which was caused by massive ascites and complicated by hepatorenal syndrome type I. The patient was taken to the operating theater again. After the second operation, the chronic liver failure decompensated and the patient died. Ascites caused by liver cirrhosis is still a medical challenge. The indication for the use of the correct percutaneous catheter for permanent paracentesis should be carefully considered. Some catheters are obviously not suited to drain ascites and may lead to fatal outcomes. PMID:24453504

  3. Post radiation chylous ascites: a case report

    PubMed Central

    2009-01-01

    We report a 64 years old gentleman with unresectable right-sided retroperitoneal liposarcoma, who underwent radiotherapy & subsequently developed chylous ascites. He failed conservative management of chylous ascites and this was successfully managed with a peritoneovenous shunt. The pathophysiology and management of post radiational chylous ascites is discussed. PMID:20069070

  4. TIPS Versus Peritoneovenous Shunt in the Treatment of Medically Intractable Ascites

    PubMed Central

    Rosemurgy, Alexander S.; Zervos, Emmanuel E.; Clark, Whalen C.; Thometz, Donald P.; Black, Thomas J.; Zwiebel, Bruce R.; Kudryk, Bruce T.; Grundy, L Shane; Carey, Larry C.

    2004-01-01

    Objective: We undertook a prospective randomized clinical trial comparing TIPS to peritoneovenous (PV) shunts in the treatment of medically intractable ascites to establish relative efficacy and morbidity, and thereby superiority, between these shunts. Methods: Thirty-two patients were prospectively randomized to undergo TIPS or peritoneovenous (Denver) shunts. All patients had failed medical therapy. Results: After TIPS versus peritoneovenous shunts, median (mean ± SD) duration of shunt patency was similar: 4.4 months (6 ± 6.6 months) versus 4.0 months (5 ± 4.6 months). Assisted shunt patency was longer after TIPS: 31.1 months (41 ± 25.9 months) versus 13.1 months (19 ± 17.3 months) (P < 0.01, Wilcoxon test). Ultimately, after TIPS 19% of patients had irreversible shunt occlusion versus 38% of patients after peritoneovenous shunts. Survival after TIPS was 28.7 months (41 ± 28.7 months) versus 16.1 months (28 ± 29.7 months) after peritoneovenous shunts. Control of ascites was achieved sooner after peritoneovenous shunts than after TIPS (73% vs. 46% after 1 month), but longer-term efficacy favored TIPS (eg, 85% vs. 40% at 3 years). Conclusion: TIPS and peritoneovenous shunts treat medically intractable ascites. Absence of ascites after either is uncommon. PV shunts control ascites sooner, although TIPS provides better long-term efficacy. After either shunt, numerous interventions are required to assist patency. Assisted shunt patency is better after TIPS. Treating medically refractory ascites with TIPS risks early shunt-related mortality for prospects of longer survival with ascites control. This study promotes the application of TIPS for medically intractable ascites if patients undergoing TIPS have prospects beyond short-term survival. PMID:15166968

  5. Chylous ascites following robotic lymph node dissection on a patient with metastatic cervical carcinoma

    PubMed Central

    Soto, Enrique; Soto, Carlos; Nezhat, Farr R.; Gretz, Herbert F.

    2011-01-01

    Chylous ascites is an uncommon postoperative complication of gynecological surgery. We report a case of chylous ascites following a robotic lymph node dissection for a cervical carcinoma. A 38-year-old woman with IB2 cervical adenocarcinoma with a palpable 3 cm left external iliac lymph node was taken to the operating room for robotic-assisted laparoscopic pelvic and para-aortic lymph node dissection. Patient was discharged on postoperative day 2 after an apparent uncomplicated procedure. The patient was readmitted the hospital on postoperative day 9 with abdominal distention and a CT-scan revealed free fluid in the abdomen and pelvis. A paracentesis demonstrated milky-fluid with an elevated concentration of triglycerides, confirming the diagnosis of chylous ascites. She recovered well with conservative measures. The risk of postoperative chylous ascites following lymph node dissection is still present despite the utilization of new technologies such as the da Vinci robot. PMID:21607099

  6. Pleurovenous shunt in treating refractory nonmalignant hepatic hydrothorax: a case report.

    PubMed

    Hadsaitong, Damrong; Suttithawil, Wudthichai

    2005-12-01

    We report a case of successful, long-term pleurovenous shunt (PVS) in treating refractory nonmalignant hepatic hydrothorax. An 82-year-old woman with liver cirrhosis, hypertension complicated with chronic renal failure while on hemodialysis, presented with progressive dyspnea in association with a recurrent right-sided pleural effusion, occurring secondary to transdiaphragmatic migration of ascites. The diagnosis was established by a demonstration of (99m)Tc-sulphur colloid sequential scintigraphic scan. Despite repetitive thoracenteses and traditional medical treatment, she suffered dyspnea without relief. Denver peritoneovenous shunt was inserted into the right-sided pleural cavity to drain effusion into the subclavian vein without short- and long-term complications. Manually pumping schedule of 10 min was performed twice daily to remove pleural fluid into the venous circulation for maintaining shunt patency. After 19 months of follow-up, the patient is doing well and PVS remains patent without significant pleural effusion. PVS opens a window of opportunity and offers an alternative procedure with minimal invasiveness for high-risk patients with refractory hepatic hydrothorax. It could be an alternative treatment to other conventional surgical interventions. PMID:16291082

  7. Immunopathological analysis of Erdheim-Chester disease with massive ascites.

    PubMed

    Ota, Muneo; Sakamoto, Mayuko; Sato, Kojiro; Yoshida, Yoshihiro; Funakubo Asanuma, Yu; Akiyama, Yuji; Yamakawa, Mitsunori; Mimura, Toshihide

    2012-01-01

    We treated a 77-year-old woman with pleural and pericardial effusion and ascites. Initially, collagen vascular disease was suspected due to the presence of anti-centromere antibodies and suspected complication of pulmonary arterial hypertension. However, soft-tissue abnormalities surrounding the bilateral kidneys detected on computed tomography (CT) and symmetrical lesions of the long bones detected on bone scintigraphy made us consider a diagnosis of Erdheim-Chester disease (ECD), which is a rare form of histiocytosis. We immunochemically analyzed the cells derived from the ascites in detail and confirmed the diagnosis. Immunocytochemical analyses may therefore help to achieve a better understanding of the pathogenesis of this rare disease. PMID:23037484

  8. -C Refractories

    NASA Astrophysics Data System (ADS)

    Xu, Yibiao; Sang, Shaobai; Li, Yawei; Ren, Bo; Zhao, Lei; Li, Yuanbing; Li, Shujing

    2014-06-01

    Al2O3-C refractories were first fabricated in a coke bed at 1673 K (1400 °C) using tabular corundum, reactive alumina, carbon black, silicon, and microsilica as the starting materials and phenol resin as the binder. Then the alkali attack resistance of those materials was conducted in the powder mixture of carbon black and potassium carbonate (1:1 wt pct) in a graphite crucible at 1273 K (1000 °C) for 10 hours. The correlation between pore size, permeability of Al2O3-C refractories, and their alkali (K2CO3) attack was investigated by means of mercury intrusion porosimetry, X-ray diffraction (XRD), and scanning electron microscopy (SEM). The results showed that the pore structure of Al2O3-C refractories was controlled by the addition of silicon, ultrafine reactive alumina, and microsilica to in-situ form SiC whiskers and mullite in the preparation process. The mean pore size of Al2O3-C refractories was strongly associated with permeability. With the decrease of the mean pore size, the permeability of the Al2O3-C refractories reduced constantly. The alkali attack test also verified that the Al2O3-C refractories with lower permeability had better alkali corrosion resistance, because the penetration of K vapor into the materials could be restricted effectively. The corrosion mechanism of Al2O3-C refractories supposes that (1) K2CO3 was reduced to K vapor and penetrated into the specimen through the open pores and (2) K vapor reacted with SiC, SiO2, and alumina to form KAlSi2O6 and KAlSiO4, which is in agreement with the thermodynamic prediction.

  9. Echocardiographic characteristics of chickens with ascites syndrome.

    PubMed

    Deng, G; Zhang, Y; Peng, X; Guo, D; Li, C

    2006-12-01

    1. B- and M-mode echocardiography was used to compare cardiac function in broilers with spontaneous ascites syndrome with that of normal chickens. 2. Thirty ascitic chickens and 15 normal chickens aged three, 4, 5, and 6 weeks from the same flock (180 birds in total) were examined. They were restrained gently in a natural standing position, and echocardiographs were obtained from a 7.0-MHz linear transducer placed on the left pectoral apterium. Indices of cardiac structure and functioning were calculated from the echocardiographs, and some were normalised to body weight. Heart rate was also measured. 3. All cardiac structural indices in both ascitic and normal chickens increased with age. Compared with normal chickens, right ventricular diameter at the end of systole in ascitic chickens was greater at 4, 5 and 6 weeks of age. Ventricular septal thickness at the end of both systole and diastole was greater in ascitic chickens at 5 and 6 weeks. Left ventricular free wall thickness at the end of diastole was less in ascitic chickens at 3 weeks. However, all the structural indices decreased with age after normalisation with body weight. 4. The heart rate of ascitic chickens was lower at 4, 5 and 6 weeks. Normalised left ventricular fractional shortening was lower in ascitic chickens at 4, 5 and 6 weeks, as was normalised right ventricular fractional shortening. Incrassation of the ventricular septum (Delta T), which changed little in normal chickens, was less at 4, 5 and 6 weeks in ascitic chickens. Left ventricular fractional shortening, right ventricular fractional shortening and Delta T were all negatively correlated with ascites heart index at all ages. 5. Taken together the results suggest heart failure of both ventricle, but that right ventricular dysfunction is more extensive than left ventricular dysfunction. We suggest that secondary pulmonary hypertension would result in these ascitic chickens due to volume overload. PMID:17190684

  10. Therapeutic effects of viral vector-mediated antiangiogenic gene transfer in malignant ascites.

    PubMed

    Hampl, M; Tanaka, T; Albert, P S; Lee, J; Ferrari, N; Fine, H A

    2001-09-20

    Malignant ascites is a common complication of advanced intraabdominal neoplasms for which standard treatments are suboptimal. Evidence suggests that tumor-mediated angiogenesis and enhanced vascular permeability in the peritoneal wall due to high levels of vascular endothelial growth factor play a fundamental role in the pathogenesis of malignant ascites. To explore the advantage of viral vector-mediated "targeted antiangiogenic therapy" in ascites formation, we constructed and administered adenoviral vectors encoding several different antiangiogenic proteins (angiostatin, endostatin, platelet factor 4, and a fusion protein between angiostatin and endostatin) alone or in combination intraperitoneally in mice with peritoneal carcinomatosis from breast cancer (TA3 cells) and ovarian cancer (SKOV-3 i.p. and ES-2 cell lines) to explore the potential of additive or synergistic activity. Our data demonstrated statistically significant downregulation of ascites formation, tumor growth, vascularity, and prolongation of animal survival after intraperitoneal treatment with antiangiogenic adenoviral vectors in three different ascites tumor models. Combined treatment proved to be more effective than treatment with one vector alone. Reduced ascites formation was accompanied by decreased microvascular density in the peritoneal wall and increased apoptosis of tumor cells after administration of antiangiogenic vectors in vivo. Of interest was the observation that AdPF4 caused a significant decrease in the level of VEGF secreted by tumor cells both in vitro and in TA3 ascites tumor-bearing animals in vivo. These data suggest that adenoviral vector-mediated delivery of genes encoding antiangiogenic proteins may represent a potentially new treatment modality for malignant ascites. PMID:11560766

  11. Eosinophilic ascites: A case report and literature review

    PubMed Central

    Alsulaiman, Raed M.

    2015-01-01

    Eosinophilic gastroenteritis is a rare gastrointestinal (GI) disorder characterized by nonspecific GI symptoms, peripheral eosinophilia, and eosinophilic infiltration of the intestinal wall. The disorder is classified into mucosal, muscular, and sub-serosal types, depending on the clinical picture and the depth of eosinophilic infiltration within the GI wall. Sub-serosal disease, which is complicated by ascites, usually results in the most severe clinical form of eosinophilic gastroenteritis and requires early corticosteroid therapy. In such cases, a favorable outcome can be achieved after a short course of corticosteroids. We present the case of a 28-year-old female with diffuse abdominal pain and distention for 2 weeks. Her physical examination was significant for moderate ascites. Initial work-up demonstrated severe peripheral blood eosinophilia, normal liver function tests, and elevated serum immunoglobulin E (IgE). Upper endoscopy, colonoscopy showed a thickening of the stomach and colon, and biopsies showed marked eosinophilic infiltration of the mucosa. Ascitic fluid analysis showed significant eosinophilia. Subsequent treatment with oral prednisone resulted in the normalization of laboratory and radiologic abnormalities 45 days after the start of the treatment. Despite its rarity, eosinophilic gastroenteritis needs to be recognized by the clinician because the disease is treatable, and timely diagnosis and initiation of treatment could be of major importance. PMID:26392801

  12. Embolization of Portosystemic Shunts for Treatment of Medically Refractory Hepatic Encephalopathy

    PubMed Central

    Lynn, Amanda M.; Singh, Siddharth; Congly, Stephen E.; Khemani, Disha; Johnson, David H.; Wiesner, Russell H.; Kamath, Patrick S.; Andrews, James C.; Leise, Michael D.

    2016-01-01

    Treatment options for refractory hepatic encephalopathy (HE) are limited. Patients who fail medical management may harbor large portosystemic shunts (PSSs) which are possible therapeutic targets. This study aims to describe patient selection, effectiveness, and safety of percutaneous PSS embolization in those with medically refractory HE. A retrospective evaluation of consecutive adult patients with medically refractory HE referred for PSS embolization at a tertiary center was performed (2003–2015). Patient data collected included the type of HE, medications, Model for End-Stage Liver Disease (MELD) score, shunt type, embolization approach, and materials used. Outcomes of interest were immediate (7 days), intermediate (1–4 months), and longer-term (6–12 months) effectiveness and periprocedural safety. Effectiveness was determined based on changes in hospitalization frequency, HE medications, and symptoms. Twenty-five patients with large PSS were evaluated for shunt embolization. Five were excluded due to high MELD scores (n = 1), comorbid conditions (n = 1), or technical considerations (n = 3). Of 20 patients who underwent embolization, 13 had persistent and 7 had recurrent HE; 100% (20/20) achieved immediate improvement. Durable benefit was achieved in 100% (18/18) and 92% (11/12) at 1–4 and 6–12 months, respectively. The majority (67%; 8/12) were free from HE-related hospitalizations over 1 year; 10% developed procedural complications, and all resolved. Six developed new or worsening ascites. In conclusion, PSS embolization is a safe and effective treatment strategy that should be considered for select patients with medically refractory HE. PMID:26970243

  13. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration.

    PubMed

    Llach, J; Rimola, A; Navasa, M; Ginès, P; Salmerón, J M; Ginès, A; Arroyo, V; Rodés, J

    1992-09-01

    To investigate the long-term probability of the appearance of the first episode of spontaneous bacterial peritonitis in cirrhosis with ascites and to identify predictors of this complication, we closely followed throughout their illness 127 patients consecutively admitted to our unit for the treatment of an episode of ascites without prior spontaneous bacterial peritonitis (follow-up period: 21 +/- 22 mo). Thirteen patients (10%) had the first spontaneous bacterial peritonitis episode during follow-up. The appearance probability of this complication is 11% at 1 yr and 15% at 3 yr. Thirty-three variables obtained at admission (including clinical data, standard liver and kidney function test results, ascitic fluid protein concentrations and hemodynamic parameters) were analyzed in relation to their value in predicting spontaneous bacterial peritonitis development. In univariate analysis (Kaplan-Meier curves) five variables reached statistical significance (p less than 0.05) as predictive factors for the development of the first spontaneous bacterial peritonitis episode. These five variables were poor nutritional status, increased serum bilirubin levels, increased serum AST levels, decreased prothrombin activity and reduced total protein concentration in ascitic fluid. When these five variables were introduced in a multivariate analysis, only the ascitic fluid protein concentration was found to correlate independently with spontaneous bacterial peritonitis development (p = 0.002). The probability of first spontaneous bacterial peritonitis after 3 yr of follow-up was 24% and 4% in patients with ascitic fluid protein content lower than 1 gm/dl and greater than or equal to 1 gm/dl, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1505916

  14. Management of ascites due to gastrointestinal malignancy

    PubMed Central

    Saif, Muhammad W.; Siddiqui, Imran A. P.; Sohail, Muhammad A.

    2009-01-01

    Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduced mobility. There are many potential causes of ascites in cancer patients, including peritoneal carcinomatosis, malignant obstruction of draining lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephrotic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascitic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available. PMID:19700895

  15. Chylous Ascites: Evaluation and Management

    PubMed Central

    Al-Busafi, Said A.; Ghali, Peter; Deschênes, Marc; Wong, Philip

    2014-01-01

    Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt. PMID:27335837

  16. Profound Autonomic Instability Complicated by Multiple Episodes of Cardiac Asystole and Refractory Bradycardia in a Patient with Anti-NMDA Encephalitis

    PubMed Central

    Mehr, Stephanie R.; Neeley, Roy C.; Wiley, Melissa; Kumar, Avinash B.

    2016-01-01

    Anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE) is autoimmune encephalitis primarily affecting young adults and children. First described about a decade ago, it frequently manifests as a syndrome that includes progressive behavioral changes, psychosis, central hypoventilation, seizures, and autonomic instability. Although cardiac arrhythmias often accompany anti-NMDARE, the need for long-term electrophysiological support is rare. We describe the case of NMDARE whose ICU course was complicated by progressively worsening episodes of tachyarrhythmia-bradyarrhythmia and episodes of asystole from which she was successfully resuscitated. Her life-threatening episodes of autonomic instability were successfully controlled only after the placement of a permanent pacemaker during her ICU stay. She made a clinical recovery and was discharged to a skilled nursing facility after a protracted hospital course. PMID:27190663

  17. Macrophage Blockade Using CSF1R Inhibitors Reverses the Vascular Leakage Underlying Malignant Ascites in Late-Stage Epithelial Ovarian Cancer

    PubMed Central

    Moughon, Diana L.; He, Huanhuan; Schokrpur, Shiruyeh; Jiang, Ziyue Karen; Yaqoob, Madeeha; David, John; Lin, Crystal; Iruela-Arispe, M. Luisa; Dorigo, Oliver; Wu, Lily

    2015-01-01

    Malignant ascites is a common complication in the late stages of epithelial ovarian cancer (EOC) that greatly diminishes the quality of life of patients. Malignant ascites is a known consequence of vascular dysfunction, but current approved treatments are not effective in preventing fluid accumulation. In this study, we investigated an alternative strategy of targeting macrophage functions to reverse the vascular pathology of malignant ascites using fluid from human patients and an immunocompetent murine model (ID8) of EOC that mirrors human disease by developing progressive vascular disorganization and leakiness culminating in massive ascites. We demonstrate that the macrophage content in ascites fluid from human patients and the ID8 model directly correlates with vascular permeability. To further substantiate macrophages’ role in the pathogenesis of malignant ascites, we blocked macrophage function in ID8 mice using a colony-stimulating factor 1 receptor kinase inhibitor (GW2580). Administration of GW2580 in the late stages of disease resulted in reduced infiltration of protumorigenic (M2) macrophages and dramatically decreased ascites volume. Moreover, the disorganized peritoneal vasculature became normalized and sera from GW2580-treated ascites protected against endothelial permeability. Therefore, our findings suggest that macrophage-targeted treatment may be a promising strategy toward a safe and effective means to control malignant ascites of EOC. PMID:26471360

  18. Macrophage Blockade Using CSF1R Inhibitors Reverses the Vascular Leakage Underlying Malignant Ascites in Late-Stage Epithelial Ovarian Cancer.

    PubMed

    Moughon, Diana L; He, Huanhuan; Schokrpur, Shiruyeh; Jiang, Ziyue Karen; Yaqoob, Madeeha; David, John; Lin, Crystal; Iruela-Arispe, M Luisa; Dorigo, Oliver; Wu, Lily

    2015-11-15

    Malignant ascites is a common complication in the late stages of epithelial ovarian cancer (EOC) that greatly diminishes the quality of life of patients. Malignant ascites is a known consequence of vascular dysfunction, but current approved treatments are not effective in preventing fluid accumulation. In this study, we investigated an alternative strategy of targeting macrophage functions to reverse the vascular pathology of malignant ascites using fluid from human patients and an immunocompetent murine model (ID8) of EOC that mirrors human disease by developing progressive vascular disorganization and leakiness culminating in massive ascites. We demonstrate that the macrophage content in ascites fluid from human patients and the ID8 model directly correlates with vascular permeability. To further substantiate macrophages' role in the pathogenesis of malignant ascites, we blocked macrophage function in ID8 mice using a colony-stimulating factor 1 receptor kinase inhibitor (GW2580). Administration of GW2580 in the late stages of disease resulted in reduced infiltration of protumorigenic (M2) macrophages and dramatically decreased ascites volume. Moreover, the disorganized peritoneal vasculature became normalized and sera from GW2580-treated ascites protected against endothelial permeability. Therefore, our findings suggest that macrophage-targeted treatment may be a promising strategy toward a safe and effective means to control malignant ascites of EOC. PMID:26471360

  19. [The significance of low levels of total proteins, albumins, globulins and complement factors in ascitic fluid and the development of spontaneous bacterial peritonitis in patients with liver cirrhosis].

    PubMed

    Ljubicić, N; Bilić, A; Babić, Z; Roić, D; Banić, M

    1992-01-01

    Spontaneous bacterial peritonitis is one of the most common complications of ascitic fluid in patients with liver cirrhosis. The aim of this study was to investigate the role of total protein, albumin, globulin and complement ascitic fluid concentrations in development of spontaneous bacterial peritonitis in patients with liver cirrhosis. In patients with liver cirrhosis and spontaneous bacterial peritonitis (n = 8) the ascitic fluid total protein, albumin and globulin concentrations were significantly lower than in patients with sterile ascites (n = 11) (p < 0.01). The ascitic fluid complement C3 and C4 concentrations were significantly lower in patients with spontaneous bacterial peritonitis than in patients with sterile ascites (9.1 +/- 3.1 mg/dL to 22.9 +/- 17.4 mg/dL, p < 0.01; 3.8 +/- 5.9 mg/dL to 8.2 +/- 5.9 mg/dL, p < 0.01, respectively). The ascites total protein, albumin, globulin and complement concentrations in cirrhotic patients with spontaneous bacterial peritonitis were significantly lower than in patients with sterile ascites demonstrating the importance of those factors in ascitic fluid defense against secondary bacterial infection. PMID:1343119

  20. [Changes in antidiuretic hormone (ADH) in liver cirrhosis with resistant ascites].

    PubMed

    Marenco, G; Giudici Cipriani, A; Folco, U; Colombo, P; Menardo, G; Cattana, A; Barbetti, V; Rembado, R

    1989-09-01

    The pathogenetic role of ADH in determining hyponatremia in patients with liver cirrhosis is still much debated. Osmotic stimuli are not able to inhibit secretion of ADH in refractory ascites and under such conditions the reduction in effective plasma volume has been put forward as the main cause. Twenty patients with liver cirrhosis and refractory ascites were studied before and during extraction-concentration-reinfusion (ECR) of ascitic fluid by means of Rhodiascit. ADH, renin, aldosterone, blood and urine osmolarity, plasma and urinary concentration of sodium, potassium, chlorine, and the clearance of free water were evaluated. All patients presented high renin values (15.4 +/- 11.7 ng/ml), aldosterone (341 +/- 172 ng/ml), ADH (6.3 +/- 5.2 pg/ml). During ECR, a significant drop was observed in renin (p less than 0.001), aldosterone (p less than 0.001) urinary osmolarity (p less than 0.001) and an equality significant increase in diuresis (p less than 0.001), natriuria (p less than 0.005), kaliuria (p less than 0.001) while ADH presented an irregular course: in 11 cases it remained unchanged, in 3 it fell and in 6 it presented a constant increase. To conclude, data suggest that the diminished filtrate reaching the distal tubule constitutes the greatest cause of the inability to dilute urine in many patients with cirrhosis and that ADH is a permissive rather than a primary factor. PMID:2682381

  1. The application of nutrition support in conservative treatment of chylous ascites after abdominal surgery

    PubMed Central

    Pan, Wu; Cai, Shen-Yang; Luo, Hai-Long; Ouyang, Shu-Rui; Zhang, Wen-Duo; Wei, Zai-Rong; Wang, Da-Li

    2016-01-01

    Background Chylous ascites is the pathologic leakage of triglycerides-rich lymphatic fluid into the peritoneal cavity. Chylous ascites is a rare complication in abdominal surgery. This study aimed to find a relatively better method for nutrition support in the treatment of chylous ascites after abdominal surgery. Methods This study was a retrospective study. This study retrospectively reviewed patients who underwent abdominal surgery and developed chylous ascites, from the year 2010 to 2014, at the West China Hospital of Sichuan University and the Affiliated Hospital of Zunyi Medical College. Fifty-eight patients who developed chylous ascites after abdominal surgery were included in the study. The clinical effect of somatostatin was evaluated. The differences in the curative efficacy among a daily diet, a low-fat diet supplemented with medium-chain triglyceride (MCT), and total parenteral nutrition (TPN) were also analyzed in this study. Results Complete clinical success was reached earlier in patients treated with somatostatin (P<0.001). The tube removal time, the time to resumption of an oral diet, and the length of hospital stay after chylous leakage were significantly different between patients treated with and without somatostatin. The curative efficacies of the enteral nutrition (EN) + MCT plan and the TPN plan were quite similar, with no significant difference, however, were significantly different from the MCT regime, which was the worst. However, using the EN + MCT plan was more cost-effective (P=0.038). Conclusion In treating chylous ascites, EN + MCT instead of TPN was the best nutrition support. Moreover, somatostatin or its analog octreotide should be used immediately. The treatment with somatostatin in combination with EN + MCT is recommended in the conservative treatment of postoperative chylous ascites. PMID:27143902

  2. Ovarian hemangioma with elevated CA125 and ascites mimicking ovarian cancer.

    PubMed

    Erdemoglu, E; Kamaci, M; Ozen, S; Sahin, H G; Kolusari, A

    2006-01-01

    We report a case of a very rare tumor of the ovary with an unusual presentation; an ovarian hemangioma with massive ascites and elevated CA125. A 57-year-old woman presenting with elevated CA125, massive ascites and a left solid adnexal mass of 60 x 47 mm, with calcification and increased blood flow at Doppler examination, was submitted to laparotomy. Frozen section was inconclusive and a staging procedure which complicated the patient was performed. Pathologic examination revealed cavernous hemangioma which is an extremely rare tumor of the ovary. Although it is very unusual, an ovarian hemangioma may present with ascites and elevated CA125 and the differential diagnosis from ovarian cancer should be considered. PMID:16620071

  3. Assessment of intestinal permeability and absorption in cirrhotic patients with ascites using combined sugar probes.

    PubMed

    Zuckerman, Marc J; Menzies, Ian S; Ho, Hoi; Gregory, Gavin G; Casner, Nancy A; Crane, Roger S; Hernandez, Jesus A

    2004-04-01

    Gastrointestinal dysfunction in patients with cirrhosis may contribute to complications such as malnutrition and spontaneous bacterial peritonitis. To determine whether cirrhotic patients with ascites have altered intestinal function, we compared intestinal permeability and absorption in patients with liver disease and normal subjects. Intestinal permeability and absorption were investigated in 66 cirrhotic patients (48 with ascites, 18 without ascites) and 74 healthy control subjects. Timed recovery of 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose in urine following oral administration was measured in order to assess active and passive carrier-mediated, and nonmediated, absorptive capacity, as well as intestinal large-pore/small-pore (lactulose/rhamnose) permeability. Test sugars were measured by quantitative thin-layer chromatography and results are expressed as a percentage of test dose recovered in a 5-h urine collection. Sugar excretion ratios relating to small intestinal permeability (lactulose/rhamnose) and absorption (rhamnose/3-O-methyl-D-glucose) were calculated to avoid the effects of nonmucosal factors such as renal clearance, portal hypertension, and ascites on the recovery of sugar probes in urine. Compared with normal subjects, the mean lactulose/rhamnose permeability ratio in cirrhotic patients with ascites was significantly higher (0.058 vs. 0.037, P < 0.001) but not in cirrhotic patients without ascites (0.041 vs. 0.037). Cirrhotic patients with ascites had significantly lower mean recoveries of 3-O-methyl-D-glucose (23.0 vs. 49.1%; P < 0.001), D-xylose (18.8 vs. 34.5%; P < 0.001), L-rhamnose (4.0 vs. 9.1%; P < 0.001), and lactulose (0.202 vs. 0.337%; P < 0.001) than normal subjects. However, the mean rhamnose/3-O-methyl-D-glucose ratio was the same in cirrhotic patients with ascites as normal subjects (0.189 vs. 0.189), indicating that the reduction in probe recovery was due to nonmucosal factors. Compared with normal subjects

  4. [Refractory hypoxia].

    PubMed

    Cuchard, P; Guillemin, P

    2011-04-27

    We report a case of refractory hypoxia in an 85 years old smoker patient, who is known for cardiac and pulmonary comorbidities. The whole clinical picture at the time of his admission to hospital was pointing to a cardiac failure or a pneumonia that were causing the respiratory insufficiency. Despite an optimal treatment which stabilised these conditions, the patient remained severely hypoxic, but with relatively few symptoms. The non response to the oxygen and the worsening of the oxygen saturation when changing from the lying to the sitting (or supine) position finally evoke the syndrome of platypnea-orthodeoxia caused by a cardiac right to left shunt; that diagnosis was confirmed by a cardiac ultrasound with contrast which revealed an important inter-auricular shunt. The patient didn't wish to undertake the curative treatment (shunt closure). PMID:21526473

  5. Delayed-Onset Chylous Ascites After a Living-Donor Liver Transplant: First Case Successfully Treated With Conservative Treatment?

    PubMed

    Chen, Jian-Han; Chang, Chun-Ming; Lu, Min-Chi; Wei, Chang-Kuo; Yin, Wen-Yao

    2016-06-01

    Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors. We report a case of chylous ascites after a living-donor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayed-onset chylous ascites after a liver transplant that was successfully treated conservatively. PMID:25365187

  6. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations.

    PubMed

    Pericleous, Marinos; Sarnowski, Alexander; Moore, Alice; Fijten, Rik; Zaman, Murtaza

    2016-03-01

    Several pathogenic processes have been implicated in the development of abdominal ascites. Portal hypertension, most usually in the context of liver cirrhosis, can explain about 75% of the cases, whereas infective, inflammatory and infiltrative aetiologies can account for the rest. In this article, we discuss the consensus best practice as published by three professional bodies for the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The aim of this study was to compare available clinical guidelines and identify areas of agreement and conflict. We carried out a review of the guidance documentation published by three expert bodies including the British Society of Gastroenterology, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as a wider literature search for ascites, SBP and HRS. Abdominal ultrasonography, diagnostic paracentesis and ascitic fluid cultures are recommended by all three guidelines, especially when there is strong clinical suspicion for infection. EASL and AASLD advocate the use of ascitic amylase and mycobacterial cultures/PCR when there is strong suspicion for tuberculosis and pancreatitis, respectively. Ascitic cytology can be useful when cancer is suspected and has a good diagnostic yield if performed correctly. EASL supports the use of urinary electrolytes for all patients; however, the British Society of Gastroenterology and AASLD only recommend their use for therapy monitoring. All three societies recommend cefotaxime as the antibiotic of choice for SBP and large-volume paracentesis for the management of ascites greater than 5 l in volume. For HRS, cautious diuresis, volume expansion with albumin and the use of vasoactive drugs are recommended. There appears to be good concordance between recommendations by the European, American and British guidelines for the management of ascites and the possible

  7. Lymphomas and chylous ascites: review of the literature.

    PubMed

    Almakdisi, Tony; Massoud, Samuel; Makdisi, George

    2005-09-01

    Chylous ascites is a rare and challenging clinical condition that occurs as a result of disruption of the abdominal lymphatics. We include a review of the literature describing the etiology, diagnosis, and therapy of chylous ascites. PMID:16177287

  8. Diagnostic accuracy of ascitic cholesterol concentration for malignant ascites: a meta-analysis

    PubMed Central

    Zhu, Hong; Shen, Yongchun; Deng, Kai; Liu, Xia; Zhao, Yaqin; Liu, Taiguo; Huang, Ying

    2015-01-01

    Many studies have investigated whether ascitic cholesterol can aid in diagnosis of malignant related ascites (MRA), and the results have varied considerably. To gain a more reliable answer to this question, we meta-analyzed the literature on using ascitic cholesterol as diagnostic tests to help identify MRA. Literature databases were systematically searched for studies examining accuracy of ascitic cholesterol for diagnosing MRA. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled using random effects models. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall test performance. At last, our meta-analysis included 8 studies involving 743 subjects. Summary estimates for ascitic cholesterol in the diagnosis of MRA were as follows: sensitivity, 0.82 (95% CI 0.78 to 0.86); specificity, 0.90 (95% CI 0.87 to 0.93); PLR, 9.24 (95% CI 4.58 to 18.66); NLR, 0.16 (95% CI 0.08 to 0.32); and DOR, 66.96 (95% CI 18.83 to 238.11). The AUC was 0.96. The ascitic cholesterol level is helpful for the diagnosis of MRA. Nevertheless, the results of ascitic cholesterol assays should be interpreted in parallel with the results of traditional tests and clinical information. PMID:26770458

  9. Chylous ascites in a hedgehog (Atelerix albiventris).

    PubMed

    Roh, Yoon-Seok; Kim, Eun-Ju; Cho, Ara; Kim, Min-Su; Cho, Ho-Seong; Lim, Chae Woong; Kim, Bumseok

    2014-12-01

    An African pygmy hedgehog (Atelerix albiventris) was diagnosed as chylous ascites with biliary cirrhosis. Abdomenocentesis revealed a milky fluid with a 324 mg/dl triglyceride level. On serum biochemical examination, the hedgehog had hypoalbuminemia, hypoglycemia, and high blood urea nitrogen. There was no cytologic or genomic evidence of infection, and a blood culture was negative. Histopathologic examination revealed a liver with proliferative bile ducts that were often surrounded by prominent septa of fibrous connective tissue. In the area of ductular reaction, proliferative cells positive for CD66, an embryogenic antigen of epithelial cells, were revealed. The potential association between chylous ascites and liver cirrhosis is undetermined but could be an aspect of future study. This is the first description of chylous ascites in a hedgehog. PMID:25632690

  10. Neonatal Urinary Ascites: A Report of Three Cases

    PubMed Central

    Gajjar, Priya; Nourse, Peter

    2015-01-01

    Urinary ascites in neonates is not a common condition. Three cases of urinary ascites are presented and each of them has a different aetiology. Neonates with urinary ascites usually present as clinical emergency, requiring resuscitation, ventilator support, and subsequent drainage of urine. The ultimate management depends on the site of extravasation and the underlying cause. PMID:25954559

  11. Refractory gastroesophageal reflux disease

    PubMed Central

    Subramanian, Charumathi Raghu; Triadafilopoulos, George

    2015-01-01

    Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms, esophageal injury, and/or complications. Use of proton pump inhibitors (PPI) remains the standard therapy for GERD and is effective in most patients. Those whose symptoms are refractory to PPIs should be evaluated further and other treatment options should be considered, according to individual patient characteristics. Response to PPIs could be total (no symptoms), partial (residual breakthrough symptoms), or absent (no change in symptoms). Patients experiencing complete response do not usually need further management. Patients with partial response can be treated surgically or by using emerging endoscopic therapies. Patients who exhibit no response to PPI need further evaluation to rule out other causes. PMID:25274499

  12. Chylous Ascites after Abdominal Aortic Aneurysm Repair

    PubMed Central

    Ohki, Shinichi; Kurumisawa, Soki

    2015-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  13. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    PubMed

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  14. First case report of chylous ascites after robot-assisted donor nephrectomy.

    PubMed

    Janki, Shiromani; Terkivatan, Türkan; Kimenai, Hendrikus J A N; IJzermans, Jan N M; Tran, T C Khé

    2016-01-01

    We present the first case report of chylous ascites following total robot-assisted donor nephrectomy. A 39-year-old female underwent a transperitoneal left-sided total robot-assisted donor nephrectomy. The procedure was uneventful and the patient was discharged without any symptoms. At postoperative Day 29, the patient presented with abdominal pain, nausea and a distended, painful abdomen with shifting dullness. She was diagnosed with chylous ascites by ultrasonography and puncture analysis, and treated with therapeutic drainage and dietary restriction. After 4 weeks, she was free of symptoms. The occurrence of this complication is rare after donor nephrectomy. Fortunately, the complication can be successfully treated within a few weeks with minimal discomfort for the patient as demonstrated in this case. It is of utmost importance to minimize the risks and limit discomfort for live kidney donors who willingly undergo major surgery to improve the well-being of another individual. PMID:27381018

  15. Benign mesothelial cells in lymph nodes and lymphatic spaces associated with ascites.

    PubMed

    Pizzi, Marco; Valentini, Elisa; Galligioni, Alessandra; Cesaro, Sonia; Pontisso, Patrizia; Da Dalt, Gianfranco; Rugge, Massimo

    2016-07-01

    Intra-nodal mesothelial cells are assumed to be indicative of metastatic mesothelioma. The invasion of benign mesothelial cells into lymph nodes is an extraordinary complication of different (mostly inflammatory) disorders involving the serosal cavities. In a cirrhotic patient with recurrent ascites, this report describes the first case of mesothelial cell spreading into lymphatic vessels, coexisting with non-malignant inclusions of mesothelial cells in multiple abdominal lymph nodes. PMID:26696597

  16. Intravenous albumin infusion is an effective therapy for hyponatraemia in cirrhotic patients with ascites.

    PubMed Central

    McCormick, P A; Mistry, P; Kaye, G; Burroughs, A K; McIntyre, N

    1990-01-01

    The treatment of moderate to severe hyponatraemia in patients with decompensated liver disease is unsatisfactory. We report our preliminary experience using intravenous infusion of albumin to treat this condition. Three patients with cirrhosis, ascites, and hyponatraemia responded satisfactorily to treatment; one patient with fulminant hepatitis B did not respond. Intravenous albumin infusion is a safe and effective therapy for patients with cirrhosis complicated by hyponatraemia. Its main role may be in preparing patients for surgery, particularly liver transplantation. PMID:2311979

  17. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures

    PubMed Central

    Sangisetty, Suma L; Miner, Thomas J

    2012-01-01

    Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites. PMID:22590662

  18. Characterisation of bacteria in ascites--reporting the potential of culture-independent, molecular analysis.

    PubMed

    Rogers, G B; Russell, L E; Preston, P G; Marsh, P; Collins, J E; Saunders, J; Sutton, J; Fine, D; Bruce, K D; Wright, M

    2010-05-01

    Spontaneous bacterial peritonitis (SBP) is a severe complication of liver disease. A significant proportion of patients have culture-negative ascites, despite having similar signs, symptoms and mortality to those with SBP. Therefore, empirical antibiotic treatment for infection is often started without knowledge of the causative organisms. Here, we investigated the potential of molecular techniques to provide rapid and accurate characterisation of the bacteria present in ascitic fluid. Ascites samples were obtained from 29 cirrhotic patients undergoing clinically indicated therapeutic paracentesis. Bacterial content was determined by terminal restriction fragment length polymorphism (T-RFLP) analysis, quantitative polymerase chain reaction (PCR) and 16S ribosomal clone sequence analysis. Bacterial signal was detected in all samples, compared to three out of ten using standard methods. Bacterial loads ranged from 5.5 x 10(2) to 5.4 x 10(7) cfu/ml, with a mean value of 1.9 x 10(6) cfu/ml (standard deviation +/- 9.6 x 10(6) cfu/ml). In all but one instance, bacterial species identified by culture were also confirmed by molecular analyses. Preliminary data presented here suggests that culture-independent, molecular analyses could provide rapid characterisation of the bacterial content of ascites fluid, providing a basis for the investigation of SBP development and allowing early and targeted antibiotic intervention. PMID:20238135

  19. Divergent Selection for Ascites Incidence in Chickens

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chicken lines that were either resistant or susceptible to ascites syndrome were developed by using a hypobaric chamber to induce the disease. Birds were reared in a hypobaric chamber that simulated high altitude by operating under a partial vacuum, which thereby lowered the partial pressure of oxyg...

  20. Spontaneous Resolution of Fetal and Neonatal Ascites after Birth

    PubMed Central

    Abdellatif, Mohamed; Alsinani, Siham; Al-Balushi, Zenab; Al-Dughaishi, Tamima; Abuanza, Mazen; Al-Riyami, Nihal

    2013-01-01

    Fetal ascites is an uncommon abnormality usually reported in relation to non- immunological causes. The prospect for fetal and neonatal mortality is high, particularly when the ascites develops before 24 weeks of gestation. The diminution of severe fetal ascites without intrauterine management, especially with an uncomplicated neonatal outcome, is unusual. We report a case of isolated fetal ascites detected at 20 weeks' gestation. All investigations carried out were normal. Consecutive ultrasound examination showed ascites at 20 weeks’ gestation. A follow-up ultrasound examination at 6 months of age revealed complete recovery from the ascites. Spontaneous resolution of fetal ascites, with a good prognosis, can occur in cases with an idiopathic aetiology. PMID:23573403

  1. Managing complications in cirrhotic patients

    PubMed Central

    Angeli, Paolo; Cordoba, Juan; Farges, Oliver; Valla, Dominique

    2015-01-01

    Liver cirrhosis is a serious and potentially life-threatening condition. This life-threatening condition usually arises from complications of cirrhosis. While variceal bleeding is the most acute and probably best studied, several other complications of liver cirrhosis are more insidious in their onset but nevertheless more important for the long-term management and outcome of these patients. This review summarizes the topics discussed during the UEG-EASL Hepatology postgraduate course of the United European Gastroenterology Week 2013 and discusses emergency surgical conditions in cirrhotic patients, the management of hepatic encephalopathy, ascites and hepatorenal syndrome, coagulation disorders, and liver cancer. PMID:25653862

  2. Portal hypertension and ascites in extramedullary hematopoiesis.

    PubMed

    Amarapurkar, Pooja; Parekh, Sunil; Amarapurkar, Anjali; Amarapurkar, Deepak

    2012-06-01

    Myeloproliferative diseases (MPD) are clonal stem cell disorders which mainly include polycythemia vera (PV), essential thrombocythemia (ET), and idiopathic myelofibrosis (IMF). They are characterized by leucocytosis, thrombocytosis, erythrocytosis, splenomegaly, and bone marrow hypercellularity. This might also result in extramedullary hematopoiesis. Abdominal manifestation has been recognized as a feature of these disorders. Splenomegaly and hepatomegaly are fairly common as opposed to ascites which is rare. The MPDs mainly affect the hepatic circulatory systems. The common hepatic manifestations are Budd-Chiari syndrome (BCS), portal vein thrombosis (PVT), and nodular regenerative hyperplasia. A few other features seen in MPDs are caused by extramedullary hematopoiesis, increased hepatic blood flow, and secondary hemosiderosis from multiple blood transfusions. Portal hypertension is found in up to 7% of patients. We report a case of portal hypertension with ascites in a patient with extramedullary hematopoiesis treated with transjugular intrahepatic portocaval shunt (TIPS). PMID:25755427

  3. Hepatic hydrothorax in the absence of ascites

    PubMed Central

    Sukcharoen, Kittiya; Dixon, Steven; Mangat, Kamarjit; Stanton, Andrew

    2013-01-01

    A previously well 66-year-old woman presented with a recurrent transudative right-sided pleural effusion. A nodular liver with coarse echotexture was demonstrated on ultrasound and subsequent MRI found hepatocellular carcinoma. In the absence of cardiopulmonary disease and significant protein uria, the recurrent pleural effusion was presumed to be hepatic hydrothorax despite the absence of ascites or other clinical features of chronic liver disease. The patient is currently awaiting liver transplantation. PMID:24027255

  4. Ascites syndrome in broilers: physiological and nutritional perspectives.

    PubMed

    Baghbanzadeh, A; Decuypere, E

    2008-04-01

    Broiler chickens are intensively selected for productive traits. The management of these highly productive animals must be optimal to allow their full genetic potential to be expressed. If this is not done, inefficient production and several metabolic diseases such as ascites become apparent. The causes of the ascites are multifactorial but diet and, particularly, interactions between diet, other environmental and genetic factors play an important role. The relatively high heritability estimates for ascites-related traits and the significance of maternal genetic effects for most of the traits indicate that direct and maternal genetic effects play an important role in development of the ascites syndrome. An imbalance between oxygen supply and the oxygen required to sustain rapid growth rates and high food efficiencies causes ascites in broiler chickens. Because of the relationship to oxygen demand, ascites is affected and/or precipitated by factors such as growth rate, altitude (hypoxia) and environmental temperature. As the high metabolic rate (fast growth) is a major factor contributing to the susceptibility of broilers to ascites, early-age feed or nutrient restriction (qualitative or quantitative) or light restriction in order to slow down the growth rate seem practically viable methods, since final body weight is not compromised. Manipulation of the diet composition and/or feed allocation system can have a major effect on the incidence of ascites. Optimization of the house temperature and ventilation in cold weather seem helpful practices to decrease ascites incidence. PMID:18393088

  5. Refractory Thrombocytopenia and Neutropenia: a Diagnostic Challenge

    PubMed Central

    Gyan, Emmanuel; Dreyfus, François; Fenaux, Pierre

    2015-01-01

    The 2008 WHO classification identified refractory cytopenia with unilineage dysplasia (RCUD) as a composite entity encompassing refractory anemia, refractory thrombocytopenia (RT), and refractory neutropenia (RN), characterized by 10% or more dysplastic cells in the bone marrow respective lineage. The diagnosis of RT and RN is complicated by several factors. Diagnosing RT first requires exclusion of familial thrombocytopenia, chronic auto-immune thrombocytopenia, concomitant medications, viral infections, or hypersplenism. Diagnosis of RN should also be made after ruling out differential diagnoses such as ethnic or familial neutropenia, as well as acquired, drug-induced, infection-related or malignancy-related neutropenia. An accurate quantification of dysplasia should be performed in order to distinguish RT or RN from the provisional entity named idiopathic cytopenia of unknown significance (ICUS). Cytogenetic analysis, and possibly in the future somatic mutation analysis (of genes most frequently mutated in MDS), and flow cytometry analysis aberrant antigen expression on myeloid cells may help in this differential diagnosis. Importantly, we and others found that, while isolated neutropenia and thrombocytopenia are not rare in MDS, those patients can generally be classified (according to WHO 2008 classification) as refractory cytopenia with multilineage dysplasia or refractory anemia with excess blasts, while RT and RN (according to WHO 2008) are quite rare. These results suggest in particular that identification of RT and RN as distinct entities could be reconsidered in future WHO classification updates. PMID:25745545

  6. Unilateral pleural effusion without ascites in liver cirrhosis

    SciTech Connect

    Faiyaz, U.; Goyal, P.C.

    1983-09-01

    The source of massive pleural effusion was not apparent in a 58-year-old man who had cirrhosis but no demonstrable ascites. Intraperitoneal injection of technetium Tc 99m sulfur colloid established the presence of peritoneopleural communication. This diagnostic technique can be helpful in evaluating patients with cirrhosis of the liver and pleural effusion with or without ascites.

  7. Synthesis of refractory materials

    DOEpatents

    Holt, Joseph B.

    1984-01-01

    Refractory metal nitrides are synthesized during a combustion process utilizing a solid source of nitrogen. For this purpose, a metal azide is employed. The azide is combusted with a transition metal of the IIIB, IVB group, or a rare earth metal, and ignited to produce the refractory material.

  8. Synthesis of refractory materials

    DOEpatents

    Holt, J.B.

    Refractory metal nitrides are synthesized during a combustion process utilizing a solid source of nitrogen. For this purpose, a metal azide is employed. The azide is combusted with a transition metal of the IIIB, IVB group, or a rare earth metal, and ignited to produce the refractory material.

  9. Development of improved refractories

    SciTech Connect

    Wereszczak, A.A.; Ferber, M.K.; Liu, K.C.; Moore, R.E.

    1997-04-01

    The goal of the proposed project is to provide expertise and facilities for the high temperature mechanical properties characterization of refractory materials which are of interest to the US DOE`s Office of Industrial Technologies Advanced Industrial Materials Project. Initially the project would establish dedicated refractory testing facilities which would be capable of generating representative engineering creep and high temperature modulus of elasticity (MOE) data to a temperature of 3300{degrees}F (1815{degrees}C) in ambient air. The generated engineering creep and MOE data would serve R&D requirements of refractories-manufacturers and its glass-manufacturer end-users and designers. The relevance of this effort to the refractory and glass-making industries would be ensured by coordinating the research activities through a membership with Alfred University`s Center for Glass Research (CGR) Satellite Center at the University of Missouri-Rolla (UMR), an NSF Center. Valid engineering creep and high temperature MOE data currently do not exist for almost all commercial refractories. Refractory end-users such as glass-manufacturers require such data for efficient and economical design of their various glass-melting furnace superstructures (e.g., furnace crowns). Refractories in glass production furnaces may be subjected to extreme temperatures as high as 3200{degrees}F (1760{degrees}C). With the simultaneous imposition of mechanical and thermal stresses, creep deformation of the refractory material will assuredly occur as a consequence. Designers must ensure that the structural integrity is maintained, so these high temperature deformations must be considered for successful glass furnace superstructure design. These criteria can only be satisfied with the utilization of representative engineering creep and high temperature MOE data for the refractory materials that are chosen for the design of the refractory superstructures.

  10. Identification of platelet refractoriness in oncohematologic patients

    PubMed Central

    Ferreira, Aline Aparecida; Zulli, Roberto; Soares, Sheila; de Castro, Vagner; Moraes-Souza, Helio

    2011-01-01

    OBJECTIVES: To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients. INTRODUCTION: Platelet refractoriness (unsatisfactory post-transfusion platelet increment) is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services. METHODS: Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT) and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA). RESULTS: Of the 16 patients evaluated (median age: 53 years), nine (56%) were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43% of the transfusion events, being more frequent in transfusions of random platelet concentrates (54%). Platelet refractoriness was confirmed in three patients (19%), who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50%) by the PIFT and in three (19%) by the PRA-HLA. Among alloimmunized patients, nine (64%) had a history of transfusion, and three as a result of pregnancy (43%). Of the former, two were refractory (29%). No significant differences were observed, probably as a result of the small sample size. CONCLUSION: The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management. PMID:21437433

  11. Portal hypertension complicating myelofibrosis: reversal following splenectomy.

    PubMed Central

    Lukie, B. E.; Card, R. T.

    1977-01-01

    Portal hypertension occurs in approximately 10% of patients with myelofibrosis. Increased portal blood flow secondary to splenomegaly has been proposed to explain its development. In a 60-year-old woman with proven myelofibrosis of 10 years' duration and gross splenomegaly, portal hypertension developed with esophageal varices and ascites. There was no demonstrable obstruction to portal blood flow. Following splenectomy the ascites and esophageal varices disappeared. Despite the presence of splenic myeloid metaplasia, splenectomy did not impair the patient's hematologic status. Portal hypertension complicating myelofibrosis has a poor prognosis, so careful attention should be given to its detection. Splenectomy may be preferable to portal-systemic shunting in the management of this complication. Images FIG. 1 FIG. 2 PMID:907949

  12. CFB refractory repair

    SciTech Connect

    Sur, C.; Nagar, A.; Singh, D.K.; Chakraborty, I.N.

    2006-01-15

    ACC Refractories has provided the refractories of 13 of the 20 circulating fluidized-bed combustion (CFBC) plants in India. If high levels of sulfur oxide gases are generated in India's coal, lignite or pet coke fuelled power plants they can wreak havoc on furnace liners. Calcium sulfate was the most common denominator in failed castable matrices analysed by ACC. To solve the problem, Accplast 80, a phosphate-bonded aluminous plastic has been used successfully. The article gives advice on installation of plastic refractories and on steps to prevent erosion. 10 figs., 1 tab., 4 photos.

  13. A Rare Case of Ascites due to Peritoneal Amyloidosis.

    PubMed

    Stofer, Fernanda; Barretto, Maria Fernanda; Gouvea, Ana Luisa; Ribeiro, Mario; Neves, Marcio; Gismondi, Ronaldo Altenburg; Mocarzel, Luís Otavio

    2016-01-01

    BACKGROUND The clinical manifestations of amyloidosis depend on the type of insoluble protein as well as the location of amyloid deposits in tissues or organs. In the gastrointestinal tract, the small intestine is the most common site of amyloid deposits, whereas peritoneal involvement and ascites are rare. CASE REPORT We report on a case of ascites due to peritoneal amyloidosis. A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators. Despite improvement in pulmonary congestion and peripheral edema, his ascites was not reduced. Echocardiogram revealed restrictive cardiomyopathy and a speckle-tracking pattern suggestive of cardiac amyloidosis. Subcutaneous and peritoneal biopsies revealed amyloidosis. CONCLUSIONS Amyloidosis is rare in the peritoneum and is usually asymptomatic. Ascites occurs in only 20% of patients with peritoneal amyloidosis. We searched PubMed using "ascites" and "amyloidosis" and identified only eight case reports of amyloidosis with ascites. Physicians should be particularly careful in heart failure and anasarca cases when ascites is disproportional or not responsive to diuretic treatment. To date, there is no specific treatment for peritoneal amyloidosis. PMID:27353538

  14. Ascites in broilers. 1. Experimental factors evoking symptoms related to ascites.

    PubMed

    Scheele, C W; De Wit, W; Frankenhuis, M T; Vereijken, P F

    1991-05-01

    Male broilers of two genetically related stocks with divergent growth rates and feed conversion ratios were used to study metabolic backgrounds on the occurrence of pulmonary hypertension, heart failure, hypoxemia, and ascites in poultry. An experiment with a 2 x 2 x 2 x 2 factorial split-plot arrangement of treatments with 96 groups of 12 broilers was performed. Effects of stock and environmental factors such as ambient temperature, dietary fat, and dietary energy on performance, energy metabolism, oxygen consumption, hematocrit values, and mortality were investigated in broilers from 1 to 5 wk of age. Dissimilar responses of the two stocks to environmental factors reflected genotype by environment interactions and revealed metabolic disorders related to heart failure and ascites. The results indicated that in the stock with the lower feed conversion ratio, a fast protein accretion was achieved together with a reduced ability to convert chemical energy to metabolic heat and to deposit body fat directly from ingested fat. Birds with a low feed conversion ratio show less flexibility in metabolic adaptation to a changing environment, which can account for the development of ascites. PMID:1852684

  15. THERMOCHEMICAL MODELING OF REFRACTORY CORROSION IN SLAGGING COAL GASIFIERS IN SUPPORT OF DEVELOPMENT OF IMPROVED REFRACTORY MATERIAL

    SciTech Connect

    Besmann, Theodore M; Petty, Arthur; Kwong, Kyei-Sing; Powell, Dr. Cynthia; Bennett, Dr. James

    2007-01-01

    Slagging coal gasifiers suffer from significant attack by the coal slag on the refractory liner. To better understand the corrosive attack on the refractory the interactions were thermochemically simulated. The slag is observed to penetrate the refractory, which complicates modeling the phase behavior of the slag-penetrated interior of the refractory. To address this issue a simple strategy was adopted such that step-wise changes in composition with decreasing slag content were assumed to account for the compositional changes as slag penetrates the refractory, at least partially through its thickness. The thermochemical equilibrium calculations following this strategy typically yielded three solution phases as well as the stoichiometric crystalline phases AlPO4, Ca3(PO4)2, and (MgO)(Cr2O3), depending on composition/penetration. In addition, under some conditions a slag liquid miscibility gap exists such that two slag liquids co-exist.

  16. Mucinous borderline ovarian tumor with ascites.

    PubMed

    Batool, Tahira; Ullah, Nasreen Rehmat

    2014-11-01

    Borderline mucinous tumors are epithelial ovarian tumors with low rate of growth and low potential to invade or metastasize and associated with significantly better prognosis and excellent disease-free survival after surgical removal than other epithelial ovarian cancers. The accepted initial treatment is surgical removal of the tumor. Fertility-sparing surgery may suffice in young patients with tumors confined to the ovary. Radical surgery is recommended in patients with advanced disease and advanced age. Long-term surveillance is recommended to document and treat late recurrences. We report a case of a 59 years old postmenopausal patient with complex ovarian mucinous tumor and gross ascites; she had received three lines of chemotherapeutic agents pre-operatively, without any favorable outcome. Then, she went for staging laparotomy and histopathology showed borderline ovarian mucinous tumor required no further treatment and is fine till date. PMID:25518783

  17. Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer

    PubMed Central

    Harding, V; Fenu, E; Medani, H; Shaboodien, R; Ngan, S; Li, H K; Burt, R; Diamantis, N; Tuthill, M; Blagden, S; Gabra, H; Urch, C E; Moser, S; Agarwal, R

    2012-01-01

    Background: Paracentesis for malignant ascites is usually performed as an in-patient procedure, with a median length of stay (LoS) of 3–5 days, with intermittent clamping of the drain due to a perceived risk of hypotension. In this study, we assessed the safety of free drainage and the feasibility and cost-effectiveness of daycase paracentesis. Method: Ovarian cancer admissions at Hammersmith Hospital between July and October 2009 were audited (Stage 1). A total of 21 patients (Stage 2) subsequently underwent paracentesis with free drainage of ascites without intermittent clamping (October 2010–January 2011). Finally, 13 patients (19 paracenteses, Stage 3), were drained as a daycase (May–December 2011). Results: Of 67 patients (Stage 1), 22% of admissions and 18% of bed-days were for paracentesis, with a median LoS of 4 days. In all, 81% of patients (Stage 2) drained completely without hypotension. Of four patients with hypotension, none was tachycardic or symptomatic. Daycase paracentesis achieved complete ascites drainage without complications, or the need for in-patient admission in 94.7% of cases (Stage 3), and cost £954 compared with £1473 for in-patient drainage. Conclusions: Free drainage of malignant ascites is safe. Daycase paracentesis is feasible, cost-effective and reduces hospital admissions, and potentially represents the standard of care for patients with malignant ascites. PMID:22878372

  18. Ovarian hemangioma associated with concomitant stromal luteinization and ascites.

    PubMed

    Yamawaki, T; Hirai, Y; Takeshima, N; Hasumi, K

    1996-06-01

    A 62-year-old female presented with a pelvic mass and ascites. The Papanicolaou vaginal smear showed an unusual maturation, maturation index being 0/80/20. The serum level of estradiol was 48.7 pg/ml. The preoperative checkup suggested a pelvic malignancy with a differential diagnosis of hormone-secreting ovarian tumor. On surgical exploration, she had a hemangioma of the ovary without malignant cytology in the ascitic fluid. Histologically, this tumor was associated with stromal luteinization. This is the first case, reported in the literature, possessing ovarian hemangioma with stromal luteinization accompanying massive ascites. It should be noted that an ovarian hemangioma can be associated with stromal luteinization and ascites, and that MR imaging is sometimes of value for making a preoperative diagnosis of ovarian hemangioma. PMID:8641629

  19. [A simple peritoneovenous shunt in the treatment of chronic ascites].

    PubMed

    Pafko, P; Hladík, P

    2001-02-01

    The authors describe their own initial experience with a peritoneo-venous shunt in otherwise incurable ascites. It is a simple procedure which is more satisfactory than the formerly used technique of implantation of Le Veen's system. PMID:12881921

  20. Palliative treatment of malignant ascites: profile of catumaxomab

    PubMed Central

    Ammouri, Lila; Prommer, Eric E

    2010-01-01

    Malignant ascites is the abnormal accumulation of fluid in the peritoneal cavity associated with several intrapelvic and intra-abdominal malignancies. The development of ascites leads to significant symptoms and poor quality of life for the cancer patient. Available therapies for palliation include treatment of the underlying disease, but when there are no treatment options, the use of diuretics, implantation of drainage catheters, and surgical shunting techniques are considered. None of these symptom palliation options affect the course of disease. The development of trifunctional antibodies, which attach to specific overexpressed surface markers on tumor cells, and trigger an immune response leading to cytoreductive effects, represents a new approach to the management of malignant ascites. The purpose of this review is to highlight current therapies for malignant ascites and review data as to the effectiveness of a new trifunctional antibody, catumaxomab. PMID:20531969

  1. Ascites and other incidental findings revealing undiagnosed systemic rheumatoid arthritis.

    PubMed

    Szeto, Matthew Chak Hin; Disney, Benjamin; Perkins, Philip; Wood, Gordon

    2015-01-01

    We describe a case of a 43-year-old man presenting to the gastroenterology outpatient department with exudative ascites. Mediastinal lymphadenopathy, pericardial effusion and pleural effusion were detected on further imaging. Further clinical examination revealed subcutaneous nodules on the left arm, which were confirmed to be rheumatoid nodules on histology. Inflammatory markers were elevated with positive serology for rheumatoid factor and anticyclic citrullinated protein antibody. Our investigations excluded tuberculosis, pancreatitis and malignancy in the patient. Following review by a rheumatologist, a diagnosis of systemic rheumatoid arthritis (RA) was made. Pleuritis and pericarditis are well recognised as extra-articular manifestation of RA. Ascites, however, is rarely recognised as a manifestation of RA. Our literature search revealed two other cases of ascites due to RA disease activity, and both patients had long-standing known RA. This case adds to the discussion on whether ascites and peritonitis should be classified as extra-articular manifestations of RA. PMID:26055583

  2. Ascites produced in rats without tubercle bacilli or tumor cells.

    PubMed

    Levine, S; Saltzman, A

    1999-01-01

    Intraperitoneal injection of rats with two doses of pertussis vaccine produces a small amount of ascitic fluid. Much larger amounts of fluid are produced when two spaced injections of the vaccine are preceded by a small amount of liquid petrolatum. A similar result is obtained by a single injection of pertussis vaccine emulsified in liquid petrolatum and Arlacel A. Ascites produced without tubercle bacilli or tumor cells may increase the use of rats for antibody production. PMID:10574628

  3. A Rare Case of Ascites due to Peritoneal Amyloidosis

    PubMed Central

    Stofer, Fernanda; Barretto, Maria Fernanda; Gouvea, Ana Luisa; Ribeiro, Mario; Neves, Marcio; Gismondi, Ronaldo Altenburg; Mocarzel, Luís Otavio

    2016-01-01

    Patient: Male, 65 Final Diagnosis: Peritoneal amyloidosis Symptoms: Anasarca • Dyspnea • Orthopnea Medication: — Clinical Procedure: Paracentesis and peritoneal biopsy Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: The clinical manifestations of amyloidosis depend on the type of insoluble protein as well as the location of amyloid deposits in tissues or organs. In the gastrointestinal tract, the small intestine is the most common site of amyloid deposits, whereas peritoneal involvement and ascites are rare. Case Report: We report on a case of ascites due to peritoneal amyloidosis. A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators. Despite improvement in pulmonary congestion and peripheral edema, his ascites was not reduced. Echocardiogram revealed restrictive cardiomyopathy and a speckle-tracking pattern suggestive of cardiac amyloidosis. Subcutaneous and peritoneal biopsies revealed amyloidosis. Conclusions: Amyloidosis is rare in the peritoneum and is usually asymptomatic. Ascites occurs in only 20% of patients with peritoneal amyloidosis. We searched PubMed using “ascites” and “amyloidosis” and identified only eight case reports of amyloidosis with ascites. Physicians should be particularly careful in heart failure and anasarca cases when ascites is disproportional or not responsive to diuretic treatment. To date, there is no specific treatment for peritoneal amyloidosis. PMID:27353538

  4. SINTERED REFRACTORY MASS

    DOEpatents

    Williams, A.E.

    1955-09-01

    A method is given for joining sintered masses of refractory compounds. It consists in maintaining the masses in contact with each other by application of a moderate pressure, while they are at sintering temperature. The sintered masses are subjected to am applied pressure of about 1/2 to 1 ton per square inch of the surface in contact for about 10 minutes, and the temperature employed may be fropn about 1400 deg C to 2000 deg C. Refractory oxides to which the invention may be applied are beryllia, alumina, thoria, and magnesia.

  5. Generation of hydroxyl radicals during ascites experimentally induced in broilers.

    PubMed

    Arab, H A; Jamshidi, R; Rassouli, A; Shams, G; Hassanzadeh, M H

    2006-04-01

    Increased metabolic rates, pulmonary hypertension and cardiac dysfunction are the most important features of the ascites syndrome in broiler chickens. However, the mechanism of cell injury causing the pathogenesis of the syndrome is not clearly understood. Our study aimed to examine the generation of hydroxyl radicals (OH*) in broiler chickens experiencing ascites. The hundred and fifty 1-d-old chickens were purchased from a local hatchery and reared in an open poultry house for 46 d. They were divided at random into three groups and ascites was induced in two groups by exposing them to low temperature or administration of triiodothyronine (T(3)). The third group served as control and was reared normally. Haematological, biochemical and pathological tests were used to determine the incidence of ascites: including total red blood cell (RBC), packed cell volume (PCV), release of alanine transaminase (ALT) and aspartate transaminase (AST) and ratio of right ventricular weight to total ventricular weight (RV/TV). A salicylate hydroxylation method was used to examine the generation of hydroxyl radicals (OH*) in treated groups. TWo hydroxylated salicylic acid metabolites, 2,3- and 2,5-dihydroxy benzoic acid (2,3- and 2,5-DHBA), were measured by HPLC to detect the generation of OH*. An ascites syndrome was observed in T(3) and low-temperature treated groups, as shown by necropsy changes and increases in f RBC, PCV, ALT, AST and the ratio of RV/TV. Concentrations of 2,3- and 2,5-DHBA were increased in groups experiencing ascites compared to control group. It is suggested that reactive oxygen species that is OH* ions, may be involved in the pathogenesis of the ascites syndrome in broiler chickens. PMID:16641033

  6. Changes in gut bacterial populations and their translocation into liver and ascites in alcoholic liver cirrhotics

    PubMed Central

    2014-01-01

    Background The liver is the first line of defence against continuously occurring influx of microbial-derived products and bacteria from the gut. Intestinal bacteria have been implicated in the pathogenesis of alcoholic liver cirrhosis. Escape of intestinal bacteria into the ascites is involved in the pathogenesis of spontaneous bacterial peritonitis, which is a common complication of liver cirrhosis. The association between faecal bacterial populations and alcoholic liver cirrhosis has not been resolved. Methods Relative ratios of major commensal bacterial communities (Bacteroides spp., Bifidobacterium spp., Clostridium leptum group, Enterobactericaea and Lactobacillus spp.) were determined in faecal samples from post mortem examinations performed on 42 males, including cirrhotic alcoholics (n = 13), non-cirrhotic alcoholics (n = 15), non-alcoholic controls (n = 14) and in 7 healthy male volunteers using real-time quantitative PCR (RT-qPCR). Translocation of bacteria into liver in the autopsy cases and into the ascites of 12 volunteers with liver cirrhosis was also studied with RT-qPCR. CD14 immunostaining was performed for the autopsy liver samples. Results Relative ratios of faecal bacteria in autopsy controls were comparable to those of healthy volunteers. Cirrhotics had in median 27 times more bacterial DNA of Enterobactericaea in faeces compared to the healthy volunteers (p = 0.011). Enterobactericaea were also the most common bacteria translocated into cirrhotic liver, although there were no statistically significant differences between the study groups. Of the ascites samples from the volunteers with liver cirrhosis, 50% contained bacterial DNA from Enterobactericaea, Clostridium leptum group or Lactobacillus spp.. The total bacterial DNA in autopsy liver was associated with the percentage of CD14 expression (p = 0.045). CD14 expression percentage in cirrhotics was significantly higher than in the autopsy controls (p = 0

  7. Dynamic Testing of Gasifier Refractory

    SciTech Connect

    Michael D. Mann; Wayne S. Seames; Devdutt Shukla; Xi Hong; John P. Hurley

    2005-12-01

    The University of North Dakota (UND) Chemical Engineering Department in conjunction with the UND Energy & Environmental Research Center (EERC) have initiated a program to examine the combined chemical (reaction and phase change) and physical (erosion) effects experienced by refractory materials under slagging coal gasification conditions. The goal of this work is to devise a mechanism of refractory loss under these conditions. The controlled-atmospheric dynamic corrodent application furnace (CADCAF) was utilized to simulate refractory/slag interactions under dynamic conditions that more realistically simulate the environment in a slagging coal gasifier than any of the static tests used previously by refractory manufacturers and researchers. High-alumina and high-chromia refractory bricks were tested using slags obtained from two solid fuel gasifiers. Testing was performed at 1475 C in a reducing atmosphere (2% H{sub 2} in N{sub 2}) The CADCAF tests show that high-chrome refractories have greater corrosion resistance than high-aluminum refractories; coal slag readily diffuses into the refractory through its grain boundaries; the refractory grains are more stable than the matrix in the tests, and the grains are the first line of defense against corrosion; calcium and alkali in the slag are more corrosive than iron; and silicon and calcium penetrate the deepest into the refractory. The results obtained from this study are preliminary and should be combined with result from other research programs. In particular, the refractory corrosion results from this study should be compared with refractories removed from commercial gasifiers.

  8. Refractory ceramic fibers

    Integrated Risk Information System (IRIS)

    Refractory ceramic fibers ; CASRN Not found Human health assessment information on a chemical substance is included in the IRIS database only after a comprehensive review of toxicity data , as outlined in the IRIS assessment development process . Sections I ( Health Hazard Assessments for Noncarcino

  9. THERMOCHEMICAL MODELING OF REFRACTORY CORROSION IN SLAGGING COAL GASIFIERS

    SciTech Connect

    Besmann, Theodore M

    2008-01-01

    Slagging coal gasifiers suffer corrosive attack on the refractory liner and these interactions were thermochemically simulated. The slag is observed to penetrate the refractory, which complicates modeling the phase behavior of the slag-penetrated interior of the refractory. A simple strategy was adopted such that step-wise changes in composition with decreasing slag content were assumed to account for the compositional changes as slag penetrates the refractory. The thermochemical equilibrium calculations following this strategy typically yielded three solution phases as well as the stoichiometric crystalline phases AlPO4 and Ca3(PO4)2 depending on composition/penetration. Under some conditions a slag liquid miscibility gap exists such that two slag liquids co-exist.

  10. A novel treatment for refractory plantar fasciitis.

    PubMed

    Patel, Mihir M

    2015-03-01

    Chronic plantar fasciitis is a major health care problem worldwide and affects nearly 10% of the US population. Although most cases resolve with conservative care, the numerous treatments for refractory plantar fasciitis attest to the lack of consensus regarding these cases. The emerging goals for this condition are a minimally invasive percutaneous intervention that is safe, effective, and well-tolerated and has minimal morbidity and a low complication rate. We conducted a prospective study in which patients were allowed either to continue with noninvasive treatment or to undergo focal aspiration and partial fasciotomy with an ultrasonic probe. This is the first report of a plantar fascia partial release guided by ultrasonic energy delivered by a percutaneously inserted probe under local anesthesia. The procedure appears to be a safe, effective, well-tolerated treatment for a condition that is refractory to other options. PMID:25750942

  11. Endoscopic Treatment of Refractory Gastroesohageal Reflux Disease

    PubMed Central

    Kim, Won Hee; Park, Pil Won; Hahm, Ki Baik

    2013-01-01

    Though efficient acid suppression with proton pump inhibitors (PPIs) remains the mainstay of treatment of gastroesophageal reflux disease (GERD), some of the patients showed refractory response to PPIs, necessitating further intervention. After increasing dose of PPIs and other kinds of pharmacological intervention adopting prokinetics or others, variable endoscopic treatments are introduced for the treatment of these refractory cases. The detailed introduction regarding endoscopic treatment for GERD is forwarded in this review article. Implantation of reabsorbable or synthetic materials in the distal esophagus was tried in vain and is expelled from the market due to limited efficacy and serious complication. Radiofrequency energy delivery (Stretta) and transoral incisionless fundoplication (EsophyX) are actively tried currently. PMID:23767031

  12. The effect of abdominal massage in reducing malignant ascites symptoms.

    PubMed

    Wang, Tsae-Jyy; Wang, Hung-Ming; Yang, Tsai-Sheng; Jane, Sui-Whi; Huang, Tse-Hung; Wang, Chao-Hui; Lin, Yi-Hsin

    2015-02-01

    As many as 50% of end-stage cancer patients will develop ascites and associated symptoms, including pain, tiredness, nausea, depression, anxiety, drowsiness, loss of appetite, dyspnea, perceived abdominal bloating, and immobility. Abdominal massage may stimulate lymph return to the venous system and reduce ascites-related symptoms. The purpose of this study was to test the effect of abdominal massage in reducing these symptoms and reducing ascites itself as reflected in body weight. For a randomized controlled design using repeated measures, a sample of 80 patients with malignant ascites was recruited from gastroenterology and oncology units of a medical center in northern Taiwan and randomly assigned to the intervention or the control group. A 15-minute gentle abdominal massage, using straight rubbing, point rubbing, and kneading, was administered twice daily for 3 days. The control group received a twice-daily 15-minute social interaction contact with the same nurse. Symptoms and body weight were measured in the morning for 4 consecutive days from pre- to post-test. In generalized estimation equation modeling, a significant group-by-time interaction on depression, anxiety, poor wellbeing, and perceived abdominal bloating, indicated that abdominal massage improved these four symptoms, with the greatest effect on perceived bloating. The intervention had no effect on pain, tiredness, nausea, drowsiness, poor appetite, shortness of breath, mobility limitation, or body weight. Abdominal massage appears useful for managing selected symptoms of malignant ascites. PMID:25558030

  13. A case of chronic lymphocytic leukemia with massive ascites

    PubMed Central

    Yonal, Ipek; Nazlıgul, Esra; Tas, Gulsum; Agan, Mehmet Ramazan; Yenerel, Mustafa Nuri; Nalcaci, Meliha

    2012-01-01

    An 81-year old woman with a history of chronic lymphocytic leukemia (CLL) was admitted with night sweats and abdominal distension. A complete blood count showed hemoglobin 5 g/dL, white blood cell (WBC) count 28.5×109/L and platelets 38.4×109/L. Peripheral blood smear examination showed a large number of smudge cells and lymphocytosis composed of mature-looking lymphocytes with clumped nuclear chromatin. Computed tomography scan demonstrated enlarged cervical, axillary, paraaortic, retroperitoneal and mesenteric lymph nodes with concomitant omental thickening and ascites. Also, the liver and the spleen were enlarged in the presence of multiple ill-defined hypoechoic areas in the latter. Histopathological analysis of the cervical lymph node biopsy was consistent with CLL. Bone marrow examination showed diffuse infiltration of the marrow with small lymphocytes. Analysis of the ascitic fluid revealed an exudate with WBC 1220 cells/mL. Cytocentrifuge preparation of the ascitic fluid showed small mature lymphoid cells containing hyperchromatic nuclei with coarsely granular chromatin. On flow cytometric analysis of the ascitic fluid, expression of CD5, CD19, CD20, CD22, CD23, CD45 and HLA-DR was compatible with a diagnosis of CLL, in accordance with the results of the peripheral blood analysis. The patient was treated with chemotherapy consisting of cyclophosphamide, vincristine and prednisolone but died within one month after development of non-chylous ascites. PMID:23372915

  14. Eosinophilic ascites, as a rare presentation of eosinophilic gastroenteritis

    PubMed Central

    Cuko, L; Bilaj, F; Bega, B; Barbullushi, A; Resuli, B

    2014-01-01

    Background: Eosinophilic ascites is the most unusual presentation of eosinophilic gastroenteritis (EGE), caused by edema and eosinophilic inflammation of the small bowel wall's serosal layer. Case Report: We report the case of a 37-year-old woman, who presented with diffuse abdominal pain, nausea, abdominal distension, moderate ascites and diarrhea of two weeks duration. The rest of physical and clinical examination was unremarkable, and her past medical history was uneventful. Magnetic Resonance Imaging showed the presence of ascites and diffuse thickening of small bowel wall, but did not detect a primary malignancy in the abdominal cavity; and no signs of portal hypertension or liver damage. Laboratory test results revealed essential peripheral blood eosinophilia, elevated serum IgE and marked increase of eosinophils in the abdominal fluid. Treatment with corticosteroids normalized laboratory tests results, and the ascites resolved immediately. Conclusions: EGE is a rare entity and it should be kept in mind in patients of unexplained ascites. The absence of primary malignancy on imaging, coupled with marked increase of fluid esinophilia and immediate response to treatment with steroids, confirm indirectly the diagnosis of EGE. Hippokratia 2014; 18 (3): 275-277. PMID:25694765

  15. Optic chiasm glioma, electrolyte abnormalities, nonobstructive hydrocephalus and ascites.

    PubMed

    Shuper, A; Horev, G; Michovitz, S; Korenreich, L; Zaizov, R; Cohen, I J

    1997-07-01

    A 4-year-old girl with optic chiasm glioma (OCG), nonobstructive hydrocephalus and ventriculoperitoneal shunt is described, in whom marked ascites developed. The ascitic fluid was protein-rich and its amount correlated with cerebrospinal fluid (CSF) protein. The CSF protein level and the amount of ascitic fluid were influenced by chemotherapy. Very unusual hypernatremia, up to 190 mEq/l with no associated alteration in mental status, was also found. It is suggested that altered absorption ability owing to the high protein content was the cause of both the nonobstructive hydrocephalus and the ascites. The unusual well being with very high sodium concentrations may have resulted from osmoreceptor dysfunction, presumably caused by hypothalamic involvement as well as by the high CSF protein. This combination of findings may point toward specific characteristics of OCG. In an effort to reduce the amount of the ascitic fluid, a further chemotherapeutic trial may be done, before converting the shunt to the vetriculoatrial system. PMID:9142203

  16. Observations on the mechanism and location of ascites reabsorption in man

    SciTech Connect

    Rector, W.G. Jr.; Ibarra, F.

    1987-04-01

    Animal data indicate that ascites is reabsorbed by a lymphatic mechanism and that these vessels are subdiaphragmatic in location. We evaluated the relative role of lymphatics in ascites reabsorption in man by comparing the ascites clearance and plasma appearance rates of intraperitoneally injected radiolabeled albumin to those of intraperitoneally injected labeled autologous red blood cells, which require, owing to their large size, lymphatic removal, in patients with cirrhosis and ascites. To evaluate the location of reabsorption, we repeated these measurements after replacing ascites in the subdiaphragmatic region with 500-1000 ml of intraperitoneally injected air, reasoning that this maneuver should slow or eliminate ascites reabsorption occurring at this site. We found that the transfer rates of albumin and red cells out of ascites were similar and that creation of pneumoperitoneum did not influence these rates. These data confirm that ascites protein reabsorption occurs via a lymphatic mechanism in man. They suggest, however, that these vessels may not be subdiaphragmatic in location.

  17. The Interstitial Lymphatic Peritoneal Mesothelium Axis in Portal Hypertensive Ascites: When in Danger, Go Back to the Sea

    PubMed Central

    Aller, M. A.; Prieto, I.; Argudo, S.; de Vicente, F.; Santamaría, L.; de Miguel, M. P.; Arias, J. L.; Arias, J.

    2010-01-01

    Portal hypertension induces a splanchnic and systemic low-grade inflammatory response that could induce the expression of three phenotypes, named ischemia-reperfusion, leukocytic, and angiogenic phenotypes.During the splanchnic expression of these phenotypes, interstitial edema, increased lymph flow, and lymphangiogenesis are produced in the gastrointestinal tract. Associated liver disease increases intestinal bacterial translocation, splanchnic lymph flow, and induces ascites and hepatorenal syndrome. Extrahepatic cholestasis in the rat allows to study the worsening of the portal hypertensive syndrome when associated with chronic liver disease. The splanchnic interstitium, the mesenteric lymphatics, and the peritoneal mesothelium seem to create an inflammatory pathway that could have a key pathophysiological relevance in the production of the portal hypertension syndrome complications. The hypothetical comparison between the ascitic and the amniotic fluids allows for translational investigation. From a phylogenetic point of view, the ancestral mechanisms for amniotic fluid production were essential for animal survival out of the aquatic environment. However, their hypothetical appearance in the cirrhotic patient is considered pathological since ultimately they lead to ascites development. But, the adult human being would take advantage of the potential beneficial effects of this “amniotic-like fluid” to manage the interstitial fluids without adverse effects when chronic liver disease aggravates. PMID:21152120

  18. Cirrhosis and its complications: Evidence based treatment

    PubMed Central

    Nusrat, Salman; Khan, Muhammad S; Fazili, Javid; Madhoun, Mohammad F

    2014-01-01

    Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease. It is among the ten leading causes of death in United States. Cirrhosis can result in portal hypertension and/or hepatic dysfunction. Both of these either alone or in combination can lead to many complications, including ascites, varices, hepatic encephalopathy, hepatocellular carcinoma, hepatopulmonary syndrome, and coagulation disorders. Cirrhosis and its complications not only impair quality of life but also decrease survival. Managing patients with cirrhosis can be a challenge and requires an organized and systematic approach. Increasing physicians’ knowledge about prevention and treatment of these potential complications is important to improve patient outcomes. A literature search of the published data was performed to provide a comprehensive review regarding the management of cirrhosis and its complications. PMID:24833875

  19. Development of chylous ascites in an infant with ventricular septal defect: a case report.

    PubMed

    Ootaki, Yoshio; Verghese, George R; Ungerleider, Ross M

    2016-08-01

    This case report describes chylous ascites associated with a CHD in a 4-month-old infant. Although atraumatic chylous ascites are a rare clinical finding, the recognition and treatment of chylous ascites influence the timing of cardiac surgery. PMID:27246265

  20. Protein-losing enteropathy associated with refractory systemic lupus erythematosus with a good response to rituximab.

    PubMed

    Sansinanea, Pierina; Carrica, Sebastián Augusto; Marcos, Josefina; García, Mercedes Argentina

    2016-01-01

    A case is presented of a protein-losing enteropathy (PLE) as the initial manifestation of systemic lupus erythematosus (SLE) in a 17 year-old female patient, who presented with ascites, edema and hypoalbuminemia. The diagnosis of SLE was based on the presence of: malar rash, oral ulcers, thrombocytopenia, antinuclear antibodies, IgM anticardiolipin antibody, and lupus anticoagulant. Renal and liver diseases were ruled out. The PLE diagnosis was confirmed with fecal alpha 1-antitrypsin clearance. The PLE was refractory to different lines of immunosuppressive agents like glucocorticoids, cyclophosphamide, azathioprine, and cyclosporine, showing a satisfactory and sustained response with rituximab, allowing steroid sparing and long term remission. PMID:25818375

  1. [Chylous ascites following radical nephrectomy and retroperitoneal lymphadenectomy].

    PubMed

    Rodríguez Alonso, Andrés; González Blanco, Alfonso; Barbagelata López, Alfonso; Bonelli Martín, Carlos; Fernández López, María; Cuerpo Pérez, Miguel A

    2009-02-01

    Chylous ascites consists of the accumulation of chyle in the abdominal cavity. Postoperative presentation develops as a consequence of unrecognized injury of cisterna chyli or one of its major lumbar tributaries. It usually present as abdominal distention and pain or drainage of milky fluid from surgical wound or abdominal drain. Diagnosis is established by cytochemical analysis of fluid and staining with Sudan III, that shows fat globules, leukocytes with lymphocytic predominance and a high triglyceride content. We present a case of postoperative chylous ascites following radical nephrectomy and retroperitoneal lymphadenectomy for renal cancer, which successfully respond to conservative measures: total parenteral nutrition and octreotide. PMID:19418845

  2. Catalytic, hollow, refractory spheres

    NASA Technical Reports Server (NTRS)

    Wang, Taylor G. (Inventor); Elleman, Daniel D. (Inventor); Lee, Mark C. (Inventor); Kendall, Jr., James M. (Inventor)

    1987-01-01

    Improved, heterogeneous, refractory catalysts are in the form of gas-impervious, hollow, thin-walled spheres (10) suitable formed of a shell (12) of refractory such as alumina having a cavity (14) containing a gas at a pressure greater than atmospheric pressure. The wall material may be itself catalytic or a catalytically active material coated onto the sphere as a layer (16), suitably platinum or iron, which may be further coated with a layer (18) of activator or promoter. The density of the spheres (30) can be uniformly controlled to a preselected value within .+-.10 percent of the density of the fluid reactant such that the spheres either remain suspended or slowly fall or rise through the liquid reactant.

  3. Quantum dot-based multiplexed imaging in malignant ascites: a new model for malignant ascites classification

    PubMed Central

    Zeng, Wei-Juan; Peng, Chun-Wei; Yuan, Jing-Ping; Cui, Ran; Li, Yan

    2015-01-01

    Purpose The aims of this study are to establish a new method for simultaneously detecting the interactions between cancer cells and immunocytes in malignant ascites (MA) and to propose a new model for MA classification. Methods A quantum dot (QD)-based multiplexed imaging technique was developed for simultaneous in situ imaging of cancer cells, lymphocytes, and macrophages. This method was first validated in gastric cancer tissues, and then was applied to MA samples from 20 patients with peritoneal carcinomatosis from gastrointestinal and gynecological origins. The staining features of MA and the interactions between cancer cells and immunocytes in the ascites were further analyzed and correlated with clinical features. Results The QD-based multiplexed imaging technique was able to simultaneously show gastric cancer cells, infiltrating macrophages, and lymphocytes in tumor tissue, and the technique revealed the distinctive features of the cancer tumor microenvironment. When this multiplexed imaging protocol was applied to MA cytology, different features of the interactions and quantitative relations between cancer cells and immunocytes were observed. On the basis of these features, MA could be classified into immunocyte-dominant type, immunocyte-reactive type, cancer cell-dominant type, and cell deletion type; the four categories were statistically different in terms of the ratio of cancer cells to immunocytes (P<0.001). Moreover, in the MA, the ratio of cancer cells to immunocytes was higher for patients with gynecological and gastric cancers than for those with colorectal cancer. Conclusion The newly developed QD-based multiplexed imaging technique was able to better reveal the interactions between cancer cells and immunocytes. This advancement allows for better MA classification and, thereby, allows for treatment decisions to be more individualized. PMID:25784803

  4. Does Artificial Ascites Induce the Heat-Sink Phenomenon during Percutaneous Radiofrequency Ablation of the Hepatic Subcapsular Area?: an in vivo Experimental Study Using a Rabbit Model

    PubMed Central

    Kim, Young-sun; Choi, Dongil; Lim, Hyo K.

    2009-01-01

    Objective To evaluate the effect of the heat-sink phenomenon induced by artificial ascites on the size of the ablation zone during percutaneous radiofrequency (RF) ablation of the hepatic subcapsular area in an in vivo rabbit model. Materials and Methods A total of 21 percutaneous rabbit liver RF ablations were performed with and without artificial ascites (5% dextrose aqueous solution). The rabbits were divided into three groups: a) control group (C, n = 7); b) room temperature ascites group (R, n = 7); and c) warmed ascites group (W, n = 7). The tip of a 1 cm, internally cooled electrode was placed on the subcapsular region of the hepatic dome via ultrasound guidance, and ablation was continued for 6 min. Changes in temperature of the ascites were monitored during the ablation. The size of the ablation zones of the excised livers and immediate complications rates were compared statistically between the groups (Mann-Whitney U test, Kruskal-Wallis test, linear-by-linear association, p = 0.05). Results One rabbit from the "W" group expired during the procedure. In all groups, the ascites temperatures approached their respective body temperatures as the ablations continued; however, a significant difference in ascites temperature was found between groups "W" and "R" throughout the procedures (39.2±0.4℃ in group W and 33.4±4.3℃ in group R at 6 min, p = 0.003). No significant difference was found between the size of the ablation zones (782.4±237.3 mL in group C, 1,172.0±468.9 mL in group R, and 1,030.6±665.1 mL in group W, p = 0.170) for the excised liver specimens. Diaphragmatic injury was identified in three of seven cases (42.9%) upon visual inspection of group "C" rabbits (p = 0.030). Conclusion Artificial ascites are not likely to cause a significant heat-sink phenomenon in the percutaneous RF ablation of the hepatic subcapsular region. PMID:19182502

  5. Refractory plasmonics (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Guler, Urcan; Boltasseva, Alexandra; Shalaev, Vladimir M.

    2016-04-01

    The use of plasmonic effects over a broad range of electromagnetic spectrum has been a challenge over the first few decades of research due to limited number of available materials. Recently, the efforts in the area has been concentrated on identifying and examining new material classes as the building blocks for optical technologies over a broader electromagnetic spectrum. Transition metal nitrides attract attention as plasmonic materials in the visible and infrared spectral regions with optical properties resembling gold. As refractory materials, nitrides can withstand heat induced physical phenomena as well as aggressive chemical environment. Adjustable dielectric permittivity of plasmonic nitrides allow fine tuning of optical properties for selected applications. In addition to favorable optical, physical and chemical properties; transition metal nitrides provide CMOS- and bio-compatibility. In this talk, novel designs and concepts based on refractory plasmonic materials for infrared applications will be presented. Additionally, light confinement at the nanoscale with refractory plasmonic antennas, spectral engineering of absorption and emission with metamaterials, and the use of colloidal solutions for a variety of applications will be discussed.

  6. Refractory leg ulcers associated with Klinefelter syndrome.

    PubMed

    Yabuno, Yuto; Tosa, Mamiko; Iwakiri, Itaru; Nomoto, Shunichi; Kaneko, Mayuko; Kuwahara, Kousuke; Hyakusoku, Hiko; Murakami, Masahiro

    2015-01-01

    We present a man with refractory leg ulcers, bilateral varicosis of the lower extremities, and Buerger disease. Autoimmune work-up was negative. However, chromosome analysis showed Klinefelter syndrome (48 XXY). Ulcerative lesions of the lower extremities are a complication of Klinefelter syndrome. To date, the pathogenesis of ulcers in Klinefelter syndrome has not been clarified, but several factors, such as abnormalities of fibrinolysis and prothrombotic states, might be involved. Our present case emphasizes the importance of considering Klinefelter syndrome in the differential diagnosis of a male patient with nonhealing ulcers of the lower extremities. PMID:25797879

  7. Refractories Keep Silicon Crystals Pure

    NASA Technical Reports Server (NTRS)

    Schmid, F.; Khattak, C. P.

    1982-01-01

    Formation of carbon monoxide gas is prevented by a linear of refractory material free of elemental carbon. For pressures above about 4 torr, silicon carbide can be used as refractory liner. The problem of carbide contamination can arise in crystal growth of any material that forms a carbide more stable than carbon monoxide. Prevention in such cases is possible by using noncarbon refractories in place of graphite.

  8. Increased calcium deposits and decreased Ca2+ -ATPase in erythrocytes of ascitic broiler chickens.

    PubMed

    Li, Kai; Zhao, Lihong; Geng, Guangrui; Ma, Liqin; Dong, Shishan; Xu, Tong; Wang, Jianlin; Wang, Huiyu; Tian, Yong; Qiao, Jian

    2011-06-01

    The decrease of erythrocyte deformability may be one of the predisposing factors for pulmonary hypertension and ascites in broiler chickens. In mammals, the cytoplasmic calcium is a major regulator of erythrocyte deformability. In this study, the erythrocyte deformability was measured, and the precise locations of Ca2+ and Ca2+ -ATPase in the erythrocytes were investigated in chickens with ascites syndrome induced by low ambient temperature. The results showed that ascitic broilers had higher filtration index of erythrocyte compared with control groups, indicating a decrease in erythrocyte deformability in ascitic broilers. The more calcium deposits were observed in the erythrocytes of ascitic broilers compared with those of the age-matched control birds. The Ca2+ -ATPase reactive grains were significantly decreased on the erythrocyte membranes of ascitic broilers. Our data suggest that accumulation of intracellular calcium and inhibition of Ca2+ -ATPase might be important factors for the reduced deformability of the erythrocytes of ascitic broilers. PMID:20728193

  9. Analysis of morphological markers of chromosomal instability in ascitic fluid.

    PubMed

    Tyagi, Ruchita; Dey, Pranab; Uppal, Radha; Rajwanshi, Arvind

    2015-10-01

    Chromosomal instability (CI) plays a major role in the carcinogenesis. Micronuclei, nuclear budding, chromatin bridges,and multipolar mitoses are the morphological markers of CI and have never been studied in routine cytological specimens. Aims of the study is to analyze the significance of morphological markers of CI in malignant and benign ascitic fluid smears. A total of sixty benign and 40 malignant ascitic fluid samples were selected for this study. All the cases with malignant ascitic fluid showed histopathological evidence of malignancy in ovary and omentum. Chromatin bridges, multipolar mitosis (MPM), micronuclei and nuclear budding were counted in 1000 cells in representative May Grunwald Giemsa (MGG) stained smears. The CI markers were correlated with the cytological diagnosis of effusion. The mean number of micronuclei, nuclear budding, chromatin bridge and multipolar mitoses found in malignant effusions were 13.2611.79, 10.1067.07, 2.5362.67, 1.964.5, respectively. The mean number of micronuclei, nuclear budding, anaphase bridges, and MPM found in benign effusion cases were 0.566761.07934, 0.516761.33, 0.66760.25, and 0, respectively. The student t test showed significant differences between malignant and benign ascitic fluid samples for each marker of CI. This is the first comprehensive study of morphological markers of CI in ascitic fluid smears. This study has shown strong correlation between markers of CI and cytological diagnosis of malignancy. In future, the knowledge of these markers can be applied to diagnose malignancy in suspected cases of effusion in difficult situations. PMID:25611316

  10. Reduction of ascites mortality in broilers by coenzyme Q10.

    PubMed

    Geng, A L; Guo, Y M; Yang, Y

    2004-09-01

    Effects of coenzyme Q10 (CoQ10) supplementation on growth performance and ascites were studied in broilers. One hundred eighty 1-d-old Arbor Acre male broiler chicks were randomly allocated into 3 groups with 6 replicates each. From d 8, the diets were supplemented with CoQ10 at levels of 0, 20, and 40 mg/kg, respectively. From d 15 to 21, all the chicks were exposed to low ambient temperature (15 to 18 degrees C) to induce ascites. Average feed intake, BW gain, and feed conversion ratio of the broilers during 0 to 3 wk, 3 to 6 wk, and 0 to 6 wk were measured. The results showed that there were no influences observed on broilers' growth performance, but the mortality due to ascites was reduced by CoQ10 supplementation (P < or = 0.05). Erythrocyte osmotic fragility (EOF) was significantly decreased by 40 mg/kg CoQ10 compared with the control, but no significant changes were observed on blood packed cell volume (PCV) among the treatments. Pulmonary arterial diastolic pressure was significantly decreased on d 36, but no significant changes were observed on right ventricular pressure (RVP), pulmonary arterial systolic pressure, and the maximum change ratio of right intraventricular pressure (+/- dp/ dtmax). Ascites heart index (AHI) was significantly decreased by 40 mg/kg CoQ10 supplementation (P < or = 0.05). The results of this study suggested that CoQ10 has a beneficial effect in reducing ascites mortality in broilers, and 40 mg/kg CoQ10 seems to be more effective than 20 mg/ kg CoQ10. PMID:15384911

  11. Pericardiectomy for Pleuropericardial Effusion Complicating Bacterial Pneumonia

    PubMed Central

    Quarti, Andrea; de Benedictis, Fernando Maria; Soura, Elli; Pozzi, Marco

    2010-01-01

    Severe pericardial effusion is a rare complication of bacterial pneumonia and it usually disappears under medical treatment. Herein we report a case of a girl with a congenital immunodeficient syndrome and bacterial pneumonia, who developed recurrent and life-threatening pericardial effusion refractory to medical treatment. She was finally treated with pericardiectomy. PMID:20585369

  12. [The refractory glaucomas].

    PubMed

    Valtot, F

    2003-10-01

    Refractory types of glaucoma continue to present a therapeutic challenge to ophthalmologists. Approaches toward the management of these difficult glaucomas are addressed in this paper. The first part devotes special attention to understand the cause(s) of the failure of previous filtering surgery(ies). The next part emphasizes filtration surgery with intraoperative application of antimetabolites: 5-fluorouracil or mitomycin C and the surgical and pharmacological management of failing filtration. In case of failure of multiple filtering surgery with application of antimetabolites, surgeons have to consider cyclodestructive procedures (transscleral diode laser or endoscopic cyclophotocoagulation) to reduce aqueous production, or fistulizing procedures with tube implants or other drainage devices (valves). PMID:14646834

  13. Synthesis of refractory materials

    DOEpatents

    Holt, J.B.

    1983-08-16

    Refractory metal nitrides are synthesized during a self-propagating combustion process utilizing a solid source of nitrogen. For this purpose, a metal azide is employed, preferably NaN/sub 3/. The azide is combusted with Mg or Ca, and a metal oxide is selected from Groups III-A, IV-A, III-B, IV-B, or a rare earth metal oxide. The mixture of azide, Ca or Mg and metal oxide is heated to the mixture's ignition temperature. At that temperature the mixture is ignited and undergoes self-sustaining combustion until the starter materials are exhausted, producing the metal nitride.

  14. Synthesis of refractory materials

    DOEpatents

    Holt, Joseph B.

    1984-01-01

    Refractory metal nitrides are synthesized during a self-propagating combustion process utilizing a solid source of nitrogren. For this purpose, a metal azide is employed, preferably NaN.sub.3. The azide is combusted with Mg or Ca, and a metal oxide is selected from Groups III-A, IV-A, III-B, IV-B, or a rare earth metal oxide. The mixture of azide, Ca or Mg and metal oxide is heated to the mixture's ignition temperature. At that temperature the mixture is ignited and undergoes self-sustaining combustion until the starter materials are exhausted, producing the metal nitride.

  15. Growth rate of ascites-resistant versus ascites-susceptible broilers in commercial and experimental lines.

    PubMed

    Druyan, S; Hadad, Y; Cahaner, A

    2008-05-01

    The high growth rate (GR) of contemporary broilers is driven by high rate of feed intake and metabolism. Because of the consequent high oxygen demand, especially when coupled with exposure to high altitude or low temperatures, some broilers fail to regulate oxygen supply and develop the ascites syndrome (AS), which leads to mortality and economic losses. Because of the association between high GR, oxygen demand, and AS, it has been suggested that AS is induced by high GR. If true, further GR enhancement should be avoided because it will increase the proportion of AS-susceptible individuals in contemporary stocks. An alternative hypothesis claims that AS is associated with high actual GR only because the latter increases oxygen demand and that there are genetically AS-resistant broilers that do not develop AS, even when exhibiting high GR. These hypotheses were tested in trials in the years 2002 and 2006, with broilers differing in potential GR: contemporary fast-growing commercial lines and an experimental line derived from commercial broilers in 1986, and (in 2002 only) divergently selected AS-susceptible and AS-resistant lines. A protocol of high-challenge ascites-inducing conditions (AIC) from d 19 was used to distinguish between AS-susceptible and AS-resistant individuals and to determine their GR up to this age. The difference in AS incidence between the divergent lines (93.9 vs. 9.5%) was not explained by the 5% difference in their GR, thus indicating a lack of genetic correlation. In the broiler lines, AS incidence was 31 and 47% in 2002 and 2006, respectively, and 32% in the 1986 slow-growing line. Most broilers that remained healthy under the high-challenge AIC exhibited the same early GR and BW as those that later developed AS. These results, and the relatively high incidence of AS in the slow-growing line, indicate that there is very little, if any, direct genetic association between AS and genetic differences in potential GR, and suggest that AS

  16. Development of ascites-resistant and ascites-susceptible broiler lines.

    PubMed

    Druyan, S; Ben-David, A; Cahaner, A

    2007-05-01

    The rapid growth of modern broilers is associated with enhanced appetite and high metabolic rate and, consequently, high O(2) demand. Ascites syndrome (AS) develops in individuals that fail to fully supply the increasing demand for O(2) in their bodies under ascites-inducing conditions (AIC) such as high altitude or low temperatures. The tendency of broilers to develop AS is heritable, but efficacious selection against AS susceptibility (without affecting the normal expression of other important traits) requires identification of indirect selection criteria. In the present study, divergent AS-susceptible (AS-S) and AS-resistant (AS-R) lines were developed to confirm the heritability of AS and to facilitate future detection of criteria for indirect selection against AS susceptibility. The base population consisted of 85 sire families with a mean of 73 progeny per sire, reared in a commercial broiler house under low-challenge AIC (cold environment and pelleted feed). Chicks dying with AS manifestations were designated AS-susceptible, whereas the surviving birds were designated AS-resistant. By the end of the trial (d 48), AS mortality had accumulated to 17.2%, but AS incidence per family (%ASF) ranged from 0 to 49%, with a high heritability (0.57). Parents of 7 families with very high %ASF produced the first generation (S(1)) of the AS-S line, and parents of 7 families with very low %ASF produced the S(1) of the AS-R line. The S(1) males and females reproduced generation S(2) of the selected lines, whereas additional S(1) males were tested under high-challenge AIC (individual cages, cool wind, and pelleted feed). Progeny testing under this high-challenge AIC, followed by sib selection, was repeated in generations S(2) and S(3), resulting in a divergence of 86.6% in the incidence of AS between the AS-S (91.3%) and AS-R (4.7%) lines. The rapid genetic divergence, and family analysis of %ASF suggested that a single or few major genes are responsible for the difference

  17. Refractory anaphylactoid shock potentiated by beta-blockers.

    PubMed

    Javeed, N; Javeed, H; Javeed, S; Moussa, G; Wong, P; Rezai, F

    1996-12-01

    Allergic reactions, including anaphylactoid shock due to contrast material, are not uncommon. However, persistent anaphylactoid shock refractory to conventional therapy is rare. We present a case of refractory anaphylactoid shock during coronary angiography unresponsive to aggressive standard therapy in a patient on beta-blockers. Significant clinical improvement was noted upon administration of glucagon. Since beta-blockers are commonly used in patients with coronary artery disease, this potentially life-threatening complication has to be kept in mind with any procedure involving contrast media in patients on beta-blockers. Immediate access to glucagon by keeping it in the procedure room may be lifesaving in these situations. PMID:8958428

  18. Survey made of refractory metals

    NASA Technical Reports Server (NTRS)

    Ault, G. M.

    1968-01-01

    Survey reviews the structural applications of refractory metals and the special problems they present in manufacture, evaluation, and application. The unique facilities required for their processing and evaluation, a summary of accomplishments in achieving commercial products, and the present status of the most advanced refractory materials are presented.

  19. REFRACTORY COATING FOR GRAPHITE MOLDS

    DOEpatents

    Stoddard, S.D.

    1958-06-24

    Refractory coating for graphite molds used in the casting of uranium is described. The coating is an alumino-silicate refractory composition which may be used as a mold surface in solid form or as a coating applied to the graphite mold. The composition consists of a mixture of ball clay, kaolin, alumina cement, alumina, water, sodium silicate, and sodium carbonate.

  20. Diphtheria Complications

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Diphtheria Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Diphtheria Home About Diphtheria Causes and Transmission Symptoms Complications ...

  1. Management of drainage for malignant ascites in gynaecological cancer

    PubMed Central

    Keen, Alison; Fitzgerald, Debbie; Bryant, Andrew; Dickinson, Heather O

    2014-01-01

    Background Most patients with advanced ovarian cancer and some patients with advanced endometrial cancer need repeated drainage for malignant ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence-based but mainly based on clinicians’ anecdotal evidence and experience. To discover whether there are ways of managing drains that have been demonstrated to improve the efficacy and quality of the procedure is key in making recommendations which could improve the quality of life (QOL) for women at this critical period of their lives. Objectives To evaluate the benefit and harms of different practices in the management of drains for malignant ascites in the care of women with advanced or recurrent gynaecological cancer. The review aimed to evaluate the evidence regarding the following questions; How long should the drain stay in place? Should the volume of fluid drained be replaced intravenously? Should the drain be clamped to regulate the drainage of fluid? Should any particular vital observations be regularly recorded? Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 1, 2009, Cochrane Gynaecological Cancer Group Trials Register, MEDLINE1950 to February Week 3 2009, Embase 1980 to 2009 Week 8 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of review articles and contacted experts in the field. Selection criteria We searched for randomised controlled trials (RCTs), quasi-RCTs and non-randomised studies that compared a range of interventions for management of multiple paracentesis in women with malignant ascites who had a confirmed histological diagnosis of gynaecological cancer. Data collection and analysis Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found and therefore no data were analysed. Main results The search

  2. Ascitic Fluid Calprotectin and Serum Procalcitonin as Accurate Diagnostic Markers for Spontaneous Bacterial Peritonitis

    PubMed Central

    Abdel-Razik, Ahmed; Mousa, Nasser; Elhammady, Dina; Elhelaly, Rania; Elzehery, Rasha; Elbaz, Sherif; Eissa, Mohamed; El-Wakeel, Niveen; Eldars, Waleed

    2016-01-01

    Background/Aims The diagnosis of spontaneous bacterial peritonitis (SBP) is based on a polymorphonuclear leukocytes (PMNs) exceeding 250/μL in ascitic fluid. The aim of the study was to evaluate serum procalcitonin and ascitic fluid calprotectin as accurate diagnostic markers for detecting SBP. Methods Seventy-nine patients with cirrhotic ascites were included. They were divided into a SBP group, including 52 patients, and a non-SBP group of 27 patients. Serum procalcitonin, ascitic calprotectin, and serum and ascitic levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured using an enzyme-linked immunosorbent assay. Results Serum procalcitonin and ascitic calprotectin were significantly higher in SBP patients than in non-SBP patients. Significant increases in both serum and ascitic levels of TNF-α and IL-6 were observed in SBP patients versus non-SBP patients. At a cutoff value of 0.94 ng/mL, serum procalcitonin had 94.3% sensitivity and 91.8% specificity for detecting SBP. In addition, at a cutoff value of 445 ng/mL, ascitic calprotectin had 95.4% sensitivity and 85.2% specificity for detecting SBP. Both were positively correlated with ascitic fluid proteins, PMN count, TNF-α, and IL-6. Conclusions According to our findings, determination of serum procalcitonin levels and ascitic calprotectin appears to provide satisfactory diagnostic markers for the diagnosis of SBP. PMID:26601826

  3. Selection strategies for body weight and reduced ascites susceptibility in broilers.

    PubMed

    Pakdel, A; Bijma, P; Ducro, B J; Bovenhuis, H

    2005-04-01

    Ascites syndrome is a metabolic disorder in broilers. Mortality due to ascites results in significant economic losses and has a negative impact on animal welfare. It has been shown that genetic factors play a considerable role in susceptibility of birds to ascites, which offers perspectives for selection against this syndrome. The aim of the present study was to evaluate the consequences of alternative selection strategies for BW and resistance to ascites syndrome using deterministic simulation. In addition to the consequences of current selection (i.e., selection for increased BW only) alternative selection strategies including information on different ascites-related traits measured under normal or cold conditions and the consequences of having information on the underlying genes (i.e., MAS) were quantified. Five different breeding schemes were compared based on the selection response for BW, ascites susceptibility, and the rate of inbreeding. Traits investigated in the index as indicators for ascites were hematocrit value (HCT) and ratio of right ventricle to the total ventricular weight of the heart (RV:TV). The results indicated that by ignoring ascites susceptibility in the breeding goal, the gain for BW is 130 g and the birds will become more susceptible to ascites. Testing 50% of the birds under cold temperature conditions and including information of ascites related traits (HCT and RV:TV) measured under normal and cold conditions makes it possible to achieve a relatively high gain for BW (111.4 g) while controlling the genetic level for ascites susceptibility (selection response was 0). The results of scenarios including QTL information of ascites susceptibility showed that QTL information could be used very effectively in controlling ascites susceptibility. PMID:15844807

  4. Gamma knife radiosurgery for medically refractory idiopathic trigeminal neuralgia.

    PubMed

    Kang, J H; Yoon, Y S; Kang, D W; Chung, S S; Chang, J W

    2008-01-01

    Gamma knife radiosurgery (GKS) has been generally considered as a viable therapeutic option for the management of medically refractory idiopathic trigeminal neuralgia (TN). We reviewed our experience with GKS in patients with TN. Between Feb 1996 and May 2006, 77 patients with medical refractory idiopathic TN were treated using GKS. Thirty-six patients who had undergone other previous procedures, previous GKS, or had brain stem lesion, atypical symptoms, were excluded from this study. Pain improvement was achieved in 38 of the patients with TN (pain response rate 92.7%). Twenty-three patients were pain free and 15 had reduced pain. There were no serious complications. We think that GKS is an effective treatment option for patients with medical refractory idiopathic TN. PMID:18642631

  5. Management of refractory hypoxemia

    PubMed Central

    Mehta, Chitra; Mehta, Yatin

    2016-01-01

    Mechanical ventilation remains the cornerstone in the management of severe acute respiratory failure. Acute respiratory distress syndrome (ARDS) is the most common cause of respiratory failure. It is associated with substantial mortality, and unmanageable refractory hypoxemia remains the most feared clinical possibility. If hypoxemia persists despite application of lung protective ventilation, additional therapies including inhaled vasodilators, prone positioning, recruitment maneuvers, high-frequency oscillatory ventilation, neuromuscular blockade (NMB), and extracorporeal membrane oxygenation may be needed. NMB and prone ventilation are modalities that have been clearly linked to reduced mortality in ARDS. Rescue therapies pose a clinical challenge requiring a precarious balance of risks and benefits, as well as, in-depth knowledge of therapeutic limitations. PMID:26750680

  6. Antioxidant effects in the development of Ehrlich ascites carcinoma.

    PubMed

    Baumgartner, W A; Hill, V A; Wright, E T

    1978-03-01

    The effect of Ehrlich ascites tumor growth on selenium-turnover rates and selenium-75 distribution in liver, kidney, and immunological tissues (spleen, thymus, and lymph nodes) was investigated in Swiss Webster mice that had been prelabeled with selenium-75. Ehrlich ascites tumor caused a decrease in the selenium-75 content of liver, kidney, and thymus; it also decreased the rate of the total-body selenium-turnover. In liver, depletion of selenium-75 was almost as great as that produced by a selenium and vitamin E-deficient diet. When mice had been fed an antioxidant-deficient diet, considerable quantities of selenium-75 were accumulated by the tumor; the specific activity of the tumor increased 9-fold over that in antioxidant-supplemented mice. The same diet produced a premature, and in some cases drastic, contraction in tumor volume. The possible significance of tumor-induced antioxidant deficiencies to the etiology of certain paraneoplastic syndromes is discussed. PMID:629217

  7. Management of refractory Eosinophilic Esophagitis

    PubMed Central

    Mukkada, Vincent A.; Furuta, Glenn T.

    2014-01-01

    Background/Aims Whereas most children and adults respond to traditional EoE treatments, such as exclusion of dietary allergens or the use of topical steroids, a small fraction may not. Methods Based on clinical experiences and review of the literature, the aim of this work is to provide practical advice to care for ‘refractory’ patients with EoE. Results The approach to this type of patient continues to evolve and decision-making should consider a number of issues including the patient's age, lack of complete understanding of the natural history of this disease, risks of monitoring and side effects of treatments. Next, one needs to define the term refractory, in that this can refer either to persistent symptoms, or to continued inflammation in the face of presumably effective drug or diet therapy. Before considering alternative treatments, it is important to rule out any other cause of persistent symptoms. For instance, could they be related to an occult esophageal narrowing not identified at the time of endoscopy? Esophagrams may be necessary to identify localized or longitudinal narrowing that could be amenable to dilation. If symptoms and inflammation are persistent and no narrowing is appreciated, an elemental diet can be considered but the long term use of this in older children and adults may be difficult. Prednisone or systemic steroids may be indicated to induce remission but side effects and complications associated with chronic use are limiting. Finally, the use of immunosuppression or biological agents has been reported in case reports and studies; use of these may be limited by side effects or the need to utilize compassionate use protocols. Conclusions As the scope of esophageal eosinophilia continues to evolve, the clinical and molecular characterization of new clinical phenotypes will be important so that new therapeutic targets can be identified. PMID:24603397

  8. Thoracic vertebral osteomyelitis: an unusual complication of Crohn's disease.

    PubMed

    Ajayi, Olushola; Mayooran, Nithiananthan; Iqbal, Nasir

    2014-01-01

    Vertebral osteomyelitis complicating Crohn's disease is a rare occurrence and mostly occurred in patients with Crohn's disease complicated by an abscess or fistulising disease. We report a case of thoracic vertebral osteomyelitis, occurring in a refractory Crohn's disease without contiguous abscess or fistula with the bowel. PMID:24916975

  9. Peritoneal Mesothelioma: An Unusual Cause of High-Protein Ascites

    PubMed Central

    2015-01-01

    We present a case illustrating the workup and diagnosis of peritoneal sarcomatous mesothelioma as an unusual etiology of intestinal obstruction and high-protein ascites in an otherwise healthy man. This rare disorder is diagnosed based on immunohistochemistry, which is necessary to differentiate it from other rare sarcomatous carcinomas. In many cases, localized disease can be treated to cure with surgery and intraperitoneal chemotherapy. Advanced disease is often treated for palliation of symptoms. PMID:26504886

  10. Alteration of the serum microbiome composition in cirrhotic patients with ascites

    PubMed Central

    Santiago, Alba; Pozuelo, Marta; Poca, Maria; Gely, Cristina; Nieto, Juan Camilo; Torras, Xavier; Román, Eva; Campos, David; Sarrabayrouse, Guillaume; Vidal, Silvia; Alvarado-Tapias, Edilmar; Guarner, Francisco; Soriano, German; Manichanh, Chaysavanh; Guarner, Carlos

    2016-01-01

    The progression of cirrhosis is associated with alterations in the composition of the gut microbiome. To assess microbial translocation, we compared the serum microbial composition of patients with and without ascites and characterized the ascitic fluid microbiome using 16S rDNA high-throughput sequencing data. A complex and specific microbial community was detected in the serum and ascitic fluid of patients with cirrhosis but barely detectable in the serum of healthy controls. The serum microbiome of patients with ascites presented higher levels of lipopolysaccharide binding protein, a marker of microbial translocation, associated with higher diversity and relative abundance of Clostridiales and an unknown genus belonging to the Cyanobacteria phylum compared to patients without ascites. The composition of the fecal microbiome was also more altered in patients with than without ascites, confirming previous studies on fecal microbiome. We propose that alteration of the serum and fecal microbiome composition be considered indicators of cirrhosis progression. PMID:27112233

  11. IN VITRO INHIBITION OF YEAST GROWTH BY MOUSE ASCITES FLUID AND SERUM

    PubMed Central

    Summers, Donald F.; Hasenclever, H. F.

    1964-01-01

    Summers, Donald F. (National Institute of Allergy and Infectious Diseases, Bethesda, Md.), and H. F. Hasenclever. In vitro inhibition of yeast growth by mouse ascites fluid and serum. J. Bacteriol. 87:1–7. 1964.—A nondialyzable heat-stable factor(s) present in experimentally produced mouse ascites fluid and in serum from these ascitic mice was shown to inhibit the invitro growth of several yeasts. The inhibitory activity was almost totally abolished by trypsin treatment of the ascites fluid, and was progressively diminished by repeated adsorption of the ascites fluid by heat-killed Candida albicans cells. A close relationship was shown to exist between growth inhibition by ascites fluid and concentration of free iron or nutrients in the growth medium. Increased concentration of nutrients or free iron caused diminution of inhibitory activity. PMID:14102855

  12. IN VITRO INHIBITION OF YEAST GROWTH BY MOUSE ASCITES FLUID AND SERUM.

    PubMed

    SUMMERS, D F; HASENCLEVER, H F

    1964-01-01

    Summers, Donald F. (National Institute of Allergy and Infectious Diseases, Bethesda, Md.), and H. F. Hasenclever. In vitro inhibition of yeast growth by mouse ascites fluid and serum. J. Bacteriol. 87:1-7. 1964.-A nondialyzable heat-stable factor(s) present in experimentally produced mouse ascites fluid and in serum from these ascitic mice was shown to inhibit the invitro growth of several yeasts. The inhibitory activity was almost totally abolished by trypsin treatment of the ascites fluid, and was progressively diminished by repeated adsorption of the ascites fluid by heat-killed Candida albicans cells. A close relationship was shown to exist between growth inhibition by ascites fluid and concentration of free iron or nutrients in the growth medium. Increased concentration of nutrients or free iron caused diminution of inhibitory activity. PMID:14102855

  13. Pharmacological approaches of refractory angina.

    PubMed

    Giannopoulos, Andreas A; Giannoglou, George D; Chatzizisis, Yiannis S

    2016-07-01

    Refractory angina refers to a group of patients with stable coronary atherosclerotic disease and angina symptoms, unresponsive to traditional medical management, while considered to be suboptimal candidates for revascularization procedures. Up to 15% of angina patients are considered to have refractory angina and, taking into account the aging population and the improvements in the treatment of stable coronary artery disease, the incidence of this entity is expected to increase. This review describes traditional and novel pharmacotherapies for symptoms relief and for long-term management of refractory angina. Mechanisms of action and relevant clinical trials are discussed and current recommendations from major European and US cardiovascular societies are reported. PMID:27013345

  14. Scintigraphic diagnosis of peritoneo-pleural communication in the absence of ascites.

    PubMed

    Daly, J J; Potts, J M; Gordon, L; Buse, M G

    1994-10-01

    Pleural effusion in the presence of cirrhosis and ascites is well recognized. Peritoneal fluid is thought to enter the pleural cavity either because of overloaded lymphatics or a structural defect between the peritoneal and chest cavities. Pleural effusion rarely occurs in the absence of demonstrable ascites. This report describes the scintigraphic diagnosis of peritoneo-pleural communication in a patient with cryptogenic cirrhosis and pleural effusion without ascites. PMID:7805325

  15. The use of blood gas parameters to predict ascites susceptibility in juvenile broilers.

    PubMed

    van As, P; Elferink, M G; Closter, A M; Vereijken, A; Bovenhuis, H; Crooijmans, R P M A; Decuypere, E; Groenen, M A M

    2010-08-01

    Ascites syndrome is a metabolic disorder found in modern broilers that have insufficient pulmonary vascular capacity. Commercial breeding programs have heavily focused on high growth rate, which led to fast-growing chickens, but as a negative consequence, the incidence of ascites syndrome increased. However, not all birds with a high growth rate will suffer from ascites syndrome, which might indicate a genetic susceptibility to ascites. Information on blood gas parameters measured early in life and their relation to ascites susceptibility is expected to contribute to identification on the cause of ascites syndrome. In this study, several physiological parameters, such as blood gas parameters [pH, partial pressure of CO(2) in venous blood (pvCO(2)), and partial pressure of O(2) in venous blood], hematocrit, electrolytes (Na(+), Ca(2+), and K(+)), metabolites (lactate and glucose), were measured at d 11 to 12 of age from 100 female and 100 male broilers. From d 14 onward, the birds were challenged to provoke the development of ascites syndrome. Our results showed that high pvCO(2) values together with low pH values (males) or high pH values (females) in the venous blood of juvenile broilers coincided with ascites. Therefore, blood pvCO(2) and pH in both juvenile male and female broilers seem to be critical factors in ascites pathophysiology and can be used as phenotypic traits to predict ascites susceptibility in juvenile broilers at d 11 to 12. A prediction model was built on a subpopulation of the broilers without any loss in sensitivity (0.52) and specificity (0.78) when applied to the validation population. The parameter sex was included in the prediction model because levels of pvCO(2) and pH that associated with ascites susceptibility are different between males and females. Commercial breeders can include these phenotypic traits in their genetic selection programs to reduce the incidence of ascites syndrome. PMID:20634524

  16. Changes of hepatic biochemical parameters and proteomics in broilers with cold-induced ascites

    PubMed Central

    2012-01-01

    Ascites syndrome is still a problem for chicken industry in various parts of the world. Despite the intensive investigations of this syndrome for many years, its pathogenesis remains unclear. The objective of this study was to analyze the difference in hepatic proteomics between ascites and healthy broilers by two-dimensional electrophoresis (2-DE) and matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). Changes of biochemical parameters of liver and blood were also determined. The results indicated that red blood cell counts (RBC), hematocrit (HCT) and haemoglobin (HGB) of ascites broilers were significantly greater than healthy broilers. Hepatic malondialdehyde (MDA) level of ascites broilers was significantly increased, and the activity of total superoxide dismutase (T-SOD) was significantly decreased. Hepatic lactic acid (LD) level of ascitic broilers were significantly lower than healthy ones. Serum glucose and cholesterol level of ascites broilers were significantly increased, and serum globulin level was significantly decreased in ascites broilers. There was no significant difference in triglyceride (TG) and blood urea nitrogen (BUN) level. The activity of liver hexokinase (HK) and succinodehydrogenase (SDH) in ascites broilers was significantly decreased, and there was no significant difference in the activity of liver pyruvate kinase (PK) and Na+-K+-ATPase. The hepatic proteomics analysis showed that 18 proteins expression difference were identified between ascites and healthy broilers. These proteins were mainly involved in: 1) cytoskeleton; 2) glucose, lipids and amino acid metabolism; 3) cell secretion; 4) cell apoptosis; 5) signal transduction; 6) immune and inflammatory response; and 7) cellular redox homeostasis. Mitochondrial isoform phosphoenolpyruvate carboxykinase (M-PEPCK) mainly participates in gluconeogenesis of chicken liver. In conclusion, liver oxidative damage was significantly aggravated, but

  17. Genetics of Ascites Resistance and Tolerance in Chicken: A Random Regression Approach

    PubMed Central

    Kause, Antti; van Dalen, Sacha; Bovenhuis, Henk

    2012-01-01

    Resistance and tolerance are two complementary mechanisms to reduce the detrimental effects of parasites, pathogens, and production diseases on host performance. Using body weight and ascites data on domesticated chicken Gallus gallus domesticus, we demonstrate the use of random regression animal model and covariance functions to estimate genetic parameters for ascites resistance and tolerance and illustrate the way individual variation in resistance and tolerance induce both genotype re-ranking and changes in variation of host performance along increasing ascites severity. Tolerance to ascites displayed significant genetic variance, with the estimated breeding values of tolerance slope ranging from strongly negative (very sensitive genotype) to weakly negative (less sensitive). Resistance to ascites had heritability of 0.34. Both traits are hence expected to respond to selection. The two complementary defense strategies, tolerance and resistance, were genetically independent. Ascites induced changes to the correlations between ascites resistance and body weight, with the genetic correlations being weak when birds were ascites-free but moderately negative when both healthy and affected birds were present. This likely results because ascites reduces growth, and thus high ascites incidence is genetically related to low adult body weight. Although ascites induced elevated phenotypic and genetic variances in body weight of affected birds, heritability displayed negligible changes across healthy and affected birds. Ascites induced moderate genotype re-ranking in body weight, with the genetic correlation of healthy birds with mildly affected birds being unity but with severely affected birds 0.45. This study demonstrates a novel approach for exploring genetics of defense traits and their impact on genotype-by-environment interactions. PMID:22670223

  18. Pathogenesis of ascites in broilers raised at low altitude: aetiological considerations based on echocardiographic findings.

    PubMed

    Olkowski, A A; Abbott, J A; Classen, H L

    2005-05-01

    This study reports novel insight into the aetiology of pulmonary hypertension and ascites in broiler chickens. The scope of measurements was focused on anatomical and functional parameters, and blood flow patterns in leghorns (resistant to ascites), fast-growing broilers (susceptible to ascites), broilers developing ascites, and ascitic broilers evaluated in vivo using echocardiography, and further examined in the context of postmortem findings. Both, in vivo observed features and postmortem findings, showed clear differences between broilers and leghorns, and between normal and ascitic broilers. Abnormalities in the heart chamber geometry and blood flow patterns were detected upon echocardiographic examination in all ascitic broilers. Right and left atrio-ventricular (AV) valve regurgitation were common findings in ascitic broilers and some apparently normal broilers, with left AV valve insufficiency being a predominant feature with respect to degree and frequency of occurrence. Blood flow disturbances were not detected in leghorns. Left ventricular fractional shortening (functional parameter) was considerably reduced (P < 0.01) in ascitic birds (mean: 21.7 +/- 2.0 SE) in comparison with normal broilers (mean: 39.1 +/- 3.6 SE), or leghorns (mean: 43.3 +/- 2.4 SE). The presented findings indicate that pathological and functional changes in the left ventricle and atrium play a significant role in the pathogenesis of ascites in broilers. Severe dilation of the left atrium and pulmonary veins seen on postmortem examination, as well as regurgitant blood flow in the left atrium, demonstrated by Doppler study in ascitic birds, provide evidence that chronically elevated pressure in the left atrium is involved in the aetiology of pulmonary hypertension and ascites in fast-growing broilers. PMID:15882400

  19. Changes of hepatic biochemical parameters and proteomics in broilers with cold-induced ascites.

    PubMed

    Wang, Yongwei; Guo, Yuming; Ning, Dong; Peng, Yunzhi; Cai, Hong; Tan, Jianzhuang; Yang, Ying; Liu, Dan

    2012-01-01

    Ascites syndrome is still a problem for chicken industry in various parts of the world. Despite the intensive investigations of this syndrome for many years, its pathogenesis remains unclear. The objective of this study was to analyze the difference in hepatic proteomics between ascites and healthy broilers by two-dimensional electrophoresis (2-DE) and matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). Changes of biochemical parameters of liver and blood were also determined. The results indicated that red blood cell counts (RBC), hematocrit (HCT) and haemoglobin (HGB) of ascites broilers were significantly greater than healthy broilers. Hepatic malondialdehyde (MDA) level of ascites broilers was significantly increased, and the activity of total superoxide dismutase (T-SOD) was significantly decreased. Hepatic lactic acid (LD) level of ascitic broilers were significantly lower than healthy ones. Serum glucose and cholesterol level of ascites broilers were significantly increased, and serum globulin level was significantly decreased in ascites broilers. There was no significant difference in triglyceride (TG) and blood urea nitrogen (BUN) level. The activity of liver hexokinase (HK) and succinodehydrogenase (SDH) in ascites broilers was significantly decreased, and there was no significant difference in the activity of liver pyruvate kinase (PK) and Na+-K+-ATPase. The hepatic proteomics analysis showed that 18 proteins expression difference were identified between ascites and healthy broilers. These proteins were mainly involved in: 1) cytoskeleton; 2) glucose, lipids and amino acid metabolism; 3) cell secretion; 4) cell apoptosis; 5) signal transduction; 6) immune and inflammatory response; and 7) cellular redox homeostasis. Mitochondrial isoform phosphoenolpyruvate carboxykinase (M-PEPCK) mainly participates in gluconeogenesis of chicken liver. In conclusion, liver oxidative damage was significantly aggravated, but

  20. Proteome–Metabolome Profiling of Ovarian Cancer Ascites Reveals Novel Components Involved in Intercellular Communication*

    PubMed Central

    Shender, Victoria O.; Pavlyukov, Marat S.; Ziganshin, Rustam H.; Arapidi, Georgij P.; Kovalchuk, Sergey I.; Anikanov, Nikolay A.; Altukhov, Ilya A.; Alexeev, Dmitry G.; Butenko, Ivan O.; Shavarda, Alexey L.; Khomyakova, Elena B.; Evtushenko, Evgeniy; Ashrafyan, Lev A.; Antonova, Irina B.; Kuznetcov, Igor N.; Gorbachev, Alexey Yu.; Shakhparonov, Mikhail I.; Govorun, Vadim M.

    2014-01-01

    Ovarian cancer ascites is a native medium for cancer cells that allows investigation of their secretome in a natural environment. This medium is of interest as a promising source of potential biomarkers, and also as a medium for cell–cell communication. The aim of this study was to elucidate specific features of the malignant ascites metabolome and proteome. In order to omit components of the systemic response to ascites formation, we compared malignant ascites with cirrhosis ascites. Metabolome analysis revealed 41 components that differed significantly between malignant and cirrhosis ascites. Most of the identified cancer-specific metabolites are known to be important signaling molecules. Proteomic analysis identified 2096 and 1855 proteins in the ovarian cancer and cirrhosis ascites, respectively; 424 proteins were specific for the malignant ascites. Functional analysis of the proteome demonstrated that the major differences between cirrhosis and malignant ascites were observed for the cluster of spliceosomal proteins. Additionally, we demonstrate that several splicing RNAs were exclusively detected in malignant ascites, where they probably existed within protein complexes. This result was confirmed in vitro using an ovarian cancer cell line. Identification of spliceosomal proteins and RNAs in an extracellular medium is of particular interest; the finding suggests that they might play a role in the communication between cancer cells. In addition, malignant ascites contains a high number of exosomes that are known to play an important role in signal transduction. Thus our study reveals the specific features of malignant ascites that are associated with its function as a medium of intercellular communication. PMID:25271300

  1. Intravenous ketamine for treatment of super-refractory convulsive status epilepticus with septic shock: A report of two cases

    PubMed Central

    Shrestha, Gentle Sunder; Joshi, Pankaj; Chhetri, Santosh; Karn, Ragesh; Acharya, Subhash Prasad

    2015-01-01

    Refractory and super-refractory status epilepticus is a life-threatening neurological emergency, associated with high morbidity and mortality. Treatment should be aimed to stop seizure and to avoid cerebral damage and another morbidity. Published data about effectiveness, safety and outcome of various therapies and treatment approaches are sparse and are mainly based on small case series and retrospective data. Here we report successful management of two cases of super-refractory status epilepticus refractory to anesthetic therapy with midazolam and complicated by septic shock, managed successfully with ketamine infusion. PMID:25983437

  2. Intravesical silver nitrate for refractory hemorrhagic cystitis

    PubMed Central

    Montgomery, Brian D.; Boorjian, Stephen A.; Ziegelmann, Matthew J.; Joyce, Daniel D.; Linder, Brian J.

    2016-01-01

    Objective Hemorrhagic cystitis is a challenging clinical entity with limited evidence available to guide treatment. The use of intravesical silver nitrate has been reported, though supporting literature is sparse. Here, we sought to assess outcomes of patients treated with intravesical silver nitrate for refractory hemorrhagic cystitis. Material and methods We identified nine patients with refractory hemorrhagic cystitis treated at our institution with intravesical silver nitrate between 2000–2015. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after silver nitrate instillation prior to hospital discharge. Results Median patient age was 80 years (IQR 73, 82). Radiation was the most common etiology for hemorrhagic cystitis 89% (8/9). Two patients underwent high dose (0.1%–0.4%) silver nitrate under anesthesia, while the remaining seven were treated with doses from 0.01% to 0.1% via continuous bladder irrigation for a median of 3 days (range 2–4). All nine patients (100%) had persistent hematuria despite intravesical silver nitrate therapy, requiring additional interventions and red blood cell transfusion during the hospitalization. There were no identified complications related to intravesical silver nitrate instillation. Conclusion Although well tolerated, we found that intravesical silver nitrate was ineffective for bleeding control, suggesting a limited role for this agent in the management of patients with hemorrhagic cystitis.

  3. Genetic parameters of ascites-related traits in broilers: correlations with feed efficiency and carcase traits.

    PubMed

    Pakdel, A; van Arendonk, J A M; Vereijken, A L J; Bovenhuis, H

    2005-02-01

    (1) Pulmonary hypertension syndrome followed by ascites is a metabolic disorder in broilers that occurs more often in fast-growing birds and at cool temperatures. (2) Knowledge of the genetic relationships among ascites-related traits and performance traits like carcase traits or feed efficiency traits is required to design breeding programmes that aim to improve the degree of resistance to ascites syndrome as well as production traits. The objective of this study was to estimate these genetic correlations. (3) Three different experiments were set up to measure ascites-related traits (4202 birds), feed efficiency traits (2166 birds) and carcase traits (2036 birds). The birds in different experiments originated from the same group of parents, which enabled the estimation of genetic correlations among different traits. (4) The genetic correlation of body weight (BW) measured under normal conditions and in the carcase experiment with the ascites indicator trait of right ventricle to total ventricle ratio (RV:TV) measured under cold conditions was 0.30. The estimated genetic correlation indicated that single-trait selecting for BW leads to an increase in occurrence of the ascites syndrome but that there are realistic opportunities of multi-trait selection of birds for improved BW and resistance to ascites. (5) Weak but positive genetic relationships were found between feed efficiency and ascites-related traits suggesting that more efficient birds tend to be slightly more susceptible to ascites. (6) The relatively low genetic correlation between BW measured in the carcase or in the feed efficiency experiments and BW measured in the ascites experiment (0.49) showed considerable genotype by environment interaction. (7) These results indicate that birds with high genetic potential for growth rate under normal temperature conditions have lower growth rate under cold-stress conditions due to ascites. PMID:15835251

  4. Abemaciclib in Children With DIPG or Recurrent/Refractory Solid Tumors

    ClinicalTrials.gov

    2016-04-12

    Diffuse Intrinsic Pontine Glioma; Brain Tumor, Recurrent; Solid Tumor, Recurrent; Neuroblastoma, Recurrent, Refractory; Ewing Sarcoma, Recurrent, Refractory; Rhabdomyosarcoma, Recurrent, Refractory; Osteosarcoma, Recurrent, Refractory; Rhabdoid Tumor, Recurrent, Refractory

  5. Refractory strictures despite steroid injection after esophageal endoscopic resection

    PubMed Central

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  6. Dynamic Testing of Gasifier Refractory

    SciTech Connect

    Michael D. Mann; John P. Hurley

    2002-09-27

    As DOE continues to advance new power systems, materials issues are often pivotal in determining the ultimate efficiency that can be reached in the system. Refractory performance in slagging gasification represents one of these issues. The University of North Dakota (UND) Chemical Engineering Department in conjunction with the UND Energy & Environmental Research Center (EERC) have initiated a program to thoroughly examine the combined chemical (reaction and phase change) and physical (erosion) effects experienced by a variety of refractory materials during both normal operation and thermal cycling under slagging coal gasification conditions. The goal of this work is to devise a mechanism of refractory loss under these conditions. The focus of the proposed work is to test the corrosion resistance of commercially available refractories to flowing coal slag, and propose the mechanisms of corrosion for the conditions studied. Corrosion is the degradation of material surfaces or grain boundaries by chemical reactions with melts, liquids, or gases, causing loss of material and consequently a decrease in strength of the structure. In order to develop methods of reducing corrosion, the microstructure that is attacked must be identified along with the mechanism and rates of attack. Once these are identified, methods for reducing corrosion rates can be developed. The work will take advantage of equipment and experimental techniques developed at the EERC under funding from several DOE programs. The controlled-atmospheric dynamic corrodent application furnace (CADCAF) will be utilized to simulate refractory/slag interactions under dynamic conditions that more realistically simulate the environment in a slagging coal gasifier than any of the static tests used previously by refractory manufacturers and researchers. To date, efforts have focused on final shakedown of the CADCAF and obtaining representative samples of slag and refractory for testing.

  7. Astatine-211-tellurium radiocolloid cures experimental malignant ascites

    SciTech Connect

    Bloomer, W.D.; McLaughlin, W.H.; Neirinckx, R.D.; Adelstein, S.J.; Gordon, P.R.; Ruth, T.J.; Wolf, A.P.

    1981-04-17

    An investigation of the efficacy of astatine-211-tellurium colloid for the treatment of experimental malignant ascites in mice reveals that this ..cap alpha..-emitting radiocolloid can be curative without causing undue toxicity to normal tissue. By comparison, negatron-emitting phosphorus-32 as colloidal chromic phosphate had no antineoplastic activity. The most compelling explanation for this striking difference is the dense ionization and short range of action associated with ..cap alpha..-emission. These results have important implications for the development and use of ..cap alpha..-emitters as radiocolloid therapy for the treatment of human tumors.

  8. Bilateral Cystic Lymphangioma of Ovary Associated with Chylous Ascites

    PubMed Central

    Arakeri, Surekha Ulhas; Patil, Vijaya L.; Mulay, Himanshu Dilip

    2015-01-01

    Intraabdominal cystic lymphangiomas are rare and are located in retroperitoneum, mesentery, omentum and other visceral organs. Lymphangiomas of the ovary are rare and are usually unilateral. Cases with bilateral cystic lymphangiomas of the ovary are reported very rarely in literature. We report a rare case of bilateral cystic lymphangioma of ovary associated with chylous ascites in a 35-year-old lady who presented with complaints of severe dysmenorrhoea and oligomenorrhoea since 6 months with history of chyluria for the past 3 years. PMID:26435959

  9. Nuclear Ribonucleoprotein Complexes Containing Polyadenylate from Mouse Ascites Cells

    PubMed Central

    Quinlan, Thomas J.; Billings, Peter B.; Martin, Terence E.

    1974-01-01

    Nuclear poly(A)-containing RNA of mouse ascites cells can be extracted in the form of 15-17S ribonucleoprotein complexes under conditions in which the bulk of the heterogeneous nuclear RNA is released as 30S complexes. The poly(A)-containing fraction of nuclear extracts has been resolved into two distinct components, 15 and 17 S; neither contains the two polypeptides of 30S ribonucleoprotein. The 17S particle contains approximately six polypeptide species of molecular masses 17,000-30,000 daltons. The 15S complex has four distinct polypeptides of higher molecular mass, including a prominent 80,000-dalton species. PMID:4368966

  10. Pulmonary arterial hypertension (ascites syndrome) in broilers: a review.

    PubMed

    Wideman, R F; Rhoads, D D; Erf, G F; Anthony, N B

    2013-01-01

    Pulmonary arterial hypertension (PAH) syndrome in broilers (also known as ascites syndrome and pulmonary hypertension syndrome) can be attributed to imbalances between cardiac output and the anatomical capacity of the pulmonary vasculature to accommodate ever-increasing rates of blood flow, as well as to an inappropriately elevated tone (degree of constriction) maintained by the pulmonary arterioles. Comparisons of PAH-susceptible and PAH-resistant broilers do not consistently reveal differences in cardiac output, but PAH-susceptible broilers consistently have higher pulmonary arterial pressures and pulmonary vascular resistances compared with PAH-resistant broilers. Efforts clarify the causes of excessive pulmonary vascular resistance have focused on evaluating the roles of chemical mediators of vasoconstriction and vasodilation, as well as on pathological (structural) changes occurring within the pulmonary arterioles (e.g., vascular remodeling and pathology) during the pathogenesis of PAH. The objectives of this review are to (1) summarize the pathophysiological progression initiated by the onset of pulmonary hypertension and culminating in terminal ascites; (2) review recent information regarding the factors contributing to excessively elevated resistance to blood flow through the lungs; (3) assess the role of the immune system during the pathogenesis of PAH; and (4) present new insights into the genetic basis of PAH. The cumulative evidence attributes the elevated pulmonary vascular resistance in PAH-susceptible broilers to an anatomically inadequate pulmonary vascular capacity, to excessive vascular tone reflecting the dominance of pulmonary vasoconstrictors over vasodilators, and to vascular pathology elicited by excessive hemodynamic stress. Emerging evidence also demonstrates that the pathogenesis of PAH includes characteristics of an inflammatory/autoimmune disease involving multifactorial genetic, environmental, and immune system components. Pulmonary

  11. Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

    PubMed Central

    Smith, Emily K; Ek, Edmund; Croagh, Daniel; Spain, Lavinia A; Farrell, Stephen

    2009-01-01

    We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature. PMID:19824123

  12. Dynamic Testing of Gasifier Refractory

    SciTech Connect

    Michael D. Mann; Devdutt Shukla; Xi Hong; John P. Hurley

    2004-09-27

    The University of North Dakota (UND) Chemical Engineering Department in conjunction with the UND Energy & Environmental Research Center (EERC) have initiated a program to thoroughly examine the combined chemical (reaction and phase change) and physical (erosion) effects experienced by a variety of refractory materials during both normal operation and thermal cycling under slagging coal gasification conditions. The goal of this work is to devise a mechanism of refractory loss under these conditions. The controlled-atmospheric dynamic corrodent application furnace (CADCAF) is being utilized to simulate refractory/slag interactions under dynamic conditions that more realistically simulate the environment in a slagging coal gasifier than any of the static tests used previously by refractory manufacturers and researchers. Shakedown testing of the CADCAF has been completed. Samples of slag and refractory from the Tampa Electric Polk Power Station have been obtained for testing in the CADCAF. The slag has been dried and sieved to the size needed for our flowing slag corrosion tests. Screening tests are in currently in progress. Detailed analysis of corrosion rates from the first tests is in progress.

  13. Dynamic Testing of Gasifier Refractory

    SciTech Connect

    Michael D. Mann; Devdutt Shukla; John P. Hurley

    2003-09-27

    The University of North Dakota (UND) Chemical Engineering Department in conjunction with the UND Energy & Environmental Research Center (EERC) have initiated a program to thoroughly examine the combined chemical (reaction and phase change) and physical (erosion) effects experienced by a variety of refractory materials during both normal operation and thermal cycling under slagging coal gasification conditions. The goal of this work is to devise a mechanism of refractory loss under these conditions. The controlled-atmospheric dynamic corrodent application furnace (CADCAF) is being utilized to simulate refractory/slag interactions under dynamic conditions that more realistically simulate the environment in a slagging coal gasifier than any of the static tests used previously by refractory manufacturers and researchers. Shakedown testing of the CADCAF is in progress. Samples of slag and refractory from the Tampa Electric Polk Power Station have been obtained for testing in the CADCAF. The slag has been dried and sieved to the size needed for our flowing slag corrosion tests. Testing is expected to begin in October.

  14. Refractory failure in slagging gasifiers

    SciTech Connect

    Bennett, James P.; Kwong, Kyei-Sing

    2004-08-01

    Slagging gasifiers are used to produce chemicals and/or electricity from feedstocks such as coal and/or petroleum coke. A gasifier environment includes pressures from 400 to 1000 psi, temperatures from 1250-1550 C, are cyclic, reducing gases of CO and H2, and molten ash that interacts with the refractory liner materials. The high Cr2O3 refractory liners of gasifiers fail within 3 to 24 months due to slag attack at elevated temperatures. Gasifier users seek materials with increased reliability and service life. The causes of refractory failure and efforts to increase refractory service life are discussed. Mechanisms involving corrosion and slag infiltration/spalling are the main causes of refractory wear. The reduction of slag penetration can reduce hot face lining wear. The performance of high Cr2O3-Al2O3 materials with phosphate additions were evaluated. Phosphate additions were found to have comparable wear and physical properties to materials with no additions, and to have good slag penetration resistance. Field trials in a gasifier are needed to clarify the potential of the materials.

  15. Testing Requirements for Refractory Materials

    NASA Technical Reports Server (NTRS)

    Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Curran, Jerome P.; Kolody, Mark R.; Sampson, Jeffrey W,; Montgomery, Eliza M.

    2012-01-01

    Launch Pads 39A and 39B currently use refractory material (Fondu Fyre) in the flame trenches. This material was initially approved for the Saturn program. This material had a lifetime of 10years according to the manufacturer, and it has been used for over 40 years. As a consequence, the Fondu Fyre at Launch Complex 39 requires repair subsequent to almost every launch. A review of the literature indicates that the gunned Fondu Fyre refractory product (WA-1 G) was never tested prior to use. With the recent severe damage to the flame trenches, a new refractory material is sought to replace Fondu Fyre. In order to replace Fondu Fyre, a methodology to test and evaluate refractory products was developed. This paper outlines this methodology and discusses current testing requirements, as well as the laboratory testing that might be required. Furthermore, this report points out the necessity for subscale testing, the locations where this testing can be performed, and the parameters that will be necessary to qualify a product. The goal is to identify a more durable refractory material that has physical, chemical, and thermal properties suitable to withstand the harsh environment of the launch pads at KSC.

  16. Testing Requirements for Refractory Materials

    NASA Technical Reports Server (NTRS)

    Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Curran, Jerome P.; Kolody, Mark R.; Sampson, Jeffrey W.; Montgomery, Eliza M.

    2011-01-01

    Launch Pads 39A and 39B currently use refractory material (Fondu Fyre) in the flame trenches. This material was initially approved for the Saturn program. This material had a lifetime of 10 years according to the manufacturer, and it has been used for over 40 years. As a consequence, the Fondu Fyre at Launch Complex 39 requires repair subsequent to almost every launch. A review of the literature indicates that the gunned Fondu Fyre refractory product (WA-1G) was never tested prior to use. With the recent severe damage to the flame trenches, a new refractory material is sought to replace Fondu Fyre. In order to replace Fondu Fyre, a methodology to test and evaluate refractory products was developed. This paper outlines this methodology and discusses current testing requirements, as well as the laboratory testing that might be required. Furthermore, this report points out the necessity for subscale testing, the locations where this testing can be performed, and the parameters that will be necessary to qualify a product. The goal is to identify a more durable refractory material that has physical, chemical, and thermal properties suitable to withstand the harsh environment of the launch pads at KSC.

  17. Testing Requirements for Refractory Materials

    NASA Technical Reports Server (NTRS)

    Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Curran, Jerome P.; Kolody, Mark R.; Sampson, Jeffrey W.; Montgomery, Eliza M.

    2010-01-01

    Launch Pads 39A and 39B currently use refractory material (Fondu Fyre) in the flame trenches. This material was initially approved for the Saturn program. This material had a lifetime of 10 years according to the manufacturer, and it has been used for over 40 years. As a consequence, the Fondu Fyre at Launch Complex 39 requires repair subsequent to almost every launch. A review of the literature indicates that the gunned Fondu Fyre refractory product (WA-1G) was never tested prior to use. With the recent severe damage to the flame trenches, a new refractory material is sought to replace Fondu Fyre. In order to replace Fondu Fyre, a methodology to test and evaluate refractory products was developed. This paper outlines this methodology and discusses current testing requirements, as well as the laboratory testing that might be required. Furthermore, this report points out the necessity for subscale testing, the locations where this testing can be performed, and the parameters that will be necessary to qualify a product. The goal is to identify a more durable refractory material that has physical, chemical, and thermal properties suitable to withstand the harsh environment of the launch pads at KSC.

  18. An overview of recycling refractory materials

    SciTech Connect

    Bennett, James P.; Kwong, Kyei-Sing

    2004-09-01

    Refractory materials must be disposed of or recycled when removed from service. Off-specification or reject material has been reused by the refractory industry for a number of years, with small percentages of these materials added as a part of refractory formulations. Historically, limed reuse of spent refractory materials in other applications has occurred. Environmental legislation, stewardship programs, and other forces encouraged some businesses to recycle spent refractories. Reuse of spent refractory material varies considerably among different industries and with the location of the industrial user. Efforts to recycle, the driving forces for recycling, and issues and steps to be taken into account initiating a recycling program will be discussed.

  19. Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports of Three Ovarian Tumors Presenting with Massive Ascites, but without Peritoneal Dissemination

    PubMed Central

    Miyoshi, Ai; Miyatake, Takashi; Hara, Takeya; Tanaka, Asuka; Komura, Naoko; Komiya, Shinnosuke; Kanao, Serika; Takeda, Masumi; Mimura, Mayuko; Nagamatsu, Masaaki; Yokoi, Takeshi

    2015-01-01

    Borderline ovarian tumors are benign but relatively large tumors that are often initially mistaken as ovarian cancers. We report three cases of stage I borderline ovarian tumors having massive ascites that we (preoperatively) suspected of being advanced ovarian cancer. The three patients (35, 47, and 73 years old) reported feeling fullness of the abdomen before consulting their gynecologist. By CT scan, they were diagnosed with a pelvic tumor accompanied by massive ascites, the diameters of which were 11, 20, and 11 cm, respectively. Postsurgical pathology showed all were stage I borderline ovarian tumors without dissemination; two were mucinous and one was serous. The amount of ascites was 6,300, 2,600, and 3,600 mL, respectively, and was serous in all. Cytodiagnosis of the ascites found that one was positive for tumor cells and two were negative. After resection of the mass, the ascites disappeared in all three cases. No pleural effusion was present at any time. The literature is reviewed concerning ascites and pleural effusions linked to ovarian tumors, and a supposition is forwarded of why pleural effusion presents sporadically in these cases. PMID:26858849

  20. Ascites Increases Expression/Function of Multidrug Resistance Proteins in Ovarian Cancer Cells.

    PubMed

    Mo, Lihong; Pospichalova, Vendula; Huang, Zhiqing; Murphy, Susan K; Payne, Sturgis; Wang, Fang; Kennedy, Margaret; Cianciolo, George J; Bryja, Vitezslav; Pizzo, Salvatore V; Bachelder, Robin E

    2015-01-01

    Chemotherapy resistance is the major reason for the failure of ovarian cancer treatment. One mechanism behind chemo-resistance involves the upregulation of multidrug resistance (MDR) genes (ABC transporters) that effectively transport (efflux) drugs out of the tumor cells. As a common symptom in stage III/IV ovarian cancer patients, ascites is associated with cancer progression. However, whether ascites drives multidrug resistance in ovarian cancer cells awaits elucidation. Here, we demonstrate that when cultured with ascites derived from ovarian cancer-bearing mice, a murine ovarian cancer cell line became less sensitive to paclitaxel, a first line chemotherapeutic agent for ovarian cancer patients. Moreover, incubation of murine ovarian cancer cells in vitro with ascites drives efflux function in these cells. Functional studies show ascites-driven efflux is suppressible by specific inhibitors of either of two ABC transporters [Multidrug Related Protein (MRP1); Breast Cancer Related Protein (BCRP)]. To demonstrate relevance of our findings to ovarian cancer patients, we studied relative efflux in human ovarian cancer cells obtained from either patient ascites or from primary tumor. Immortalized cell lines developed from human ascites show increased susceptibility to efflux inhibitors (MRP1, BCRP) compared to a cell line derived from a primary ovarian cancer, suggesting an association between ascites and efflux function in human ovarian cancer. Efflux in ascites-derived human ovarian cancer cells is associated with increased expression of ABC transporters compared to that in primary tumor-derived human ovarian cancer cells. Collectively, our findings identify a novel activity for ascites in promoting ovarian cancer multidrug resistance. PMID:26148191

  1. A rare case of vitamin B12 deficiency with ascites.

    PubMed

    Rajsekhar, Putta; Reddy, Mugannagari Maheshwar; Vaddera, Sameeraja; Rajini, G; Tikeli, Vinil

    2014-07-01

    Vitamin B12 deficiency is widespread than assumed in population. At risk are older people, pregnant women, vegans, patients with renal and intestinal diseases. Vitamin B12 deficiency can present with various hematological, gastrointestinal and neurological manifestations. In the population, the prevalence of vitamin B12 deficiency in younger people is 5% to 7% which is less compared to elderly people. In developing countries, deficiency is much more common, starting in early life and persisting across the life span. Here, we present a 16-year-old female patient presenting with ascites since 2 months who was subsequently investigated and diagnosed to have nutritional megaloblastic anaemia secondary to vitamin B12 deficiency after exclusion of other infective, neoplastic, autoimmune and inflammatory diseases. Inspite, patient was treated with antitubercular drugs but she did not respond. After supplementation of Vitamin B12, ascites responded well. Inadequate intake due to low consumption of animal source foods is the main cause of low serum vitamin B12 in younger adults and likely the main cause in poor population worldwide. PMID:25177593

  2. Subcutaneous tumor growth complicating the positioning of Denver shunt and intrapleural port-à-cath in mesothelioma patients.

    PubMed

    van Ooijen, B; Eggermont, A M; Wiggers, T

    1992-12-01

    Patients with malignant ascites and malignant pleural fluid from abdominal or pleural mesothelioma underwent the positioning of Denver type peritoneovenous shunt or intrapleural catheter. They developed tumor growth in the subcutaneous tissue surrounding the devices throughout their courses. Neoplastic seeding is a potential complication of the positioning of shunts and catheters in cavities filled with fluid rich in tumor cells. PMID:1478300

  3. Treatment-refractory Tourette Syndrome.

    PubMed

    Kious, Brent M; Jimenez-Shahed, Joohi; Shprecher, David R

    2016-10-01

    Tourette Syndrome (TS) is a complex neurodevelopmental condition marked by tics and frequently associated with psychiatric comorbidities. While most cases are mild and improve with age, some are treatment-refractory. Here, we review strategies for the management of this population. We begin by examining the diagnosis of TS and routine management strategies. We then consider emerging treatments for refractory cases, including deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and novel pharmacological approaches such as new vesicular monoamine transporter type 2 inhibitors, cannabinoids, and anti-glutamatergic drugs. PMID:26875502

  4. Continuous Production Of Refractory Microballoons

    NASA Technical Reports Server (NTRS)

    Schilling, Christopher H.; Lee, Mark C.; Wang, Taylor G.

    1988-01-01

    Continuous process has economic and quality advantages over batch processes. Expected to produce high-quality microballoons at relatively low cost. Continuous hollow-jet process produces microballoons of refractory metal. Microballoon products made by continuous process includes inertial-confinement fusion targets, thermal insulators, lightweight composites, impact absorbers, and containers for hazardous materials.

  5. Management of chronic refractory cough.

    PubMed

    Gibson, Peter G; Vertigan, Anne E

    2015-01-01

    Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise. PMID:26666537

  6. Refractory lining for electrochemical cell

    DOEpatents

    Blander, Milton; Cook, Glenn M.

    1987-01-01

    Apparatus for processing a metallic fluid containing iron oxide, container for a molten metal including an electrically conductive refractory disposed for contact with the molten metal which contains iron oxide, an electrolyte in the form of a basic slag on top of the molten metal, an electrode in the container in contcat with the slag electrically separated from the refractory, and means for establishing a voltage across the refractory and the electrode to reduce iron oxide to iron at the surface of the refractory in contact with the iron oxide containing fluid. A process is disclosed for refining an iron product containing not more than about 10% by weight oxygen and not more than about 10% by weight sulfur, comprising providing an electrolyte of a slag containing one or more of calcium oxide, magnesium oxide, silica or alumina, providing a cathode of the iron product in contact with the electrolyte, providing an anode in contact with the electrolyte electrically separated from the cathode, and operating an electrochemical cell formed by the anode, the cathode and the electrolyte to separate oxygen or sulfur present in the iron product therefrom.

  7. [Supportive care for malignant ascites in palliative phase: Place of paracentesis and diuretics].

    PubMed

    Gamblin, Vincent; Da Silva, Arlette; Villet, Stéphanie; El Hajbi, Farid

    2015-11-01

    Malignant ascites, occurring in advanced stages of cancer, is linked with poor prognosis and can cause invalidating symptoms. Physiopathological mechanisms of ascites formation are complex and have yet to be fully elucidated. In most cases, ascites is due to peritoneal carcinomatosis in which vascular permeability is enhanced by VEGF production while lymphatic drainage decreases. Ascites can also be secondary to portal hypertension, for example in case of multiple liver metastases, or due to lymphatic obstruction. While paracentesis and diuretics are commonly used, their efficiency has never been compared in a randomized controlled study. Paracentesis brings immediate but temporary relief in over 90% of cases, and implies multiple hospitalizations. Literature reports ascites control by aldosterone alone or in association with furosemide. But, available data is controversial, and there is no predictive factor to identify patients that respond to diuretic treatment. The indication of diuretic treatment is left to the appreciation of physicians. Existing recommendations are old, and practices influenced by results obtained in non-neoplastic ascites. Additional evidences are required before guidelines can be established for the palliative management of malignant ascites. PMID:26477275

  8. Glycoproteomic Analysis of Malignant Ovarian Cancer Ascites Fluid Identifies Unusual Glycopeptides.

    PubMed

    Miyamoto, Suzanne; Ruhaak, L Renee; Stroble, Carol; Salemi, Michelle R; Phinney, Brett; Lebrilla, Carlito B; Leiserowitz, Gary S

    2016-09-01

    Ovarian cancer is a major cause of cancer mortality among women, largely due to late diagnosis of advanced metastatic disease. More extensive molecular analysis of metastatic ovarian cancer is needed to identify post-translational modifications of proteins, especially glycosylation that is particularly associated with metastatic disease to better understand the metastatic process and identify potential therapeutic targets. Glycoproteins in ascites fluid were enriched by affinity binding to lectins (ConA or WGA) and other affinity matrices. Separate glycomic, proteomic, and glycopeptide analyses were performed. Relative abundances of different N-glycan groups and proteins were identified from ascites fluids and a serum control. Levels of biomarkers CA125, MUC1, and fibronectin were also monitored in OC ascites samples by Western blot analysis. N-Glycan analysis of ascites fluids showed the presence of large, highly fucosylated and sialylated complex and hybrid glycans, some of which were not observed in normal serum. OC ascites glycoproteins, haptoglobin, fibronectin, lumican, fibulin, hemopexin, ceruloplasmin, alpha-1-antitrypsin, and alpha-1-antichymotrypsin were more abundant in OC ascites or not present in serum control samples. Further glycopeptide analysis of OC ascites identified N- and O-glycans in clusterin, hemopexin, and fibulin glycopeptides, some of which are unusual and may be important in OC metastasis. PMID:27500424

  9. Vascular remodeling and its role in the pathogenesis of ascites in fast growing commercial broilers.

    PubMed

    Nain, S; Wojnarowicz, C; Laarveld, B; Olkowski, A A

    2009-06-01

    This study examined the putative role of blood vessel pathology in the development of ascites in broilers. Major blood vessels (aorta, brachiocephalic arteries, pulmonary arteries, and vena cava) from normal commercial male broiler chickens, and broilers that developed congestive heart failure (CHF) with or without ascites were subjected to gross and microscopic examination. On cross-section, grossly, the arteries from normal broilers and those showing dilated cardiomyopathy without ascites appeared circular, with firm wall tone characteristic of the normal artery. In contrast, the arteries from ascitic broilers appeared flaccid and lacked elasticity, which was evidenced by collapsing, ellipsoid cross-sectional arterial lumen owing to the structural weakness of the arterial walls. Microscopically, ascitic broilers showed thinning or occasionally total loss of elastic elements in the arterial wall, and reduced network density of the structural matrix of the vascular wall, as well as increased thickness of fibers in vena cava. The structural changes seen in the major arteries from ascitic broilers are maladaptive, and as such would definitively impose an increased hemodynamic burden on the already failing heart pump. The changes in veins are indicative of pathological remodeling conducive to increased permeability of the vascular wall, particularly in the situation when a poorly distensible structure is further subjected to wall stress associated with increased pressure and volume overload. Taken together, increased hemodynamic burden and reduced structural density of the venous wall constitute conditions conducive for seepage and accumulation of ascitic fluid. PMID:18947843

  10. UK survey of broiler ascites and sudden death syndromes in 1993.

    PubMed

    Maxwell, M H; Robertson, G W

    1998-05-01

    1. The mean incidence of deaths from ascites in the UK in 1993 was 1.4% (0.7% in 1991 and 0.9% in 1992) and 0.8% from sudden death syndrome (SDS). In total, the economic loss to the UK Broiler Industry in 1993 as a result of these 2 conditions was 24 Pounds M. 2. Clear geographical differences emerged in the occurrence of ascites, with, not only the lowest incidences being observed in Northern Ireland, but also the peak of the mortality from ascites occurring much later in the rearing cycle than in other regions on the mainland. 3. In all regions the incidence of SDS was lower than that of ascites but the reason for this disparity remains to be established. 4. Some of the variables associated with the road transportation of day-old chicks from the hatchery to the farm appeared to influence the incidence of ascites. These included distance or time travelled, stocking density, internal lorry temperature and the length of time the lorry was heated before transport as well as the time the shed was heated before chick arrival. Temperature was also an important factor during growth (brooding and finishing). 5. Negative pressure-powered ventilation was preferred in most organisations but more ascites was seen with positive pressure ventilation. However, the lowest incidence of ascites occurred with natural ventilation. There was more ascites relative to shed orientation when the wind direction was from the west compared to the east. 6. This survey identifies the extent of the problem of broiler ascites in the UK and also highlights the importance of good management control of day-old chicks, not only following placement, but even before their arrival on the farm. PMID:9649872

  11. Hypobaric hypoxia in ascites resistant and susceptible broiler genetic lines influences gut morphology.

    PubMed

    de los, Santos F Solis; Tellez, G; Farnell, M B; Balog, J M; Anthony, N B; Pavlidis, H O; Donoghue, A M

    2005-09-01

    Genetic selection based on rapid growth rates, improved feed conversion, and increased body weights has led to a predisposition to ascites in broiler populations. Sire-family selection was applied to a commercial elite line to produce divergent lines of ascites-resistant (RES) and ascites-susceptible (SUS) broilers by the 8th generation. One objective of this research was to determine the effects of hypobaric hypoxia on gut morphology in these genetic lines. In two separate trials, pedigree broiler chickens were randomly assigned to cages in a hypobaric chamber (simulated 2,900 m above sea level) or a matching local altitude chamber (390 m above sea level). Ascites incidence was characterized by heart enlargement and fluid accumulation in the abdominal cavity. At the end of the study on d 42, all surviving birds were killed and evaluated for the presence of ascites and 2-cm sections from the duodenum and lower ileum were collected from 5 chickens per line, per altitude for each trial for morphometric analysis. At a high altitude, ascites incidence was lower in the RES line (20.9 and 3.7%) than in the SUS line (86.4 and 66.9%, Trials 1 and 2, respectively). No ascites was observed at a local altitude. Under hypoxic conditions, duodenum villus surface area was higher (P < 0.05) in the RES line (181.3 +/- 16.8 and 219 +/- 10.9 microm) compared with the SUS line (130.1 +/- 10.5 and 134.3 +/- 9.3 microm; Trials 1 and 2, respectively). No differences in ileum villus morphology were observed for any of the parameters measured. The reduced surface area in the duodenum of birds selected for ascites susceptibility suggests reduced enteric function and may provide clues as to why these birds have increased incidence of ascites. PMID:16206574

  12. New developments in gasifier refractories

    SciTech Connect

    Dogan, Cynthia P.; Kwong, Kyei-Sing; Bennet, James P.; Chinn, Richard E.; Dahlin, Cheryl L.

    2002-01-01

    For Integrated Gasification Combined Cycle (IGCC) systems, operational reliability depends in part upon the ability of the materials of construction to tolerate harsh, high-temperature environments for extended periods of time. The harshest conditions within an IGCC system occur inside the gasifier itself, where for slagging systems the environment includes elevated temperature and pressure, as well as the presence of corrosive slags and gases. Attempts to enhance gasifier performance by operating at higher temperatures, with higher throughputs, and/or with variable feedstocks, put additional stress on the materials exposed to the operating environment, often resulting in a corresponding decrease in their useful service life. Current generation refractory materials commonly used at the hot face of commercial slagging systems will typically last from four to 18 months, depending on the operating conditions of the specific gasifier. However, as gasification technology matures, the need for new and improved materials will increase as the time between required maintenance shutdowns, and hence the economics and reliability of operation, are defined more and more by the service life of the materials from which the system is built. To address this need for materials development, the U.S. Department of Energy's Office of Fossil Energy and the Albany Research Center are exploring ways to extend the service life of the refractory liner that contains the gasification reaction in slagging gasifiers. In this paper, we examine how refractory materials fail in the gasifier environment, and introduce a new refractory designed specifically to resist such failures. Based on laboratory exposure tests, this new refractory is predicted to significantly enhance gasifier reliability and availability through increased service life.

  13. Idiopathic fetal ascites associated with pregnancy from father-daughter incest. A case report.

    PubMed

    Nwosu, U C; Bharti, D R

    1994-01-01

    A 15-year-old primigravida registered late for antenatal care (23 weeks). Ultrasound examination revealed massive idiopathic fetal ascites necessitating in utero paracentesis at 27 weeks. The family was socially dislocated, and the patient's alcoholic father doted on her. A live female fetus with ascites and multiple congenital abnormalities was delivered at 34 weeks. Following repeated hospitalization, the infant died of pneumonitis, at 5 months of age; autopsy could not determine the cause of the ascites. Young pregnant teenagers from broken homes with doting behavior from an alcoholic father should be suspected of being incest victims. PMID:8169917

  14. Meeting the challenge of ascites in ovarian cancer: new avenues for therapy and research

    PubMed Central

    Kipps, Emma; Tan, David S. P.; Kaye, Stan B.

    2015-01-01

    Malignant ascites presents a considerable clinical challenge to the management of ovarian cancer, but also provides a wealth of opportunities for translational research. The accessibility of ascitic fluid and its cellular components make it an excellent source of tumour tissue for the investigation of prognostic and predictive biomarkers, pharmacodynamic markers and for molecular profiling analysis. In this Opinion article, we discuss recent advances in our understanding of its pathophysiology, the development of new methods to characterize its molecular features and how these findings can be used to improve the treatment of malignant ascites, particularly in the context of ovarian cancer. PMID:23426401

  15. L-lactate transport in Ehrlich ascites-tumour cells.

    PubMed

    Spencer, T L; Lehninger, A L

    1976-02-15

    Ehrlich ascites-tumour cells were investigated with regard to their stability to transport L-lactate by measuring either the distribution of [14C]lactate or concomitant H+ ion movements. The movement of lactate was dependent on the pH difference across the cell membrane and was electroneutral, as evidenced by an observed 1:1 antiport for OH- ions or 1:1 symport with H+ ions. 2. Kinetic experiments showed that lactate transport was saturable, with an apparent Km of approx. 4.68 mM and a Vmax. as high as 680 nmol/min per mg of protein at pH 6.2 and 37 degrees C. 3. Lactate transport exhibited a high temperature dependence (activation energy = 139 kJ/mol). 4. Lactate transport was inhibited competitively by (a) a variety of other substituted monocarboxylic acids (e.g. pyruvate, Ki = 6.3 mM), which were themselves transported, (b) the non-transportable analogues alpha-cyano-4-hydroxycinnamate (Ki = 0.5 mM), alpha-cyano-3-hydroxycinnamate (Ki = 2mM) and DL-p-hydroxyphenyl-lactate (Ki = 3.6 mM) and (c) the thiol-group reagent mersalyl (Ki = 125 muM). 5. Transport of simple monocarboxylic acids, including acetate and propionate, was insensitive to these inhibitors; they presumably cross the membrane by means of a different mechanism. 6. Experiments using saturating amounts of mersalyl as an "inhibitor stop" allowed measurements of the initial rates of net influx and of net efflux of [14C]lactate. Influx and efflux of lactate were judged to be symmetrical reactions in that they exhibited similar concentration dependence. 7. It is concluded that lactate transport in Ehrlich ascites-tumour cells is mediated by a carrier capable of transporting a number of other substituted monocarboxylic acids, but not unsubstituted short-chain aliphatic acids. PMID:7237

  16. Functional design of refractories for slagging gasifiers

    SciTech Connect

    Kwong, Kyei-Sing; Dogan, Cynthia P.; Bennett, James P.; Chinn, Richard E.; Dahlin, Cheryl L.

    2002-09-01

    Refractories are used in coal slagging gasifiers to protect the outer steel shell from coal slag attack and to insulate it from heat. Corrosion by the aggressive coal slags and unexpected temperature shock severely shorten the service life of these refractories. Currently, the best refractories available for the slagging coal gasifiers last from 6 to 18 months. The down time for the installation of new refractory lining reduces on-line availability of the gasifier. Researchers at the Albany Research Center (ARC) have found that structural spalling by slag penetration into the refractory is responsible for the early failure of refractories in some gasifiers. The low melting point of coal slags, the low thermal gradient in the refractory, and the improper design of refractory microstructure contribute to promote slag penetration. Work at ARC has demonstrated that refractories with an improved functional design are more resistant to slag penetration. Cooperation with commercial refractory companies and gasifier designers/operators is underway to produce and test improved refractories.

  17. [Management of complications after residual tumor resection for metastatic testicular cancer].

    PubMed

    Lusch, A; Zaum, M; Winter, C; Albers, P

    2014-07-01

    Residual tumor resection (RTR) in patients with metastatic testicular cancer plays a pivotal role in a multimodal treatment. It can be performed unilaterally or as an extended bilateral RTR. Additional surgical procedures might be necessary, such as nephrectomy, splenectomy, partial colectomy, or vascular interventions with possible caval resection, cavotomy, or aortic resection with aortic grafting. Consequently, several complications can be seen in the intra- and postoperative course, most common of which are superficial wound infections, intestinal paralysis, lymphocele, and chylous ascites. We sought to describe complication management and how to prevent complications before they arise. PMID:25023235

  18. A 61-Year-Old Man With Shortness of Breath, Ascites, and Lower Extremity Edema.

    PubMed

    Ataya, Ali; Cope, Jessica M; Moguillansky, Diego; Machuca, Tiago N; Alnuaimat, Hassan

    2016-06-01

    A 61-year-old man presented with an 18-month history of progressive shortness of breath on exertion, fatigue, worsening bilateral lower extremity edema, abdominal swelling, and increased assistance with activities of daily living. Pertinent past medical history included right-sided pneumonia secondary to Streptococcus pneumoniae that was complicated by empyema, requiring right-sided video-assisted thoracoscopic surgery with decortication 2 years earlier. He had a negative cardiac history, no recent travel in the last 3 years, and no known exposure to tuberculosis. His medications included aspirin and daily furosemide. His symptoms appeared to be refractory to diuretic therapy. Previous workup 6 months earlier included an echocardiography (ECHO) showing enlarged left and right atria with a normal ejection fraction, and a catheterization of the left side of the heart with reported normal left ventricular function and unobstructed coronary arteries. PMID:27287597

  19. [Treatment of refractory hepatic encephalopathy associated with insertion of a transjugular intrahepatic portosystemic shunt through new endovascular techniques: a case report].

    PubMed

    Martínez Moreno, Belén; Bellot, Pablo; de España, Francisco; Palazón, José María; Such, José; Pérez-Mateo, Miguel

    2011-01-01

    Insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is an increasingly used treatment in the management of the complications of portal hypertension. However, one of the complications of this technique is refractory or recurrent hepatic encephalopathy, which poses a difficult clinical problem. We report the case of a patient who underwent TIPS insertion to control bleeding due to esophageal varices. The patient subsequently developed refractory hepatic encephalopathy, requiring reduction of the caliber of the shunt. PMID:21652116

  20. Ascites Due to Anastomotic Stenosis After Liver Transplantation Using the Piggyback Technique: Treatment with Endovascular Prosthesis

    SciTech Connect

    Bilbao, Jose Ignacio; Herrero, Jose Ignacio; Martinez-Cuesta, Antonio; Quiroga, Jorge; Pueyo, Jesus Ciro; Vivas, Isabel; Delgado, Carlos; Pardo, Fernando

    2000-03-15

    Liver transplantation preserving the retrohepatic inferior vena cava, the so-called piggyback technique, is becoming more frequently used because it avoids caval cross-clamping during the anhepatic phase of surgery. However, hepatic venous outflow blockade causing ascites seems to be less infrequent after piggyback than with cavo-caval anastomosis. We report a 62-year-old patient who underwent liver transplantation using the piggyback technique and developed a stenosis in the anastomosis between the hepatic veins and the inferior vena cava leading to severe postoperative ascites. Ascites was unresponsive to diuretic therapy and was associated with renal function impairment. Since the etiology of the stenosis was mechanical (torsion), percutaneous transluminal angioplasty was unsuccessful. Finally, an autoexpandable prosthesis was placed across the anastomosis resulting in rapid and permanent (3 years of follow-up) resolution of ascites.

  1. A quantitative trait locus for ascites on chromosome 9 in broiler chicken lines

    PubMed Central

    Krishnamoorthy, Sriram; Smith, Candace D.; Al-Rubaye, Adnan A.; Erf, Gisela F.; Wideman, Robert F.; Anthony, Nicholas B.; Rhoads, Douglas D.

    2014-01-01

    A genome-wide SNP survey was used to identify chromosomal regions that showed linkage disequilibrium with respect to ascites susceptibility and ventricular hypertrophy in an F2 cross between previously described ascites-resistant and -susceptible lines. Variable number tandem repeats were used to obtain genotype data to further characterize these regions. A region on chromosome 9 (12 to 13 Mbp in 2011 assembly) shows association with ascites in the ascites lines and in several commercial broiler breeder lines with a significant sex effect. There are 2 candidate genes, AGTR1 (an angiotensin II type 1 receptor) and UTS2D (urotensin 2 domain containing), in this region that have been associated with hypertension and hypoxic response in mammals. PMID:24570451

  2. Treatment of severe refractory erythema nodosum leprosum with tumor necrosis factor inhibitor Etanercept.

    PubMed

    Chowdhry, Sundeep; Shukla, Akhilesh; D'souza, Paschal; Dhali, Tapan; Jaiswal, Prashansa

    2016-06-01

    Erythema nodosum leprosum (ENL) is a common complication of lepromatous leprosy. Some patients unresponsive to conventional, first-line therapeutics develop recurrent, recalcitrant ENL. Here, we report a case of severe refractory ENL that was successfully treated with Etanercept. Biologics may be considered as therapeutic alternatives in management of severe, recalcitrant ENL. PMID:27242236

  3. Low-carbohydrate diet combined with SGLT2 inhibitor for refractory hyperglycemia caused by insulin antibodies.

    PubMed

    Shigeno, Riyoko; Horie, Ichiro; Ando, Takao; Abiru, Norio; Kawakami, Atsushi

    2016-06-01

    A low-carbohydrate diet is effective to improve hyperglycemia via insulin-independent actions. We report here that a low-carbohydrate diet combined with an SGLT2 inhibitor was effective and safe to treat refractory hyperglycemia in the perioperative period in a type 2 diabetes patient complicated with a high titer of insulin antibodies. PMID:27321315

  4. Differential expression of cardiac muscle mitochondrial matrix proteins in broilers from ascites-resistant and susceptible lines.

    PubMed

    Cisar, C R; Balog, J M; Anthony, N B; Donoghue, A M

    2005-05-01

    Ascites is a metabolic disorder of modern broilers that is distinguished by cardiopulmonary insufficiency in the face of intense oxygen demands of rapidly growing tissues. Broilers with ascites exhibit sustained elevation of pulmonary arterial pressure and right ventricular hypertrophy, the end result of which is heart failure. It has been shown that mitochondrial function is impaired in broilers with ascites. In the current study, mitochondrial matrix protein levels were compared between ascites-resistant line broilers and ascites-susceptible line broilers with and without ascites using two-dimensional (2-D) gel electrophoresis. One hundred seventy-two protein spots were detected on the gels, and 9 of the spots were present at different levels in the 4 groups of broilers. These 9 protein spots were selected for identification by mass spectrometry. Two of the spots were found to contain single mitochondrial matrix proteins. Both mitochondrial matrix proteins, the dihydrolipoamide succinyltransferase component of the 2-oxoglutarate dehydrogenase complex and the alpha-subunit of mitochondrial trifunctional enzyme, were present at higher levels in ascites-resistant line broilers with ascites in the present study. The elevated levels of 2 key proteins in aerobic metabolism in ascites-resistant line broilers with ascites observed in the present study suggests that the mitochondria of broilers with this disease may respond inappropriately to hypoxia. PMID:15913181

  5. Refractory neural nets and vision

    NASA Astrophysics Data System (ADS)

    Fall, Thomas C.

    2014-02-01

    Biological understandings have served as the basis for new computational approaches. A prime example is artificial neural nets which are based on the biological understanding of the trainability of neural synapses. In this paper, we will investigate features of the biological vision system to see if they can also be exploited. These features are 1) the neuron's refractory period - the period of time after the neuron fires before it can fire again and 2) the ocular microtremor which moves the retinal neural array relative to the image. The short term memory due to the refractory period allows the before and after movement views to be compared. This paper will discuss the investigation of the implications of these two features.

  6. REFRACTORY DIE FOR EXTRUDING URANIUM

    DOEpatents

    Creutz, E.C.

    1959-08-11

    A die is presented for the extrusion of metals, said die being formed of a refractory complex oxide having the composition M/sub n/O/sub m/R/sub x/O/sub y/ where M is magnesium, zinc, manganese, or iron, R is aluminum, chromic chromium, ferric iron, or manganic manganese, and m, n, x, and y are whole numbers. Specific examples are spinel, magnesium aluminate, magnetite, magnesioferrite, chromite, and franklinite.

  7. The refractory painful arc syndrome.

    PubMed

    Watson, M

    1978-11-01

    Twenty-three patients with a severe refractory painful arc syndrome have been treated by excision of the outer end of the clavicle and division of the coracoacromial ligament through a deltoid-splitting approach. After a follow-up of more than six months all patients have been relieved of night pain. Six still have slight pain on movement, but the rest are symptom-free. PMID:711806

  8. Separation of Ascites Myeloma Cells, Lymphocytes and Macrophages by Zonal Centrifugation on an Isokinetic Gradient

    PubMed Central

    Stewart, M. J.; Pretlow, T. G.; Hiramoto, Raymond

    1972-01-01

    In attempting to quantitate immunoglobulin synthesis by ascites myeloma cells, we were surprised to note that malignant appearing cells never exceeded 35.9 = 28.0% of ascitic cells and exceeded 22.4 ± 23.8% of ascitic cells on only one day between the transplantation of the tumor and the death of the host. The ascites tumor suspensions were separated primarily according to diameter, using a previously described isokinetic density gradient of Ficoll in tissue culture medium. This separation resulted in four modal populations of cells: red blood cells, lymphoid cells, macrophages and myeloma cells. The modal populations of macrophages and lymphoid cells always contained less than 0.2% myeloma cells. The purified cells were tested for tumorigenicity. The animal which received the largest number of cells from the macrophage zone received 296 times the number of cells which had been determined to be tumorigenic for myeloma cells. The animal which received the largest number of cells from the lymphoid zone received 1600 times the tumorigenic dose for myeloma cells. Neither of these animals has become ill 4 months after receiving the purified cells. We conclude that: a) Experimentalists who use ascites tumors are not justified in assuming that even easily detected quantitative differences between benign and malignant tissues would be reflected in analyses performed using unstandardized unexamined ascites tumor suspensions. b) In the case of the MOPC 104 mouse myeloma, cytologic criteria are adequate for distinguishing malignant cells from the inflammatory cells in the ascites suspension with a high degree of correspondence between cytologic appearance and biologic activity. c) Programmed gradient sedimentation in an isokinetic gradient of Ficoll in tissue culture medium is an effective means of separating malignant cells from benign cells in this particular ascites tumor. ImagesFig 1Fig 2Fig 3Fig 4 PMID:5080697

  9. A bivariate mixture model analysis of body weight and ascites traits in broilers.

    PubMed

    Zerehdaran, S; van Grevehof, E M; van der Waaij, E H; Bovenhuis, H

    2006-01-01

    The objective of the present study was to use bivariate mixture models to study the relationships between body weight (BW) and ascites indicator traits. Existing data were used from an experiment in which birds were housed in 2 groups under different climate conditions. In the first group, BW, the ratio of right ventricular weight to total ventricular weight (RV:TV), and hematocrit value (HCT) were measured in 4,202 broilers under cold conditions; in the second group, the same traits were measured in 795 birds under normal temperature conditions. Cold-stress conditions were applied to identify individuals that were susceptible to ascites. The RV:TV and HCT were approximately normally distributed under normal temperature conditions, whereas the distributions of these traits were skewed under cold temperature conditions, suggesting different underlying distributions. Fitting a bivariate mixture model to the observations showed that there was only one homogeneous population for ascites traits under normal temperature conditions, whereas there was a mixture of (2) distributions under cold conditions. One distribution contained nonascitic birds and the other distribution contained ascitic birds. In the distribution of nonascitic birds, the inferred phenotypic correlations (phenotypic correlations with 2 distinguishing underlying distributions) of BW with RV:TV and HCT were close to zero (0.10 and -0.07, respectively), whereas in the distribution of ascitic birds, the inferred phenotypic correlations of BW with RV:TV and HCT were negative (-0.39 and -0.4, respectively). The negative inferred correlations of BW with RV:TV and HCT in the distribution of ascitic birds resulted in negative overall correlations (correlations without 2 distinguishing distributions) of BW with RV:TV (-0.30) and HCT (-0.37) under cold conditions. The present results indicate that the overall correlations between BW and ascites traits are dependent on the relative frequency of ascitic and

  10. Refractory materials from lunar resources

    NASA Technical Reports Server (NTRS)

    Fabes, B. D.; Poisl, W. H.

    1991-01-01

    Refractories - materials which are able to withstand extremely high temperatures - are sure to be an important part of any processing facility or human outpost which is built on Mars. Containers for processing lunar oxygen will need high temperature components. Fabrication of structural material from lunar resources need both containment vessels to hold high temperature melts and molds in which to form the final shapes. Certainly, it would be desirable to fabricate such vessels and molds on the Moon, rather than carrying them up from the Earth. At first glance, this might appear to be a trivial task, since the Moon's surface consists of a variety of refractory compositions. To turn the regolith into a useful fire brick or mold, however, will require water or other binders and additives which are likely to be in extremely short supply on the Moon. The steps needed to make fire bricks and molds for lunar-derived structural materials are examined, pointing out the critical steps and resources which will be needed. While these processes and applications may seem somewhat mundane, it is emphasized that it is precisely these rudimentary processes which must be mastered before discussing making aerobrakes, and other fancier refractories from lunar resources.