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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.

  2. Clinical Profile and Complications of Paracentesis in Refractory Ascites Patients With Cirrhosis

    PubMed Central

    Sudulagunta, Sreenivasa Rao; Sodalagunta, Mahesh Babu; Bangalore Raja, Shiva Kumar; Khorram, Hadi; Sepehrar, Mona; Noroozpour, Zahra

    2015-01-01

    Background Large volume paracentesis is found to be safer and more effective for the treatment of tense ascites compared with larger-than-usual doses of diuretics according to studies. The objectives of the study was to evaluate patients with refractory ascites regarding clinical profile, technique of paracentesis, complications, amount of ascites drained, prognosis and co-morbid conditions associated with it. Methods Retrospective study was performed including patients between January 2011 and December 2013 with data pooled from total of five hospitals. A total of 4,389 paracenteses were performed on the 1,218 patients with a mean volume of 4,900 ± 2,795 mL ascitic fluid drained. Blind technique, ultrasound-guided technique of paracentesis and pig tail catheter drainage were evaluated. Diabetes mellitus data from available patients and data regarding co-morbidities were analyzed. Coagulation abnormalities in patients were studied. Results Study group age ranged from 34 to 79 years, and alcohol is the main cause of cirrhosis. Dyslipidemia was observed in 1,080 patients (88.66%). At the time of inclusion in the study, 40% of the patients had ≥ 2 other cirrhosis-related complications and 20% of the study population had ≥ 3 complications. Early complications occurred in 27.5% (337) of patients and late complications constituted 16.83% (205 patients). Conclusions Even with abnormal coagulation, paracentesis is a safe procedure. But significant co-morbidities should be addressed with care in cirrhosis patients. Ultrasound guidance during the procedure whenever required should be encouraged. PMID:27785301

  3. Application of Balloon-Occluded Retrograde Transvenous Obliteration to Gastric Varices Complicating Refractory Ascites

    SciTech Connect

    Fukuda, Tetsuya; Hirota, Shozo; Matsumoto, Shinichi; Sugimoto, Koji; Fujii, Masahiko; Tsurusaki, Masakatsu; Izaki, Kenta; Sugimura, Kazuro

    2004-01-15

    We report two cases of gastric varices complicated by massive ascites that disappeared after balloon-occluded retrograde transvenous obliteration (B-RTO). The first patient had progressive gastric varices that continued to enlarge even after three episodes of esophagogastric variceal bleeding, and the second patient was admitted to our hospital because of the bleeding from gastric varices. After B-RTO procedures in both patients, significant improvement of the ascites, hepatic function reserve, and hypoalbuminemia was observed. Although further experience is needed, our experience points to the likelihood of the amelioration of ascites after B-RTO.

  4. [Refractory ascites and dilutional hyponatremia: current management and new aquaretics].

    PubMed

    Torre Delgadillo, Aldo

    2005-01-01

    Ascites is the most common complication of cirrhosis and is associated with 50% mortality at 2 years if patients do not receive orthotopic liver transplantation. Recently the International Ascites Club defined ascites into three groups: In grade I ascites fluid is detected only by ultrasound; in grade II, ascites is moderate with symmetrical distention of the abdomen; and in Grade 3 ascites is large or tense with marked abdominal distention. About 10% of patients with ascites are refractory to treatment with diuretics. In refractory ascites, patients do not respond to highest doses of diuretics (spironolactone 400 mg/day and furosemide 160 mg/ day) or develop side effects (hyperkalemia, hyponatremia, hepatic encephalopathy, or renal failure) that prohibit their use. Patients may be treated either by repeated large volume paracentesis plus albumin or transjugular intrahepatic portosystemic shunts (TIPS). Dilutional hyponatremia in cirrhotic patients is defined as serum sodium < or = 130 mEq/L in the presence of an expanded extracellular fluid volume, as indicated by the presence of ascites and/or edema. This complication of cirrhotic patients with ascites has recently gained attention given that several reports indicate that when serum sodium concentration is combined with the Model for End-Stage liver disease (MELD) it improves the prognostic accuracy of MELD score in patients awaiting orthotopic liver transplant (OLT). The first step in the management of dilutional hyponatremia is fluid restriction and discontinuation of diuretics. Water restriction at 1,000 mL/day helps prevent the progressive decrease in serum sodium concentration but usually does not correct hyponatremia in most cases. Actually are developing drugs that are active orally and act by selectively antagonizing the specific receptors (V2 receptor) of arginine vasopressin. These agents act in the distal collecting ducts of the kidneys, by increasing solute free water excretion and, thus, improving

  5. Automated low-flow ascites pump for the treatment of cirrhotic patients with refractory ascites.

    PubMed

    Stirnimann, Guido; Banz, Vanessa; Storni, Federico; De Gottardi, Andrea

    2017-02-01

    Cirrhotic patients with refractory ascites (RA) can be treated with repeated large volume paracentesis (LVP), with the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) or with liver transplantation. However, side effects and complications of these therapeutic options, as well as organ shortage, warrant the development of novel treatments. The automated low-flow ascites pump (alfapump(®)) is a subcutaneously-implanted novel battery-driven device that pumps ascitic fluid from the peritoneal cavity into the urinary bladder. Ascites can therefore be aspirated in a time- and volume-controlled mode and evacuated by urination. Here we review the currently available data about patient selection, efficacy and safety of the alfapump and provide recommendations for the management of patients treated with this new method.

  6. Automated low-flow ascites pump for the treatment of cirrhotic patients with refractory ascites

    PubMed Central

    Stirnimann, Guido; Banz, Vanessa; Storni, Federico; De Gottardi, Andrea

    2017-01-01

    Cirrhotic patients with refractory ascites (RA) can be treated with repeated large volume paracentesis (LVP), with the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) or with liver transplantation. However, side effects and complications of these therapeutic options, as well as organ shortage, warrant the development of novel treatments. The automated low-flow ascites pump (alfapump®) is a subcutaneously-implanted novel battery-driven device that pumps ascitic fluid from the peritoneal cavity into the urinary bladder. Ascites can therefore be aspirated in a time- and volume-controlled mode and evacuated by urination. Here we review the currently available data about patient selection, efficacy and safety of the alfapump and provide recommendations for the management of patients treated with this new method. PMID:28203285

  7. 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

  8. [Guidelines for diagnosis and management of cirrhotic ascites and its complications. The Israeli Association for the Study of the Liver].

    PubMed

    Sikuler, Emanuel; Ackerman, Zvi; Braun, Marius; Baruch, Yaakov; Bruck, Refael; Safadi, Rifaat; Shlomai, Amir; Ben-Ari, Ziv

    2012-12-01

    Ascites is the most common manifestation of decompensated liver cirrhosis. The life expectancy of cirrhotic patients developing uncomplicated ascites is 50% for 3 years. Refractory ascites, electrolyte imbalance, hepato-renal syndrome and spontaneous bacterial peritonitis may develop. Successful treatment can improve symptoms and outcomes. This article summarizes the Israeli Association for the Study of the Liver guidelines for diagnosis and management of cirrhotic ascites and its complications.

  9. Refractory ascites in the chronic myeloproliferative syndrome: A case report

    SciTech Connect

    Jacobs, P.; Wood, L.; Robson, S. )

    1991-06-01

    In a patient with myelofibrosis, tense ascites refractory to conventional therapy resulted from extensive seeding of the peritoneum with colonies of extramedullary haematopoiesis. Whole abdominal radiation was found to be effective and well tolerated, and brought about prompt and lasting resorption of the exudate, with weight reduction and improvement in performance status from 50% to 90% on the Karnofsky rating.

  10. 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.

  11. Effects of alfapump system on kidney and circulatory function in patients with cirrhosis and refractory ascites.

    PubMed

    Solà, Elsa; Sanchez-Cabús, Santiago; Rodriguez, Ezequiel; Elia, Chiara; Cela, Raquel; Moreira, Rebeca; Pose, Elisa; Sánchez-Delgado, Jordi; Cañete, Nuria; Morales-Ruiz, Manuel; Campos, Francisco; Balust, Jaume; Guevara, Mónica; García-Valdecasas, Juan Carlos; Ginès, Pere

    2017-03-20

    The alfapump system has been proposed as a new treatment for the management of refractory ascites. The system removes ascites from the peritoneal cavity to urinary bladder, producing a continuous low-volume paracentesis.

  12. Bile Duct Perforation due to Inspissated Bile Presenting as Refractory Ascites.

    PubMed

    Lal, Bikrant Bihari; Bharathy, Kishore G; Alam, Seema; Khanna, Rajeev; Patidar, Yashwant; Rawat, Dinesh

    2016-09-01

    Non hepatic origin of refractory ascites is not a rarity. Hemolytic anemias are known to cause inspissated bile and biliary obstruction. Distal biliary obstruction can lead to biliary perforation. The authors report a case of hereditary spherocytosis leading to inspissated bile causing bile duct perforation and biliary ascites. A high index of suspicion for biliary ascites should be kept in a child with refractory ascites in the setting of progressive ascites with decreasing bilirubin. Ascitic fluid bilirubin analysis will clinch the diagnosis. Surgical repair is the optimal management.

  13. Clinical efficacy of tolvaptan for treatment of refractory ascites in liver cirrhosis patients

    PubMed Central

    Zhang, Xin; Wang, Shu-Zhen; Zheng, Jun-Fu; Zhao, Wen-Min; Li, Peng; Fan, Chun-Lei; Li, Bing; Dong, Pei-Ling; Li, Lei; Ding, Hui-Guo

    2014-01-01

    AIM: To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular carcinoma. METHODS: Thirty-nine patients (mean age 55 years, males: 32) with decompensated liver cirrhosis and refractory ascites were enrolled. All patients received a combination of tolvaptan (15 mg/d for 5-14 d) and diuretics (40-80 mg/d of furosemide and 80-160 mg/d of spironolactone). The etiology of cirrhosis included hepatitis B (69.2%), hepatitis C (7.7%) and alcohol-induced (23.1%). Changes in the urine excretion volume, abdominal circumference and edema were assessed. The serum sodium levels were also measured, and adverse events were recorded. A follow-up assessment was conducted 1 mo after treatment with tolvaptan. RESULTS: Tolvaptan increased the mean urine excretion volume (1969.2 ± 355.55 mL vs 3410.3 ± 974.1 mL, P < 0.001), and 89.7% of patients showed improvements in their ascites, 46.2% of whom showed significant improvements. The overall efficacy of tolvaptan in all patients was 89.7%; the efficacies in patients with hepatocellular carcinoma and hepatorenal syndrome were 84.2% and 77.8%, respectively. The incidence of hyponatremia was 53.8%. In patients with hyponatremia, the serum sodium levels increased after tolvaptan treatment (from 128.1 ± 4.22 mEq/L vs 133.1 ± 3.8 mEq/L, P < 0.001). Only mild drug-related adverse events, including thirst and dry mouth, were observed. CONCLUSION: Tolvaptan is a promising aquaretic for the treatment of refractory ascites in patients with decompensated liver cirrhosis. PMID:25170228

  14. [Septic ascites: a rare post-operative complication].

    PubMed

    La Torre, F; Taglienti, D; de Anna, L; Masoni, L; Gasparrini, M; Viola, M; Nicolai, A P; Lucidi, V; Montori, A

    1995-01-01

    Spontaneous bacterial peritonitis in patients with chronic hepatitis represents a very controversial matter in terms of frequency, pathology and treatment. This unusual complication mainly due to decreased immunological defences and ascitic fluid opsonic activity is not accepted by all the Authors as a rare event. However, there is agreement as far as management is concerned: cultural examination of the ascitic fluid and the relative antibiogram are the best tools in guiding the approach to an adequate antibiotic therapy.

  15. Splenic artery embolization for the treatment of refractory ascites after liver transplantation.

    PubMed

    Quintini, Cristiano; D'Amico, Giuseppe; Brown, Chase; Aucejo, Federico; Hashimoto, Koji; Kelly, Dympna M; Eghtesad, Bijan; Sands, Mark; Fung, John J; Miller, Charles M

    2011-06-01

    Refractory ascites (RA) is a challenging complication after orthotopic liver transplantation. Its treatment consists of the removal of the precipitating factors. When the etiology is unknown, supportive treatment can be attempted. In severe cases, transjugular intrahepatic portosystemic shunts, portocaval shunts, and liver retransplantation have been used with marginal results. Recently, splenic artery embolization (SAE) has been described as an effective procedure for reducing portal hyperperfusion in patients undergoing partial or whole liver transplantation. Here we describe our experience with SAE for the treatment of RA. Between June 2004 and June 2010, 6 patients underwent proximal SAE for RA. Intraoperative flow measurements, graft characteristics, embolization portal vein (PV) velocities before and after SAE, and spleen/liver volume ratios were collected and analyzed. The response to treatment was assessed with imaging (ultrasound/computed tomography) and on the basis of clinical outcomes (weight changes, diuretic requirements, and the time to ascites resolution). The PV velocity decreased significantly for each patient after the embolization (median = 66.5 cm/second before SAE and median = 27.5 cm/second after SAE, P < 0.01). All patients experienced a significant postprocedural weight loss (mean = 88.1 ± 28.4 kg before SAE and mean = 75.8 ± 28.4 kg after SAE, P < 0.01) and a dramatic decrease in their diuretic requirements. All but 1 of the patients experienced a complete resolution of ascites after a median time of 49.5 days (range = 12-295 days). No patient presented with postembolization complications. In conclusion, SAE was effective in reducing the PV velocity immediately after the procedure. Clinically, this translated into a dramatic weight loss, a reduction of diuretic use, and a resolution of ascites. SAE appears to be a safe and effective treatment for RA.

  16. Cases with Refractory Ascites and a Delayed Response to Tolvaptan

    PubMed Central

    Hagiwara, Satoru; Nishida, Naoshi; Chishina, Hirokazu; Ida, Hiroshi; Sakurai, Toshiharu; Komeda, Yoriaki; Kitano, Masayuki; Kudo, Masatoshi

    2016-01-01

    The patient was a 67-year-old female with liver cirrhosis due to hepatitis C. She was administered furosemide at 20 mg/day and spironolactone at 25 mg/day, but the ascites did not improve. Despite the additional administration of tolvaptan at 3.75 mg/day, the response to ascites was still poor. While the dose of tolvaptan was thereafter increased to 7.5 mg/day on the 7th hospital day, the ascites still persisted. However, she continued to receive tolvaptan (7.5 mg/day) because the worsening of her subjective symptoms was mild and she wished to do so. The ascites was later found to have almost completely disappeared on computed tomography (CT) at 6 months. PMID:27853068

  17. The transjugular intrahepatic portosystemic shunt for the management of cirrhotic refractory ascites.

    PubMed

    Garcia-Tsao, Guadalupe

    2006-07-01

    Cirrhotic ascites results from sinusoidal hypertension and sodium retention, which is secondary to a decreased effective arterial blood volume. Transjugular intrahepatic portosystemic shunt (TIPS) placement is currently indicated in cirrhotic patients with refractory ascites who require large-volume paracentesis (LVP) more than two or three times per month. TIPS placement is associated with normalization of sinusoidal pressure and a significant improvement in urinary sodium excretion that correlates with suppression of plasma renin activity, which is, itself, indicative of an improvement in effective arterial blood volume. Compared with serial LVP, placement of an uncovered TIPS stent is more effective at preventing ascites from recurring; however, increased incidence of hepatic encephalopathy and shunt dysfunction rates after TIPS placement are important issues that increase its cost. Although evidence suggests that TIPS placement might result in better patient survival, this needs to be confirmed, particularly in light of the development of polytetrafluoroethylene-covered stents. Favorable results apply to centers experienced in placing the TIPS, with the aim being to decrease the portosystemic gradient to <12 mmHg but >5 mmHg. This article reviews the pathophysiologic basis for the use of a TIPS in patients with refractory ascites, the results of controlled trials comparing TIPS placement (using uncovered stents) versus LVP, and a systematic review of predictors of death after TIPS placement for refractory ascites.

  18. Inferior Vena Cava Torsion and Stenosis Complicated by Compressive Pericaval Regional Ascites following Orthotopic Liver Transplantation

    PubMed Central

    Gilroy, Richard; Johnson, Philip

    2013-01-01

    Inferior vena cava (IVC) stenosis and torsion are well-described rare complications following orthotopic liver transplantation (OLT). We present a case of inferior vena cava intermittent torsion and stenosis complicated by compressive regional ascites. To the best of our knowledge, this is the second case of post-OLT regional ascites related compressive IVC stenosis reported and the first reported case of torsion complicated by regional ascites compression. PMID:24386585

  19. Management of refractory ascites in cirrhosis: Are we out of date?

    PubMed Central

    Annamalai, Alagappan; Wisdom, Lauren; Herada, Megan; Nourredin, Mazen; Ayoub, Walid; Sundaram, Vinay; Klein, Andrew; Nissen, Nicholas

    2016-01-01

    Cirrhosis is a major cause of morbidity and mortality worldwide with liver transplantations as it only possible cure. In the face of a significant organ shortage many patients die waiting. A major complication of cirrhosis is the development of portal hypertension and ascites. The management of ascites has barely evolved over the last hundred years and includes only a few milestones in our treatment approach, but has overall significantly improved patient morbidity and survival. Our mainstay to ascites management includes changes in diet, diuretics, shunt procedures, and large volume paracentesis. The understanding of the pathophysiology of cirrhosis and portal hypertension has significantly improved in the last couple of decades but the changes in ascites management have not seemed to mirror this newer knowledge. We herein review the history of ascites management and discuss some its current limitations. PMID:27729954

  20. Fibrin glue application in the management of refractory chylous ascites in children.

    PubMed

    Zeidan, S; Delarue, A; Rome, A; Roquelaure, B

    2008-04-01

    The purpose of this retrospective review of the charts of 6 children who underwent surgical treatment of chylous ascites refractory to conservative measures between 1993 and 2006 was to evaluate the efficiency of fibrin glue application for control of lymph leakage. Five children had postoperative chylous ascites (neuroblastoma, 4; cystic lymphangioma, 1) and 1 had a congenital malformation. Surgical exploration revealed large areas of diffuse lymphatic leakage in all of the patients. Lymphatic fistula was not identified intraoperatively in any patient. Ingestion of lipophilic dye in a concentrated fatty meal was not helpful in locating a lymph fistula. Absorbable mesh was used in association with glue application in the last 3 patients treated. Control of ascites was achieved immediately in 2 patients and within 3 weeks in 2 patients. Repeat surgery was required in the remaining 2 patients. The mean follow-up time was 4.3 years. One patient died of tumor recurrence 12 months after surgical treatment without relapse of the ascites. Two mild late recurrences were observed at 6 and 11 months after surgery and were managed conservatively. The findings of this study show that fibrin glue application on absorbable mesh after dissection of the leakage zones is easy, safe, and effective. We recommend that surgery with glue application be repeated until control of ascites is achieved. We suggest fibrin glue application as a preventive measure against postoperative chylous ascites.

  1. 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.

  2. Peritoneal ultrafiltration for refractory fluid overload and ascites due to pulmonary arterial hypertension.

    PubMed

    Husain-Syed, Faeq; Muciño-Bermejo, María-Jimena; Ronco, Claudio; Seeger, Werner; Birk, Horst-Walter

    2015-01-01

    Pulmonary hypertension is a common finding in patients with advanced liver disease. Similarly, among patients with advanced pulmonary arterial hypertension, right heart failure leads to congestive hepatopathy. Diuretic resistant fluid overload in both advanced pulmonary hypertension and chronic liver disease is a demanding challenge for physicians. Venous congestion and ascites-induced increased intra-abdominal pressure are essential regarding recurrent hospitalization, morbidity and mortality. Due to impaired right-ventricular function, many patients cannot tolerate extracorporeal ultrafiltration. Peritoneal dialysis, a well-established, hemodynamically tolerated treatment for outpatients may be a good alternative to control fluid status. We present a patient with pulmonary arterial hypertension and congestive hepatopathy hospitalized for over 3 months due to ascites induced refractory volume overload treated with peritoneal ultrafiltration. We report the treatment benefits on fluid balance, cardiorenal and pulmonary function, as well as its safety. In conclusion, we report a case in which peritoneal ultrafiltration was an efficient treatment option for refractory ascites in patients with congestive hepatopathy.

  3. Refractory ascites in systemic lupus erythematosus: further biological support of intraperitoneal steroid treatment as a suitable therapeutical option.

    PubMed

    Atisha-Fregoso, Yemil; Hernández-Ramírez, Diego F; Olivares-Martínez, Elizabeth; Núñez-Alvarez, Carlos A; Llorente, Luis; Hernández-Molina, Gabriela

    2017-03-01

    The objective of this report was to evaluate the ascitic fluid of a patient with refractory lupus ascites (proband) at different time points-pre- and post-intraperitoneal treatment with dexamethasone-using a multiparametric approach which included the presence of autoantibodies and pro- and anti-inflammatory cytokines and chemokines, and a proteomic analysis. As controls, we studied two additional patients also with lupus ascites (only at basal evaluation) and two patients with ascites due to alcoholic liver cirrhosis. High levels of anti-dsDNA and anti-nucleosomes autoantibodies were detected in the ascitic fluid of all lupus patients and remained elevated in the proband throughout the follow-up. All lupus patients have detectable ascitic high levels of IL-6, IL-8, IL-10, TNF-α, MCP-1, and IGF-1 which diminished gradually in the proband after intraperitoneal dexamethasone. In the proteomic analysis of the ascitic fluid, a marked increment of apolipoprotein A1 was observed and again, it diminished gradually after intraperitoneal treatment. Our findings further support the use of intraperitoneal steroids as an effective therapeutic option for refractory ascites in systemic lupus erythematosus.

  4. Long-term medical management and complications of `resistant' ascites

    PubMed Central

    Summerskill, William H. J.; Clowdus, Bernard F.; Rosevear, John W.

    1961-01-01

    This paper reports the experience of treating patients with hepatic cirrhosis and ascites with an aldosterone inhibitor in addition to conventional therapy. Good results are demonstrated in 13 patients previously resistant to treatment. PMID:13918387

  5. 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.

  6. 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

  7. Immune-Inflammatory and Metabolic Effects of High Dose Furosemide plus Hypertonic Saline Solution (HSS) Treatment in Cirrhotic Subjects with Refractory Ascites

    PubMed Central

    Bellia, Chiara; Clemente, Giuseppe; Pecoraro, Rosaria; Maida, Carlo; Simonetta, Irene; Vassallo, Valerio; Di Bona, Danilo; Gulotta, Eliana; Ciaccio, Marcello; Pinto, Antonio

    2016-01-01

    Introduction Patients with chronic liver diseases are usually thin as a result of hypermetabolism and malnutrition expressed by reduced levels of leptin and impairment of other adyponectins such as visfatin. Aims We evaluated the metabolic and inflammatory effects of intravenous high-dose furosemide plus hypertonic saline solutions (HSS) compared with repeated paracentesis and a standard oral diuretic schedule, in patients with cirrhosis and refractory ascites. Methods 59 consecutive cirrhotic patients with refractory ascites unresponsive to outpatient treatment. Enrolled subjects were randomized to treatment with intravenous infusion of furosemide (125–250mg⁄bid) plus small volumes of HSS from the first day after admission until 3 days before discharge (Group A, n:38), or repeated paracentesis from the first day after admission until 3 days before discharge (Group B, n: 21). Plasma levels of ANP, BNP, Leptin, visfatin, IL-1β, TNF-a, IL-6 were measured before and after the two type of treatment. Results Subjects in group A were observed to have a significant reduction of serum levels of TNF-α, IL-1β, IL-6, ANP, BNP, and visfatin, thus regarding primary efficacy endpoints, in Group A vs. Group B we observed higher Δ-TNF-α, Δ-IL-1β, Δ-IL-6, Δ-ANP, Δ-BNP, Δ-visfatin, Δ-Leptin at discharge. Discussion Our findings underline the possible inflammatory and metabolic effect of saline overload correction in treatment of cirrhosis complications such as refractory ascites, suggesting a possible role of inflammatory and metabolic-nutritional variables as severity markers in these patients. PMID:27941973

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

    PubMed Central

    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

  9. Malignant biliary obstruction complicated by ascites: Closure of the transhepatic tract with cyanoacrylate glue after placement of an endoprosthesis

    SciTech Connect

    Cekirge, Saruhan; Akhan, Okan; Ozmen, Mustafa; Saatci, Isil; Besim, Aytekin

    1997-05-15

    A new technique using cyanoacrylate glue is suggested for closing the transparenchymal tract following metallic endoprosthesis placement in a patient with malignant biliary obstruction complicated by ascites. With this technique, complications related to bile reflux through the transparenchymal tract would be avoided after transhepatic endoprosthesis placement in patients who have ascites. This technique would also be useful for avoiding bleeding following transhepatic portal venous puncture.

  10. Denver peritoneovenous shunt in the management of refractory ascites due to chronic liver diseases: impact of patients selection on its outcome.

    PubMed

    Abbas, Mohamed; El Damarawy, Mervat; Seyam, Moataz; Awad, Alaa; Madkour, Mona Ezzat; Salah, Mohamed

    2007-12-01

    Forty four patients with refractory ascites due to chronic liver diseases that fulfilling the inclusion criteria of selection were divided into 2 groups. The first group (GI, n=24) was subdivided into 2 subgroups according to degree of liver condition; GIa (n=11) with Child-Pugh class B and GIb (n=13) with early class C. The patients were subjected to P-V shunt (Denver group). Similarly, patients in the second group (GII, n=20) were divided into 2 subgroups GIIa (n=10) & GIIb (n=10) respectively and treated by the repeated tapping and albumin infusion (control group). Postoperative results revealed a significant increase in urine out put (P<0.001), decrease in abdominal girth (P<0.01) and body weight (p<0.01) with more patients fitness and satisfaction than in controls. Postoperative complications were more in GIb. Ascites recurrence occurred in 3 (23%) patients in GIb due to severe infection (2 cases) and irreversible shunt obstruction (1 case) and without recurrence in GIa. So, Denver P-V shunt offers a good palliation in such patients, but its use is more justified in selected cases.

  11. 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.

  12. PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

    PubMed Central

    Tapping, C R; Ling, L; Razack, A

    2012-01-01

    Objectives The aim of this article was to assess the success, safety, complication profile and factors associated with long-term patency of tunnelled peritoneal drains (PleurX) in the treatment of refractory malignant ascites. Methods Over a 4-year period, 28 consecutive patients (32 drain insertions) with refractory malignant ascites were treated with a PleurX drain. The study group comprised 7 males and 21 females (mean age, 61 years). A combination of fluoroscopic and ultrasound guidance was used to insert 4 drains; the remaining 28 drains were inserted under ultrasound guidance alone. Patient history, biochemical profiles, pathological and procedural records and clinical follow-up until death were reviewed. Statistical analysis included multivariate logistic regression analysis and Kaplan–Meier curves (p<0.05 was considered significant). Results There was a 100% technical success rate for the insertion of the drain; there were no procedure-related deaths and no major complications. Only minor complications were reported: three (10%) immediate; three (10%) early; and two (7%) late. Factors significantly associated with these complications included current chemotherapy, low haemoglobin levels, low albumin levels, high white cell count and high c-reactive protein levels. The length of time the drains remained in situ, and therefore patent, ranged from 5 to 365 days (mean, 113 days). Out of the original 28 tunnelled drains, 24 (86%) remained in situ and functioning until the patients’ death. Four (14%) drains dislodged and a subsequent PleurX drain was inserted on the opposite side of the abdominal wall. These new drains remained patent until the patient’s death. The annual event rate was 0.45 events per year. A comorbid diagnosis of renal disease or chemotherapy was significantly related to a decreased length of patency. Conclusion The use of tunnelled peritoneal drains is safe and effective and we would advocate their use as a first-line approach in

  13. Ethacrynic acid can be effective for refractory congestive heart failure and ascites.

    PubMed

    Alisky, Joseph M; Tuttle, Thomas F

    2003-11-01

    Ethacrynic acid is a loop diuretic little used today because of its side-effect profile and the availability of multiple alternative agents. However, in our clinical experience, ethacrynic acid can alleviate acute congestive heart failure and ascites resistant to other diuretics. Two patients aged 89 and 94 in life-threatening pulmonary edema were stabilized by ethacrynic acid after furosemide proved ineffective. A third patient, aged 83, with a pleural effusion and ascites secondary to end-stage hepatitis B and C, responded to ethacrynic acid when spironolactone and furosemide produced little urine output. Ethacrynic acid may have a unique niche as a diuretic of last resort, especially in geriatric practice.

  14. Pregnancy Complicated by Gorham–Stout Disease and Refractory Chylothorax

    PubMed Central

    Hellyer, Jessica; Oliver-Allen, Hunter; Shafiq, Majid; Tolani, Alisha; Druzin, Maurice; Jeng, Michael; Rockson, Stanley; Lowsky, Robert

    2016-01-01

    Introduction Gorham–Stout Disease (GSD) is a rare disorder of bony destruction due to lymphangiomatosis, and is often triggered by hormones. One complication of GSD is the development of chylothorax, which carries a high mortality rate. Very little experience has been published to guide management in GSD during pregnancy to optimize both fetal and maternal health. Case Study A 20-year-old woman with known GSD presented with shortness of breath at 18 weeks of pregnancy, due to bilateral chylothoraces which required daily drainage. To minimize chylous fluid formation, she was placed on bowel rest with total parenteral nutrition (limiting lipid intake) and received octreotide to decrease splanchnic blood flow and chylous fluid drainage. Treatment options were limited due to her pregnancy. Twice daily home chest tube drainage of a single lung cavity, total parenteral nutrition, octreotide, and albumin infusions allowed successful delivery of a healthy 37 weeks' gestation infant by cesarean delivery. Discussion This case illustrates the management of a rare clinical disease of bone resorption and lymphangiomatosis complicated by bilateral, refractory chylothoraces, triggered by pregnancy, in whom treatment options are limited, and the need for a multidisciplinary health care team to ensure successful maternal and fetal outcomes. PMID:27708981

  15. [A case of a patient with splenic arteriovenous fistula associated with portal hypertension who developed refractory ascites and diarrhea as initial symptom].

    PubMed

    Hino, Naoyuki; Matsuzaki, Toshihisa; Komatsu, Naohiro; Akiyama, Motohisa; Ozawa, Eisuke; Miuma, Satoshi; Takeshita, Shigeyuki; Otani, Masashi; Miyaaki, Hisamitsu; Taura, Naota; Yamaguchi, Naoyuki; Onita, Ken; Ichikawa, Tatsuki; Isomoto, Hajime; Takeshima, Fuminao; Nakao, Kazuhiko

    2013-06-01

    A 55-year-old woman was admitted to our hospital because of diverse symptoms of portal hypertension, such as refractory ascites, diarrhea, and general malaise. Blood test revealed liver and renal dysfunction and glucose tolerance. Contrast enhancement computed tomography revealed splenic arteriovenous fistula with dilated splenic artery and vein, causing portal hypertension. The splenic arteriovenous fistula was successfully treated by percutaneous transarterial embolization, resulting in the complete recovery of the patient. Herein, we report a case of arteriovenous fistula which was successfully treated with the aid of interventional radiology.

  16. Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites. Another look.

    PubMed

    Mauer, K; Manzione, N C

    1988-10-01

    The serum-ascites albumin difference is reported to be superior to ascitic total protein, ascitic-to-serum total protein ratio, lactic dehydrogenase, and ascitic-to-serum lactic dehydrogenase ratio in differentiating between ascites from liver disease and malignant ascites, S-A greater than 1.1 reflecting portal hypertension. We analyzed ascitic fluid from 46 consecutive patients with chronic liver disease, 28 patients with ascites associated with malignancy, 10 patients with right-sided heart failure, 4 patients with hypothyroidism, and 6 patients with miscellaneous causes of ascites to determine if this albumin difference is indeed a more valuable parameter. Analysis of our data confirms with a larger number of patients that the serum-ascites albumin difference is a more reliable indicator of transudative ascites, better termed portal hypertensive ascites. Malignant ascites without liver metastases had features of nonportal hypertensive ascites, and the serum-ascites albumin difference confirms this. The characteristics of malignant ascites associated with liver metastases, however, resemble those of the portal hypertensive ascites complicating liver disease. This new parameter is also helpful in distinguishing congestive heart failure with high protein ascites and portal hypertensive ascitic features from malignant ascites without liver metastases. Of particular note, myxedematous ascitic fluid, classically categorized as exudative, had an S-A greater than 1.1, indicating the possible role of portal hypertension in the development of ascites in these patients.

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

    PubMed

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

    2012-12-05

    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.

  18. Observed medical and surgical complications of prolonged barbiturate coma for refractory status epilepticus

    PubMed Central

    Newey, Christopher R.; Wisco, Dolora; Nattanmai, Premkumar; Sarwal, Aarti

    2016-01-01

    Background: Refractory status epilepticus is often treated with third-line therapy, such as pentobarbital coma. However, its use is limited by side effects. Recognizing and preventing major and minor adverse effects of prolonged pentobarbital coma may increase good outcomes. This study retrospectively reviewed direct and indirect medical and surgical pentobarbital coma. Methods: Retrospective chart review of all patients with refractory status epilepticus treated with pentobarbital over a 1 year period at a large tertiary care center. We collected baseline data, EEG data, and complications that were observed. Results: Overall, nine patients [median age 46.4 (IQR 21.7, 75.5) years] were induced with pentobarbital coma median 11 (IQR 3, 33) days after seizure onset for a median of 9 (IQR 3.5, 45.4) days. A total of four to eight concurrent antiepileptics were tried prior to the pentobarbital coma. Phenobarbital, due to recurrence of seizures on weaning pentobarbital coma, was required in seven patients. Observed complications included peripheral neuropathy (77.8%), cerebral atrophy (33.3%), volume overload (44.4%), renal/metabolic (77.8%), gastrointestinal (66.6%), endocrine (55.6%), cardiac/hemodynamic/vascular (77.8%), respiratory (100%), and infectious (77.8%). The number of complications trended with duration of induced coma but was nonsignificant. Median ICU length of stay was 40 (IQR 28, 97.5) days. Overall, five patients were able to follow commands after a median 37 (IQR 25.5, 90) days from coma onset. There were eight patients that were discharged from hospital with three remaining in a prolonged unresponsive state. There was one patient that died prior to discharge. Conclusions: This study highlights the high morbidity in patients with refractory status epilepticus requiring pentobarbital coma. Anticipating and addressing the indirect and direct complications in prolonged pentobarbital coma may improve survival and functional outcomes in patients with

  19. 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

  20. Unusual presentation of direct intraperitoneal metastases complicated with massive ascites from plasmacytoid variant of bladder cancer and adenocarcinoma of colon

    PubMed Central

    Shao, Yu-Hua; Kao, Chien-Chang; Tang, Shou-Hung; Cha, Tai-Lung; Tsao, Chih-Wei; Meng, En; Yu, Dah-Shyong; Sun, Guang-Huan; Wu, Sheng-Tang

    2017-01-01

    Abstract Background: Plasmacytoid urothelial carcinoma (PUC) is a distinct variant of urinary bladder cancer, with a high propensity for invasion and poor prognosis. These tumors occur most commonly in male patients with the age of reported cases ranging from 46 to 87 years. Case report: We present a case of a 74-year-old male patient having massive ascites and bilateral lower leg edema. Colonoscopy showed a 3-cm lesion in the sigmoid colon and an edematous nonpapillary tumor was found by cystoscopy in the bladder. Histopathology analysis of the biopsies showed adenocarcinoma of colon and PUC of bladder. The diagnosis of PUC with peritoneal carcinomatosis was then confirmed by immunohistochemical stain. Conclusion: The diagnostic dilemmas of the unusual variant of urothelial malignancy, the origin of peritoneal metastasis, and its clinical impact are discussed in the present case. PMID:28207504

  1. 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.

  2. 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.

  3. Mobilization of malignant ascites with diuretics is dependent on ascitic fluid characteristics.

    PubMed

    Pockros, P J; Esrason, K T; Nguyen, C; Duque, J; Woods, S

    1992-10-01

    Serial ascites and plasma volumes were measured during diuresis in nine patients with ascites caused by peritoneal carcinomatosis, four patients with chylous malignant ascites, and three patients with portal hypertension-related ascites caused by massive hepatic metastases. Oral diuretics were given to achieve an adequate natriuresis on a sodium-restricted diet. During the study period (7.8 +/- 3.2 days), patients with peritoneal carcinomatosis and chylous ascites lost 0.49 +/- 0.31 and 0.51 +/- 0.42 kg/day in weight, respectively, with negligible change in ascites volumes (-0.03 +/- 0.11 and 0.02 +/- 0.09 L/day). Patients with ascites caused by massive hepatic metastasis lost 1.06 +/- 0.15 kg/day in weight (P = 0.01 for massive hepatic metastasis vs. peritoneal carcinomatosis) and 0.23 +/- 0.13 L/day of ascites (P less than 0.05 vs. other groups). Plasma volume changes were not significantly different among the three groups. Patients with edema (9/16) had a greater natriuresis and daily weight loss. Three patients with peritoneal carcinomatosis and one with chylous ascites developed renal dysfunction or symptomatic hypotension. No patient with massive hepatic metastasis developed these complications. In patients with ascites caused by peritoneal carcinomatosis or chylous malignant ascites there is no mobilization of ascites, whereas in patients with massive hepatic metastasis, ascites may be mobilized with diuretics.

  4. 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

  5. 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

  6. Chylous ascites caused by resection of a choledochal cyst.

    PubMed

    Mizukami, Tatsuzo; Okada, Tadao; Honda, Shohei; Miyagi, Hisayuki; Minato, Masashi; Todo, Satoru

    2012-01-01

    Chylous ascites is a rare complication of abdominal surgery in children. Particularly, reports of postoperative chylous ascites are rare. This report describes the very rare case of a 10-month-old girl complicated by chylous ascites after resection of a choledochal cyst with a Roux-en-Y hepaticojejunostomy, who was successfully treated medically. To date, we have found a few cases of postoperative chylous ascites in the paediatric literature. To the best of our knowledge, this is the first report of chylous ascites after the resection of a choledochal cyst in a child who was successfully treated solely by no fasting. No fasting might be a therapeutic option of paediatric postoperative chylous ascites after the resection of a choledochal cyst if the outflow volume of chylous ascites is small.

  7. Predictive factors for skeletal complications in hormone-refractory prostate cancer patients with metastatic bone disease

    PubMed Central

    Berruti, A; Tucci, M; Mosca, A; Tarabuzzi, R; Gorzegno, G; Terrone, C; Vana, F; Lamanna, G; Tampellini, M; Porpiglia, F; Angeli, A; Scarpa, R M; Dogliotti, L

    2005-01-01

    Factors predictive of skeletal-related events (SREs) in bone metastatic prostate cancer patients with hormone-refractory disease were investigated. We evaluated the frequency of SREs in 200 hormone-refractory patients consecutively observed at our Institution and followed until death or the last follow-up. Baseline parameters were evaluated in univariate and multivariate analysis as potential predictive factors of SREs. Skeletal-related events were observed in 86 patients (43.0%), 10 of which (5.0%) occurred before the onset of hormone-refractory disease. In univariate analysis, patient performance status (P=0.002), disease extent (DE) in bone (P=0.0001), bone pain (P=0.0001), serum alkaline phosphatase (P=0.0001) and urinary N-telopeptide of type one collagen (P=0.0001) directly correlated with a greater risk to develop SREs, whereas Gleason score at diagnosis, serum PSA, Hb, serum albumin, serum calcium, types of bone lesions and duration of androgen deprivation therapy did not. Both DE in bone (hazard ratio (HR): 1.16, 95% confidence interval (CI): 1.07–1.25, P=0.000) and pain score (HR: 1.13, 95% CI: 1.06–1.20, P=0.000) were independent variables predicting for the onset of SREs in multivariate analysis. In patients with heavy tumour load in bone and great bone pain, the percentage of SREs was almost twice as high as (26 vs 52%, P<0.02) and occurred significantly earlier (P=0.000) than SREs in patients with limited DE in bone and low pain. Bone pain and DE in bone independently predict the occurrence of SREs in bone metastatic prostate cancer patients with hormone-refractory disease. These findings could help physicians in tailoring the skeletal follow-up most appropriate to individual patients and may prove useful for stratifying patients enrolled in bisphosphonate clinical trials. PMID:16222309

  8. 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.

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

    SciTech Connect

    Pereira, Keith

    2016-02-15

    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.

  10. Ascitic fluid analysis in malignancy-related ascites.

    PubMed

    Runyon, B A; Hoefs, J C; Morgan, T R

    1988-01-01

    A prospective study identified 45 patients with malignancy-related ascites among 448 ascites patients (10% of the total). Patients were categorized into five subgroups based on the pathophysiology of ascites formation. Each subgroup had a distinctive ascitic fluid analysis. Patients with peritoneal carcinomatosis but without massive liver metastases (53.3% of the patients with malignancy-related ascites) had a uniformly positive ascitic fluid cytology, high ascitic fluid protein concentration and low serum-ascites albumin gradient. Patients with massive liver metastases and no other cause for ascites formation (13.3% of the series) had a negative cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Those with peritoneal carcinomatosis and massive liver metastases (13.3% of the series) had a nearly uniformly positive ascitic fluid cytology, variable protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Chylous ascites (6.7%) was characterized by a milky appearance, negative cytology and an elevated ascitic fluid triglyceride concentration. Patients with hepatocellular carcinoma superimposed on cirrhosis (13.3%) had negative ascitic fluid cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and elevated serum and ascitic fluid alpha-fetoprotein concentration. Two-thirds of patients with malignancy-related ascites had peritoneal carcinomatosis; 96.7% of patients with peritoneal carcinomatosis had positive ascitic fluid cytology. Ascitic fluid analysis is helpful in identifying and distinguishing the subgroups of malignancy-related ascites.

  11. 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.

  12. Selective endovascular embolization for refractory idiopathic epistaxis is a safe and effective therapeutic option: technique, complications, and outcomes.

    PubMed

    Cohen, José E; Moscovici, Samuel; Gomori, John M; Eliashar, Ron; Weinberger, Jeffrey; Itshayek, Eyal

    2012-05-01

    Epistaxis generally responds to conservative management, but a more invasive approach, such as superselective embolization, is sometimes justified. We report our experience with endovascular procedures in 19 patients from 2002 to 2011 for the treatment of refractory idiopatic posterior epistaxis. The sphenopalatine artery and distal internal maxillary arteries were embolized in all patients. Unilateral embolization was performed in 12 patients (63%), bilateral embolization in seven (37%). Additional embolization of the descending palatine artery was performed in eight patients (42%) and embolization of the facial artery and palatine arteries in four (21%). In one patient the distal ophthalmic artery was embolized with n-butyl cyanoacrylate. No minor or major complications occurred in relation to the embolization procedures. The average hospital stay was 11.1±8.6 days, including an average 5.2±3.4 days after embolization. Average follow-up after discharge was 21.3±25.7 months. Superselective endovascular embolization proved safe and effective in controlling idiopathic epistaxis, refractory to other maneuvers.

  13. Reoperation in an adult female with "right-sided" Hirschsprung's disease complicated by refractory hypertension and cough

    PubMed Central

    Wei, Zhi-Jian; Huang, Lei; Xu, A-Man

    2016-01-01

    Hirschsprung’s disease (HD) is an intestinal malformation caused by the innate absence of ganglion cells in the neural plexus of the colorectal wall, and is most common in male infants. It is rare in adult, and is usually left-sided. Herein we reported based on the CARE guidelines a case of a 47-year-old adult female suffering from “right-sided” HD complicated by refractory hypertension and cough. The patient with a history of cesarean section and with digestive unfitness (abdominal pain, distention, and constipation) only since 20 years old had recurrence of HD after initial surgery due to the incomplete removal of the HD-affected bowel based on a diagnosis of “chronic ileus”, leading to the relapse of the digestive symptoms and the emergence of some intractable circulatory and respiratory complications which could be hardly controlled by conservative treatment. During the long interval before coming to our department for help, she had been re-hospitalized for several times with various misdiagnoses and supplied merely with symptomatic treatment which could only achieve temporary symptomatic relief. At her admission to our department, the imaging examinations strongly indicated recurrent HD which was further supported by pathological examinations, and right hemi-colectomy was performed to remove the remnant aganglionic intestinal segment. Intraoperative and postoperative pathology supported the completeness of the definitive resection. Post-operation, the patient’s bowel motility significantly improved, and interestingly, the complications disappeared. For adult patients with long-term constipation combined with cough and hypertension, rare diseases like HD which requires definite surgery and which could be “right-sided” should not be overlooked. It is vital to diagnose and cure HD patients in childhood. Through the comparison of the two surgeries, it is noteworthy that for diagnosed HD, sufficient removal of the non-functional intestine confirmed

  14. A Case of Successful Conservative Treatment for Chylous Ascites After Living-Donor Liver Transplantation

    PubMed Central

    Shiba, Hiroaki; Wakiyama, Shigeki; Gocho, Takeshi; Ishida, Yuichi; Misawa, Takeyuki; Yanaga, Katsuhiko

    2012-01-01

    A 46-year-old man underwent living-donor liver transplantation and splenectomy for primary biliary cirrhosis. On postoperative day 22, cloudiness of ascites increased, and triglyceride concentration in ascites was as high as 1046 mg/dL. With a diagnosis of chylous ascites, total parenteral nutrition was started. Nine days after starting total parenteral nutrition, cloudiness of ascites decreased, and triglycerides in ascites decreased to 93 mg/dL. Oral intake was restarted, and the patient was discharged on postoperative day 46. Chylous ascites is a rare complication after living-donor liver transplantation for which total parenteral nutrition may be useful. PMID:23294080

  15. Spontaneous Fungal Peritonitis in Ascites of Cardiac Origin

    PubMed Central

    Gandhi, Seema; Attar, Bashar M.

    2017-01-01

    Spontaneous fungal peritonitis (SFP) is an infrequent but severe complication most commonly described in patients with liver cirrhosis. We present the first case of culture-proven SFP occurring in cardiogenic ascites. The diagnosis of SFP was clinically challenging as the initial ascites was consistent with the more common diagnosis of spontaneous bacterial peritonitis (SBP). The patient did not respond to antibacterial therapy, however, and the final diagnosis was only made with positive ascitic cultures that grew Candida glabrata. SFP should be considered in patients with either cardiac or cirrhotic ascites and have a delayed or lack of response to traditional SBP treatment. PMID:28386572

  16. Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

    PubMed Central

    Hicks, Angel Mier; Chou, Joanne; Capanu, Marinela; Lowery, Maeve A.; Yu, Kenneth H.; O’Reilly, Eileen M.

    2016-01-01

    This was a cohort analysis evaluating patients with pancreatic adenocarcinoma who presented with or developed ascites. Among the 180 patients analyzed, the use of serial paracenteses and indwelling catheters is a common practice to effect symptom palliation. The complication rate was higher in patients with indwelling catheters. Analyzing ascitic fluid and calculating the serum ascites albumin gradient can help attribute the etiology of the ascites and potentially identify which patients may benefit from diuretics or other intervention. Background Ascites develops in a subset of patients with pancreatic adenocarcinoma (PAC) at presentation or as the disease advances. Limited data exist on the prognostic importance of malignant ascites in PAC. Our hypothesis is that this information will provide an understanding of the natural history and facilitate management decisions. Methods We conducted a retrospective analysis of 180 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between January 1, 2009 and December 31, 2014, with PAC and with ascites either at presentation or that developed during the disease course. Results For the 180 patients, the overall survival was 15 months. The time from diagnosis to ascites presentation was 11 months, and the survival time after ascites development was 1.8 months (range, 1.6–2.3 months; 95% confidence interval). Of 62 patients (34%) who had ascitic fluid analyzed, 36 (58%) had positive cytology. Fifty-one (82%) patients had a serum ascites albumin gradient ≥ 1, and 11 (18%) had serum ascites albumin gradient < 1. Sixty-four (36%) patients had their ascites managed solely by serial paracenteses. A total of 116 patients required a catheter; of these, 108 (93%) had a Tenckhoff catheter, 4 (3%) a Pleurx catheter, 4 (3%) a pigtail catheter, and 1 (1%) a Denver catheter. Eight (7%) patients required 2 catheters to be placed, and in 6 (5%), Tenckhoff catheters had to be removed. The main observed complications were

  17. [Laboratory chemical analysis in ascites].

    PubMed

    Satz, N

    1991-04-13

    Chemical analysis of ascitic fluid may be helpful in determining the underlying disease. We discuss the diagnostic accuracy of the common and newer chemical parameters (protein, LDH, lactate, glucose, cholesterol, triglycerides, phospholipids, fibronectin, albumin gradient [value of serum minus value of ascites], ferritin, tumor markers, immunomodulators, leukocytes, bacterial and cytologic examinations). We also review the pathogenesis and clinical findings of the most frequent ascites forms (benign hepatic, infective, malignant ascites, ascites associated with liver metastases or hepatocellular carcinoma, cardiac and pancreatic ascites) and the most important diagnosis criteria. In the malignant ascites a high cholesterol, a narrow albumin gradient or a high ferritin value have high diagnostic accuracy, but diagnosis is by the finding of malignant cells. For the diagnosis of infective ascites, bacteriology is mandatory even though the results are negative in most cases, particularly in spontaneous bacterial peritonitis where diagnosis has to be established clinically, by a low pH or by a high leukocyte count. Benign hepatic ascites is diagnosed by demonstrating an underlying chronic liver disease and laboratory examinations of the peritoneal fluid to exclude other causes. The laboratory tests in ascites associated with liver metastases or with hepatocellular carcinoma were similar to those in benign hepatic ascites and the two ascites forms must be separated by other clinical and technical findings. Pancreatic ascites can easily be distinguished from the other forms by the high amylase and lipase content.

  18. 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

  19. 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

  20. High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

    PubMed Central

    Cornejo, Rodrigo; Romero, Carlos; Ugalde, Diego; Bustos, Patricio; Diaz, Gonzalo; Galvez, Ricardo; Llanos, Osvaldo; Tobar, Eduardo

    2014-01-01

    We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team. PMID:25028955

  1. Diagnosis of malignant ascites. Comparison of ascitic fibronectin, cholesterol, and serum-ascites albumin difference.

    PubMed

    Prieto, M; Gómez-Lechón, M J; Hoyos, M; Castell, J V; Carrasco, D; Berenguer, J

    1988-07-01

    The ascitic fluid concentrations of cholesterol and fibronectin and the serum-ascites albumin difference were compared with two conventional tests of ascitic fluid, total protein and LDH, in their diagnostic ability for detection of malignancy in ascitic samples from 69 patients with ascites: 54 with ascites due to liver disease and 15 whose ascites was caused by peritoneal metastases. Sixteen cirrhotic patients with superimposed hepatocellular carcinoma in whom ascites was of uncertain etiology were considered separately. The mean ascitic fluid total protein, LDH, cholesterol, and fibronectin values in the peritoneal metastases group were 3.70 +/- 1.20 g/dl, 247.26 +/- 148.14 units/liter, 109.06 +/- 29.85 mg/dl, and 91.57 +/- 41.52 micrograms/ml, respectively, and all were significantly higher than the corresponding values in the liver disease group (P less than 0.001), which were 1.37 +/- 0.59 g/dl, 75.40 +/- 110.70 units/liter, 23.75 +/- 11.22 mg/dl, and 31.86 +/- 10.51 micrograms/ml, respectively. Mean serum-ascites albumin difference in the peritoneal metastases group was 0.62 +/- 0.38 g/dl, which was significantly different from the corresponding value in the liver disease group (1.92 +/- 0.41 g/dl, P less than 0.001). Both ascitic cholesterol above 46 mg/dl and an ascitic fibronectin concentration greater than 50 micrograms/ml had high diagnostic accuracy (97%) for malignancy, being higher than that achieved using a serum-ascites albumin difference under 1.1 g/dl and an ascitic total protein above 2.5 g/dl, which had accuracies of 94% and 93%, respectively. Ascitic fluid LDH was the least reliable test. No differences in the ascitic fluid analysis were found between cirrhotic patients with and without hepatocellular carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. [Tlaloc and ascites].

    PubMed

    Viesca-Treviño, Carlos; Macuil-García, Carmen; Monzón-Barranco, Abraham; Rosas-Peña, Jonathan

    2009-01-01

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

  3. Massive Ascites and Pleural Effusion in Preeclampsia

    PubMed Central

    Deveer, Ruya; Camuzcuoglu, Aysun; Kasap, Burcu; Camuzcuoglu, Hakan

    2017-01-01

    Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation and complicates approximately 2-8% of all pregnancies. Release of vasoconstrictive agents, endothelial damage, hyperpermeability of the capillaries and microangiopathic haemolysis involves the basic pathophysiology. It has variable clinical presentation. Here, we report a case of severe preeclampsia who developed postpartum massive ascites and pleural effusion. Primigravid patient was admitted to our clinic at 35 weeks of gestation with very high blood pressure. In biochemical analysis, Alanine aminotransferase (ALT) was 401 U/L, Aspartate aminotransferase (AST) was 292 U/L. An emergency caesarean section was performed because of fetal distress. On the 2nd post-operative day, abdominal distension and severe abdominal pain occurred. On the 3rd post-operative day, her abdominal distension increased and Ultrasonography (USG) revealed massive ascites. Abdominal drainage was performed and albumin infusion was administered. On postoperative day 4, she still had abdominal distension and concomitant respiratory distress. Computed Tomography (CT) showed ascites and bilateral pleural effusion. Her complaint regressed on the following days.

  4. 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

  5. Congenital plaque-type glomuvenous malformation associated with chylous ascites.

    PubMed

    Tejedor, Maria; Martín-Santiago, Ana; Gómez, Cristina; Fiol, Miquel; Benítez-Segura, Ignacio

    2010-01-01

    Congenital plaque-type glomuvenous malformation (GVM) is caused by loss of function mutations in glomulin gene. We report a newborn with this rare vascular disorder associated with chylous ascites. The common mesenchymal origin of GVM and lymphatic vessels as well as the glomulin expression in vascular smooth muscle cells in utero could help explain this unusual prenatal complication of glomuvenous malformations.

  6. 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

  7. Chylous ascites after resection of giant adrenocortical carcinoma

    PubMed Central

    Karakoyun, Rojbin; Demirci, Erkan; Alikanoglu, Arsenal Sezgin

    2016-01-01

    Postoperative chylous ascites (PCA) is a rare clinical state that occurs during abdominal surgery. Despite its rarity, the need to diagnose and treat PCA is increasing in importance with the increased number of wide resections and lymph node dissections being performed and the serious consequences of treatment. Here we describe the PCA complications we observed after resection for treating a case of giant adrenocortical carcinoma and we have the brief review of the PCA complication. PMID:28149812

  8. Refractory Ulcerative Colitis Treatment

    PubMed Central

    Green, Jesse A.

    2007-01-01

    Treatment of refractory ulcerative colitis (UC) is a common clinical challenge. In either acute or chronic refractory UC, the disease may continue to remain active, even though the patient is on appropriate therapy. It is important to reassess and characterize the patient's disease before adding new medications to the current medical regimen. After determining the current extent and severity of the UC—ruling out other causes of bloody diarrhea and determining what complications are present—new treatment approaches can then be started. It is critical to first optimize oral 5-aminosalicylic acid (5-ASA) therapy combined with rectal 5-ASA or corticosteroid suppositories, plus corticosteroid or 5-ASA enemas or foam preparations. Oral or intravenous corticosteroids are appropriate to use if needed, but alternative approaches must be used for long-term maintenance. 6-Mercaptopurine (6-MP) or azathioprine can be very helpful for severe chronic refractory UC. In those patients who do not respond to 5-ASA medications, corticosteroids, and 6-MP or azathioprine, infliximab offers an important approach for induction and maintenance of remission for refractory chronic ulcerative colitis as well as for select cases of refractory acute UC. Cyclosporine use is an alternative medical approach for the refractory acute UC patient. Colectomy with ileal pouch-anal anastomosis remains a valuable option for the refractory chronic or acute UC patient, because it can provide both a “cure” for the disease, as well as eliminate ineffective medications with their associated side effects. PMID:21960779

  9. Disease-induced variability of genetic correlations: ascites in broilers as a case study.

    PubMed

    de Greef, K H; Janss, L L; Vereijken, A L; Pit, R; Gerritsen, C L

    2001-07-01

    Breeding against a production disease is complicated by multiple relationships between productivity, disease, and environment. Ascites in broilers is such a disease. The combination of the reasonably well understood etiology (a physiological/pathological cascade due to inadequate oxygen supply) and the practical relevance makes ascites a relevant case for demonstrating and partly revealing these complex relationships. Chickens (n = 2,788) were tested in an ascites-challenging (cold) environment. Genetic analysis of mortality and pathology in combination with performance and physiological traits (especially blood gas traits) revealed ample opportunities for selection against ascites expression. The genetic correlation structure indicated that different mortality traits and pathology traits roughly represent one common characteristic. Direct selection against pathology is more effective than selection on the basis of growth or blood gas traits. The observed negative correlation (-0.26) between productivity and ascites was unexpected. From the etiology of ascites (inadequate supply of oxygen relative to the demand), a positive (unfavorable) correlation was expected. To demonstrate that the actual disease occurrence caused this apparent contradiction, the data from the undiseased subpopulation were reanalyzed. In the undiseased subpopulation, the genetic correlation between productivity and ascites was positive (0.29). This discrepancy was confirmed by comparing regression of ascites expression on actual performance with regression of ascites on independently assessed performance breeding values. The lability of the genetic correlation was explained from complex interactions between productivity, disease susceptibility, and actual occurrence of the disease. The revealed mechanism can be generalized to other production-related diseases and results in systematically lower genetic correlations between disease and productivity. It was inferred that genetic correlations

  10. Refractory peptic ulcer disease.

    PubMed

    Napolitano, Lena

    2009-06-01

    Refractory PUD is a diagnostic and therapeutic challenge. Optimal management of severe or refractory PUD requires a multidisciplinary team approach, using primary care providers, gastroenterologists, and general surgeons. Medical management has become the cornerstone of therapy. Identification and eradication of H pylori infection combined with acid reduction regimens can heal ulceration and also prevent recurrence. Severe, intractable or recurrent PUD and associated complications mandates a careful and methodical evaluation and management strategy to determine the potential etiologies and necessary treatment (medical or surgical) required.

  11. Lenalidomide and Dexamethasone for a Patient of POEMS Syndrome Presenting with Massive Ascites

    PubMed Central

    Ueda, Shuji; Yonemoto, Sayoko; Oka, Kazumasa; Fujii, Naohiko; Nakata, Keiichi; Matsunaga, Hitomi; Kataoka, Seiko; Iwama, Yuki; Narahara, Hiroyuki; Yasunaga, Yuichi; Inui, Yoshiaki; Kawata, Sumio

    2014-01-01

    POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. POEMS syndrome is a rare cause of refractory ascites. We report the case of a patient with POEMS syndrome presenting with massive ascites who was treated with very-low-dose lenalidomide and dexamethasone. A 57-year-old Japanese man was admitted to our hospital with pleural effusion, massive ascites, and leg edema. The diagnosis of POEMS syndrome was made based on the combination of the following findings: peripheral neuropathy, organomegaly, endocrinopathy, serum monoclonal protein elevation, skin changes, plasma VEGF elevation, and evidence of extravascular volume overload. Renal dysfunction induced by biopsy-proven renal involvement of POEMS syndrome was observed. Massive ascites of the patient dramatically diminished with long-time treatment of very-low-dose lenalidomide and dexamethasone. Lenalidomide seems to be a very promising therapy for POEMS syndrome presenting with extravascular volume overload such as edema, pleural effusion, and ascites. Very-low-dose lenalidomide might be effective especially for the patients with POEMS-related nephropathy. PMID:24782932

  12. Lenalidomide and Dexamethasone for a Patient of POEMS Syndrome Presenting with Massive Ascites.

    PubMed

    Ueda, Shuji; Yonemoto, Sayoko; Oka, Kazumasa; Fujii, Naohiko; Nakata, Keiichi; Matsunaga, Hitomi; Kataoka, Seiko; Iwama, Yuki; Narahara, Hiroyuki; Yasunaga, Yuichi; Inui, Yoshiaki; Kawata, Sumio

    2014-01-01

    POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. POEMS syndrome is a rare cause of refractory ascites. We report the case of a patient with POEMS syndrome presenting with massive ascites who was treated with very-low-dose lenalidomide and dexamethasone. A 57-year-old Japanese man was admitted to our hospital with pleural effusion, massive ascites, and leg edema. The diagnosis of POEMS syndrome was made based on the combination of the following findings: peripheral neuropathy, organomegaly, endocrinopathy, serum monoclonal protein elevation, skin changes, plasma VEGF elevation, and evidence of extravascular volume overload. Renal dysfunction induced by biopsy-proven renal involvement of POEMS syndrome was observed. Massive ascites of the patient dramatically diminished with long-time treatment of very-low-dose lenalidomide and dexamethasone. Lenalidomide seems to be a very promising therapy for POEMS syndrome presenting with extravascular volume overload such as edema, pleural effusion, and ascites. Very-low-dose lenalidomide might be effective especially for the patients with POEMS-related nephropathy.

  13. Myxedema Ascites: A Rare Presentation of Uncontrolled Hypothyroidism

    PubMed Central

    Asad-Ur-Rahman, FNU; Abbass, Aamer; Gordon, Dwayne; Abusaada, Khalid

    2016-01-01

    Less than four percent of patients with hypothyroidism develop ascites. Ascites as the presenting feature of hypothyroidism is uncommon, hence diagnosis is often delayed. Once it is diagnosed, treatment of hypothyroidism leads to quick clinical improvement in ascites. We report a case of a female patient who presented with ascites secondary to severe hypothyroidism and discuss the diagnostic characteristics of the ascitic fluid in myxedema ascites on the basis of literature review. PMID:28083456

  14. 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.

  15. -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.

  16. Ascites

    MedlinePlus

    ... syndrome Pericarditis - constrictive Transjugular intrahepatic portosystemic shunt (TIPS) Review Date 8/14/2015 Updated by: Subodh K. ... gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Internal review and ...

  17. Value of ascitic fluid ferritin in the differential diagnosis of malignant ascites.

    PubMed

    Kountouras, J; Boura, P; Tsapas, G; Charisis, K; Magoula, I; Tsakiri, I

    1993-01-01

    The ascitic fluid ferritin concentrations were compared with serum-ascites albumin gradient (SAAG), in their diagnostic ability for detection of malignancy in 60 patients with ascites: 29 with chronic liver disease alone (CLD) and 31 patients with various neoplasms. Of the patients with malignancy, 12 had liver metastases, 9 had no evidence of liver involvement, and 10 had hepatocellular carcinoma (HCC) with or without coexisting liver cirrhosis. Analysis of our data confirms that the ascitic ferritin is a more accurate indicator of malignant ascites (MA) than the SAAG. This new parameter is particularly helpful in distinguishing MA associated with HCC and/or metastatic liver disease from nonmalignant ascites due to CLD alone.

  18. Refractory rheumatoid vasculitis

    PubMed Central

    Kumar, Ashok; Goel, Anshul; Lapsiwala, Mehul; Singhal, Suman

    2016-01-01

    Systemic rheumatoid vasculitis (SRV) can develop in rheumatoid arthritis of long duration and high disease activity. It most commonly manifests as cutaneous vasculitis and mononeuritis multiplex. This can involve any organ of the body and carries very high mortality. We report a case of a young male who had rheumatoid arthritis for the past 15 years and became refractory to standard drugs and anti-TNF agents. He subsequently developed SRV, which started as mononeuritis multiplex. Disease progressed to result in gangrene of hands and feet despite receiving intravenous cyclophosphamide. Intravenous immunoglobulin and rituximab also could not provide any response. Prolonged ICU stay resulted in critical care neuromyopathy. Central nervous system vasculitis developed even after repeated infusions of intravenous immunoglobulins and at last he died of complications. In this case report, we have presented rare and chronic protracted presentation of rheumatoid vasculitis involving skin, nerves, brain and testis, which was refractory to the recommended therapies. PMID:28031844

  19. Pathophysiology of cyclic hemorrhagic ascites and endometriosis.

    PubMed

    Ussia, Anastasia; Betsas, George; Corona, Roberta; De Cicco, Carlo; Koninckx, Philippe R

    2008-01-01

    Massive hemorrhagic ascites (4470 mL, range 1-10 L) in women with endometriosis is a rare condition occurring predominantly in black women. Of the 43 case reports published, 42 are compatible with the hypothesis that the hemorrhagic ascites is predominantly a consequence of excessive ovarian transudation similar to a Meigs syndrome. Indeed, bilateral ovariectomy cures the condition without recurrences, whereas after unilateral ovariectomy or cystectomy recurrence rate is more than 50%; during ovarian suppression by luteinizing hormone-releasing hormone agonist ascites disappears, but reappears after treatment. Superficial pelvic endometriosis also contributes to the ascites because after superficial endometriosis destruction the recurrence rate is only 4 in 14. Based on these data, it is suggested, to scrutinize the ovaries for tumors given the analogy with Meigs syndrome. In women desiring fertility, conservative treatment with destruction of endometriosis only can be attempted given the cure rate of some 20%. It is unknown what the effect of ovulation induction would be.

  20. The LeVeen shunt in the elective treatment of intractable ascites in cirrhosis. A prospective study on 140 patients.

    PubMed Central

    Smadja, C; Franco, D

    1985-01-01

    One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative complications and mortality. One-year actuarial survival rate was 81.4%, respectively 77.7%, 61.3%, and 24.7% in patients with good liver function and moderate or severe liver failure. Variceal hemorrhage occurred in 11 patients and late infection in another 11 patients. Thirty-eight patients (30.5%) had recurrence of ascites. This was mostly due to an obstruction on the venous side of the shunt. An elective portacaval shunt had to be done in 23 patients for recurrence of ascites or variceal bleeding. Among the 57 patients still alive at time of writing, 51 were free of ascites. These results suggest that PVS is an efficient operation. This procedure may be largely indicated in the selected and small group of cirrhotic patients with true intractable ascites and moderate or no liver insufficiency. Images FIG. 1. FIG. 2. PMID:3977450

  1. [Concentration of lipids in ascitic fluid and the concentration gradient of albumin in blood and ascites: diagnostic significance].

    PubMed

    Barbare, J C; Diab, G; Delavenne, J; Philippe, J M; Vorhauer, W; Latrive, J P; Capron, J P

    1989-11-01

    The aim of this study was to test the diagnostic value of ascitic fluid cholesterol and triglycerides concentrations and of serum-ascites albumin concentration gradient in the differentiation between cirrhotic and malignant ascites. These biological parameters were determined, on the one hand in 34 cirrhotic patients, 6 of them having an hepatocellular carcinoma and 6 others having a spontaneous bacterial peritonitis and, on the other hand, in 16 patients with malignant ascites, 13 of them having an abdominal extra-hepatic or pelvic cancer, and 3 others having an extra-abdominal cancer with multiple liver metastases. Ascitic carcinoembryonic antigen assay and ascitic fluid cytology were also done in the 50 patients. In differentiating the cirrhotic patients from those with malignancy, ascitic fluid cholesterol concentration (discriminating value less than 1.1 mmol/l) ascitic fluid triglycerides concentration (discriminating value 0.5 mmol/l) and serum-ascites albumin concentration gradient (discriminating value greater than 11 g/l) allowed a diagnostic efficiency of 0.92, 0.80 and 0.77, respectively. Ascitic fluid cytology showed presence of malignant cells in 3/6 patients with hepatocellular carcinoma associated with cirrhosis, in 9/16 patients having a malignant ascites, and was negative in other patients. Ascitic carcinoembryonic antigen assay was abnormal only in 3/16 patients with malignant ascites. These results suggest that measurement of ascitic fluid cholesterol concentration must be included in the initial evaluation of patients with ascites of unknown origin.

  2. Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis.

    PubMed

    Keil-Ríos, Daniel; Terrazas-Solís, Hiram; González-Garay, Alejandro; Sánchez-Ávila, Juan Francisco; García-Juárez, Ignacio

    2016-04-01

    The pocket ultrasound device (PUD) is a new tool that may be of use in the early detection of ascites. Abdominal ultrasound-guided paracentesis has been reported to decrease the rate of complications due to the procedure, but must be performed in a healthcare setting; this new tool may be a useful on an ambulatory basis. The aim of this study was to determine the diagnostic usefulness of the PUD in the diagnosis of ascites and the safety of guided paracentesis. We conducted a retrospective study that included adult patients suspected of having ascites and in whom an evaluation was performed with the PUD to identify it. Concordance with abdominal ultrasound (AUS) was determined with the Kappa coefficient. Sensitivity (Se), specificity (Sp) and likelihood ratios (LR) were determined and compared with physical examination, AUS, computed tomography and procurement of fluid by paracentesis. Complications resulting from the guided paracentesis were analyzed. 89 participants were included and 40 underwent a paracentesis. The PUD for ascites detection had 95.8 % Se, 81.8 % Sp, 5.27 +LR and 0.05 -LR. It had a concordance with AUS of 0.781 (p < 0.001). Technical problems during the guided paracentesis were present in only two participants (5 %) and three patients (7.5 %) developed minor complications that required no further intervention. There were no severe complications or deaths. This study suggests that the PUD is a reliable tool for ascites detection as a complement to physical examination and appears to be a safe method to perform guided paracentesis.

  3. [Refractory anemias].

    PubMed

    Efira, A; Azerad, M-A

    2013-09-01

    Refractory anemia, also known as myelodysplastic syndromes, forms a group of clonal diseases characterized by cytopenias with mostly rich bone marrow. Preferentially reaching an older population, the prognosis depends on both comorbidities and characteristics of the disease, which have been grouped into a score established in 1997 ("IPSS = International Prognostic Scoring System") and revised in 2012 ("R-IPSS = Revised IPSS"). Overall survival and risk of transformation into acute nonlymphoblastic leukemia can now be estimated fairly accurately. Based on these characteristics, the treatment will be mainly supportive or will use several new molecules: growth factors, lenalidomide, 5-azacitidine, etc. A minority of patients may also benefit from allogeneic BMT or sometimes immunosuppressive therapy.

  4. 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.

  5. Eosinophilic ascites: A diagnostic and therapeutic challenge

    PubMed Central

    Agrawal, Shefali; Vohra, Sandeep; Rawat, Sangeeta; Kashyap, Vikas

    2016-01-01

    Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract. Depending on the dominant layer of infiltration it is classified into three types namely, mucosal, muscularis and subserosal. The most uncommon variant is the subserosal type characterized by primarily subserosal disease, eosinophilic ascites and peripheral hypereosinophilia. The clinical features are non-specific with history of atopic predisposition and allergy. Endoscopic biopsy is frequently non-diagnostic due to an uninvolved gastrointestinal mucosa rendering its diagnosis a challenge. The mainstay of diagnosis is peripheral hypereosinophilia and eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid therapy is usually the first line of treatment with dramatic response. Due to a propensity for relapse, steroid-sparing therapy should be considered for relapses of EGE. We report a case of subserosal EGE with diagnostic clinical features and treatment response and review the current strategy in the management of eosinophilic ascites. PMID:27721930

  6. Chlamydia Peritonitis and Ascites Mimicking Ovarian Cancer

    PubMed Central

    Macer, Matthew; Azodi, Masoud

    2016-01-01

    Background. Pelvic inflammatory disease (PID) rarely results in diffuse ascites. Severe adhesive disease secondary to PID may lead to the formation of inclusion cysts and even pelvic peritoneal nodularity due to postinflammatory scarring and cause an elevation of serum CA-125 levels. The constellation of these findings may mimic an ovarian neoplasm. Case. We report a case of a 22-year-old female who presented with multiple pelvic cysts and diffuse ascites due to Chlamydia trachomatis infection. The initial gynecologic exam did not reveal obvious evidence of PID; however, a positive Chlamydia trachomatis test, pathologic findings, and the exclusion of other etiologies facilitated the diagnosis. Conclusion. Chlamydia trachomatis and other infectious agents should be considered in the differential diagnosis of a young sexually active female with abdominal pain, ascites, and pelvic cystic masses. Thorough workup in such a population may reduce the number of more invasive procedures as well as unnecessary repeat surgical procedures. PMID:27747116

  7. Laparoscopic diagnosis of ascites in Lesotho.

    PubMed Central

    Menzies, R I; Fitzgerald, J M; Mulpeter, K

    1985-01-01

    In a prospective study of 98 consecutive patients with undiagnosed ascites examined by laparoscopy a correct immediate diagnosis was made in 76 (78%) and a final diagnosis in 92 (94%) of those who underwent laparoscopy. Visual diagnosis was highly accurate in patients with tuberculous peritonitis but only moderately accurate in those with carcinomatosis and liver disease. When the laparoscopic findings were compared with histological and microbiological results visual diagnosis was found to be the most accurate diagnostic method. Laparoscopy may readily be used in rural hospitals for diagnosing ascites. PMID:3160432

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

    PubMed Central

    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

  9. 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...

  10. Clinical, biochemical, and hormonal changes after a single, large-volume paracentesis in cirrhosis with ascites.

    PubMed

    Gentile, S; Angelico, M; Bologna, E; Capocaccia, L

    1989-03-01

    The use of paracentesis has recently been reproposed as a safe and effective alternative to diuretics for management of ascites. We have investigated the clinical and biochemical effects of large-volume paracentesis in 19 cirrhotics with tense ascites, and the relative changes in the hormones involved in sodium and water renal handling. Plasma renin activity (PRA), aldosterone (PA), and arginine vasopressin (AVP) levels and conventional liver and renal function tests were measured before and after 1, 2, and 7 days after the paracentesis. No complications were observed, but patients regained 37% of the weight lost after 1 wk. Percent weight regained was significantly and directly correlated with PA concentration measured before the paracentesis. No changes were recorded after paracentesis in biochemical and clinical data, except for a significant drop in diastolic blood pressure. No changes in AVP levels were observed. A significant increase in PA occurred after paracentesis, with a maximum peak after 48 h. The increase in PA was not accompanied by changes in PRA, but was associated with a reduction of urinary sodium excretion. A relevant fraction of body aldosterone was confined to the ascitic fluid. We conclude that the clinical results of a large-volume paracentesis can be predicted in part on the basis of PA measurement, and that removal of ascites is followed by an increase of PA of uncertain origin and effectiveness.

  11. 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

  12. Approaches to refractory epilepsy

    PubMed Central

    Engel, Jerome

    2014-01-01

    Epilepsy is one of the most common serious neurological conditions, and 30 to 40% of people with epilepsy have seizures that are not controlled by medication. Patients are considered to have refractory epilepsy if disabling seizures continue despite appropriate trials of two antiseizure drugs, either alone or in combination. At this point, patients should be referred to multidisciplinary epilepsy centers that perform specialized diagnostic testing to first determine whether they are, in fact, pharmacoresistant, and then, if so, offer alternative treatments. Apparent pharmacoresistance can result from a variety of situations, including noncompliance, seizures that are not epileptic, misdiagnosis of the seizure type or epilepsy syndrome, inappropriate use of medication, and lifestyle issues. For patients who are pharmacoresistant, surgical treatment offers the best opportunity for complete freedom from seizures. Surgically remediable epilepsy syndromes have been identified, but patients with more complicated epilepsy can also benefit from surgical treatment and require more specialized evaluation, including intracranial EEG monitoring. For patients who are not surgical candidates, or who are unwilling to consider surgery, a variety of other alternative treatments can be considered, including peripheral or central neurostimulation, ketogenic diet, and complementary and alternative approaches. When such alternative treatments are not appropriate or effective, quality of life can still be greatly improved by the psychological and social support services offered by multidisciplinary epilepsy centers. A major obstacle remains the fact that only a small proportion of patients with refractory epilepsy are referred for expert evaluation and treatment. PMID:24791078

  13. Hyperthermic intraperitoneal chemotherapy as palliative treatment for malignant ascites A single-center experience and a review of the literature.

    PubMed

    Graziosi, Luigina; Marino, Elisabetta; De Angelis, Verena; Rebonato, Alberto; Donini, Annibale

    Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal cancer dissemination. This clinical condition could represent the terminal evolution of a lethal disease and could influence the prognosis, severely impairing the patients' quality of life. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk; diuretics, paracentesis, peritoneo-venous shunts and intraperitoneal biologic agents like anti-VEGF molecules, metalloproteinase inhibitors and immunomodulators are included. None of these approaches have been established as a standard of care because of their low efficacy or severe side effects. The last two decades saw the emergence of cytoreductive surgery with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) as a viable therapeutic approach resulting in an effective cure against refractory malignant ascites. The following describes our experiences with 3 cases together with a literature review.

  14. Ascites syndrome in SPF Light Sussex chickens.

    PubMed

    Reece, R L

    1991-11-01

    An ascites syndrome was induced in 17 to 28 per cent of specific pathogen-free (SPF) Light Sussex (LSX) chickens given a low protein (16 per cent crude protein) high calcium (3.5 per cent calcium) layer crumble feed on two separate occasions 6 months apart. Affected chickens had increased right ventricular weight as a proportion of either total heart weight or live-weight at 3 weeks of age, compared with non-affected LSX chickens on the same feed, thus indicating right ventricular hypertrophy. The incidence of ascites was not increased by infection with avian nephritis virus, nor by limited cold-stress during brooding. It was not produced in LSX chickens given other feeds, nor in SPF Rhode Island Red chickens.

  15. [Ascitic fluid: the value of various biological tests in the differential diagnosis between cirrhotic and neoplastic ascites].

    PubMed

    Ghilain, J M; Henrion, J; Schapira, M; Majois, F; Beauduin, M; Heller, F R

    1990-01-01

    The authors have analyzed sixty cases of ascites including twenty of neoplastic origin and thirty-six of cirrhotic origin in order to evaluate the usefulness of several laboratory tests for the differential diagnosis of ascites. The tests which gave more than 85% diagnostic accuracy were ascitic fluid concentrations of fibronectin and total protein, serum-ascites gradients of albumin and total protein concentrations, ascitic fluid concentrations of albumin and cholesterol. The last three tests gave a diagnostic accuracy of more than 92% at discriminant levels of 3.8 gr/dl, 1.6 gr/dl and 60 mg/dl, respectively. For these six tests, neoplastic ascites due to liver metastasis had values intermediate between cirrhotic ascites and neoplastic ascites due to peritoneal carcinomatosis. A serum-ascites albumin gradient of more than 1.1 gr/dl was indicative of portal hypertension in cirrhotic patients; the total protein serum-ascites gradient had a better diagnostic accuracy. Flow cytometry had less diagnostic accuracy than cytology; moreover, all cases with abnormal flow cytometry were already recognized by cytology.

  16. Eosinophilic gastroenteritis with ascites and colon involvement.

    PubMed

    Levinson, J D; Ramanathan, V R; Nozick, J H

    1977-12-01

    The case of a 39-year old white man with eosinophilic gastroenteritis is presented. The major clinical features were gastric outlet obstruction, diarrhea and massive ascites. At surgery, significant involvement of the entire gastrointestinal tract from the gastric antrum to the sigmoid colon was found. Histologic documentation of colon involvement was obtained. The response to corticosteroids was prompt and sustained. At present, he is maintained on an alternating day schedule of steroid administration.

  17. [Peritoneal mesothelioma with elevated amylase in the ascitic fluid].

    PubMed

    Carrión, A; Jover, R; Carnicer, F; García, M F; Aranda, F I; Martínez, J F; Griñó

    1995-03-01

    The case of a 42-year-old woman with no previous disease admitted for abdominal pain and ascites is presented. Analysis of the ascitic fluid demonstrated high concentrations of amylase with normal lipase. The diagnosis of peritoneal mesothelioma was obtained by laparotomy. This association has not been previously described. The authors suggest that this diagnostic possibility should be considered in patients without pancreatic disease and high amylase levels in ascitic fluid.

  18. Low gradient ascites: A seven-year course review

    PubMed Central

    Mansour-Ghanaei, Fariborz; Shafaghi, Afshin; Bagherzadeh, Amir-Hossein; Fallah, Mohammad-Sadegh

    2005-01-01

    AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran). METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0 software and P<0.05 was considered statistically significant. RESULTS: Of the 148 patients enrolled in the study, 72 (48.6%) were males and 76 (51.4%) were females with a mean age of 59.03±13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%), ovarian and gastric cancers were found in 14 (22.5%) and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68±0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P<0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P<0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P<0.0001). CONCLUSION: Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making. PMID:15818749

  19. Chylous ascites caused by acute pancreatitis with portal vein thrombosis.

    PubMed

    Park, Dong Eun; Chae, Kwon Mook

    2011-12-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.

  20. Chylous ascites caused by acute pancreatitis with portal vein thrombosis

    PubMed Central

    Park, Dong Eun

    2011-01-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease. PMID:22319743

  1. 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.

  2. [Non-cirrhotic ascites: pathophysiology, diagnosis and etiology].

    PubMed

    Carrier, P; Jacques, J; Debette-Gratien, M; Legros, R; Sarabi, M; Vidal, E; Sautereau, D; Bezanahary, H; Ly, K H; Loustaud-Ratti, V

    2014-06-01

    Ascites, in 20% of cases, is not linked to liver cirrhosis. The pathophysiology is most often different. The understanding of these pathophysiological mechanisms can lead to etiologic diagnosis. The diagnostic approach is mainly based on the biological study of ascites, especially protein concentration and albumin gradient between serum and ascites. In Western countries, tumors and heart diseases are the predominant causes, while developing countries are mainly concerned by infectious diseases, among which tuberculosis is the leading cause. Other uncommon causes must be recognized, as ascites may be the presenting feature of the disease. Their knowledge will facilitate the therapeutic approach.

  3. [Sero-ascitic gradient of albumin: usefulness and diagnostic limitations].

    PubMed

    Alba, D; Torres, E; Vázquez, J J

    1995-08-01

    The serum-ascites albumin (SAA) gradient has been defined as the serum albumin concentration minus the ascitic fluid albumin concentration. The SAA gradient is superior to the exudate-transudate concept to classify ascites, being a exact portal hypertension (PH) marker. An elevated SAA gradient (1.1 g/L or greater) correlates with PH, whereas a low gradient indicates no PH. The SAA gradient correlates well with PH in cirrhotic patients. It is also of particular utility to differentiate between congestive heart failure and malignant ascites without liver metastases (both of them with elevated ascites fluid proteins -AFP-). However, a low SAA gradient do not differentiate between tuberculous and malignant ascites. Consequently, there are still need for tests a cytology, culture for mycobacteria or ascites fluid polymorphonuclear cell count in some cases. The level of AFP, apart from the exudate-transudate concept, has some value for certain cases (a low level of AFP implicates a high risk of spontaneous bacterial peritonitis). The SAA gradient should replace the AFP concentration as the initial test to classify ascites.

  4. Chylous Ascites in a Newborn with Gastroschisis. Case Report

    PubMed Central

    Zalles-Vidal, Cristian Ruben; Peñarrieta-Daher, Alejandro; Ibarra-Rios, Daniel; Fernandez-Portilla, Emilio; Bracho-Blachet, Eduardo

    2017-01-01

    Chylous ascites is a rare disease, only two cases associated with gastroschisis have been published. We report a case treated conservatively with total parenteral nutrition (TPN) and octreotide. We reviewed the literature about management options for the chylous ascites. PMID:28083502

  5. Chylous ascites as a consequence of idiopathic pancreatitis

    PubMed Central

    Baban, Chwanrow Karim; Murphy, Michael; O'Sulleabháin, Cristóir; O'Hanlon, Deirdre

    2014-01-01

    Chylous ascites (chyloperitoneum) is a rare clinical condition, characterized by an accumulation of lymph fluid in the peritoneal cavity. Most commonly it is associated with abdominal malignancy (usually lymphoma). We present an unusual case of a woman who developed a persistent pseudocyst and recurrent chylous ascites following acute necrotizing pancreatitis. PMID:24501332

  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. 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

  8. Synchronization of replicons in Ehrlich ascites cells

    SciTech Connect

    Gekeler, V.; Probst, H. )

    1988-03-01

    Ehrlich ascites cells, in which replication units at the beginning of the S phase started and grew synchronously, were obtained by the following protocol: (1) selection of G{sub 1} cells by zonal centrifugation, (2) hypoxia for 12 h, (3) reaeration, (4) addition of cycloheximide (30 {mu}M) within the first minute after reoxygenation. Studies on the effectiveness of the different steps revealed: (i) G{sub 1} cells reoxygenated after 12 h of hypoxia traverse two succeeding cell cycles high synchronously. This was shown by monitoring the thymidine incorporation rate, the thymidine pulse-labeling index, and the mitotic index. (ii) Cycloheximide, like hypoxia, suppresses replicon initiation in Ehrlich ascites cells without interfering with DNA chain growth and DNA maturation. The reversibility of the suppression is less complete than in the case of hypoxia. This was shown by DNA fiber autoradiography and by analyzing the length distribution of pulse- or pulse/pulse-chase-labeled daughter DNA in alkaline sucrose gradients. The alkaline sedimentation patterns of daughter-strand DNA, pulse labeled immediately after the cycloheximide addition at the end of the elaborated protocol and 1 and 2 h later, indicated synchronous initiation and growth of a homogeneous population of DNA molecules to replicon-sized lengths.

  9. CFB refractory maintenance

    SciTech Connect

    Johnson, R.C.

    1994-12-31

    The CFB maintenance manager has to make rapid-fire decisions regarding refractory maintenance during short or unscheduled turnarounds. This presentation offers a hands-on approach to expedient refractory failure analyses with specific repair recommendations. Photographs of most typical CFB refractory failures and their structural repairs are discussed. The most reliable repairs can be expected by using the latest state-of-the-art refractory materials and installation techniques. Refractory materials are consumable; therefore minor repairs should always be conducted at the first opportunity; this will preclude future major repairs. During a short or unscheduled outage, major repairs should be confined to the specific structural repair site; the removal of good, serviceable refractory is unnecessary under these conditions.

  10. Office Procedures in Refractory Chronic Rhinosinusitis.

    PubMed

    Thamboo, Andrew; Patel, Zara M

    2017-02-01

    Office procedures in chronic rhinosinusitis (CRS) can be considered before and after medical management, as well as before and after surgical management. This article focuses specifically on refractory CRS, meaning those patients who have failed medical and surgical management already. The options available in the management of refractory CRS depend on the personnel, equipment, and instrumentation available in the office setting; surgeon experience; and patient suitability and tolerability. This article provides readers with possible procedural options that can be done in their clinics with indications, patient selection, potential complications, and postoperative considerations.

  11. Severe ascites with hypothyroidism and elevated CA125 concentration: a case report.

    PubMed

    Kimura, Ryosuke; Imaeda, Kenro; Mizuno, Tatsuo; Wakami, Kazuko; Yamada, Kazuhiro; Okayama, Naotsuka; Kamiya, Yoshinobu; Joh, Takashi

    2007-12-01

    Ascites caused by hypothyroidism is rare and the pathogenesis is unclear. Several reports have presented cases of progressive ascites with hypothyroidism and elevated tumor markers. We report a 31-year-old female case with massive ascites and elevated serum CA 125 concentrations. The patient had no typical feature of hypothyroidism except an accumulation of ascitic fluid which showed elevated total protein concentration and a high serum-ascites albumin gradient (SAAG). There was no finding of malignancy. Following thyroid hormone replacement, the ascites was completely resolved accompanied by reduced concentrations of serum CA125. In general, primary hypothyroidism with ascites presents with coexisting massive pericardial or pleural effusion. The massive ascites and increased serum CA125 concentrations may have led us to make the incorrect diagnosis of ovarian malignancy. The evaluation of thyroid function is useful to determine the pathology of high-protein ascites or elevated tumor markers, and ascites may be treatable by thyroid replacement therapy.

  12. 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.

  13. 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.

  14. 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.

  15. Abdominal Pain and Ascites: Not Always Related to Portal Hypertension

    PubMed Central

    Kisang, Gilbert; Green, Michael; Tofteland, Nathan

    2016-01-01

    Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract with an estimated prevalence of one in 100,000. The typical presentation consists of vague gastrointestinal symptoms with the mucosal involvement of the digestive system. Rarely, it presents as eosinophilic ascites. We report the case of a 22-year-old female who presented with acute onset abdominal pain and ascites. The laboratory studies were remarkable for eosinophilia and the ascitic fluid demonstrated high eosinophilic counts. Push enteroscopy with biopsy supported the diagnosis of eosinophilic gastroenteritis, with likely serosal involvement. Other differential diagnoses were excluded. A prednisone taper along with dietary treatment was initiated. We report complete resolution of symptoms two weeks following the initiation of therapy. Nine months later, she remains asymptomatic without recurrence of ascites. PMID:27843730

  16. Palliation of malignant ascites by the Denver peritoneovenous shunt.

    PubMed Central

    Downing, R.; Black, J.; Windsor, C. W.

    1984-01-01

    Five out of 8 Denver peritoneovenous shunts placed in 7 patients provided excellent palliation of malignant ascites. Subclinical consumptive coagulopathy was detected after placement of 6 shunts, but no patient developed overt bleeding. Images Fig. 1 Fig. 2 PMID:6207757

  17. An unusual presentation of fistulating Crohn's disease: Ascites.

    PubMed

    Kia, Richard; White, David; Sarkar, Sanchoy

    2010-01-16

    Whilst ascites is a common presenting complaint in patients with decompensated chronic liver disease and disseminated malignancy, in Crohn's disease however, it is exceptionally rare. We describe a patient with no prior history of inflammatory bowel or liver disease, presenting with rapid onset gross ascites and scrotal swelling. Further investigations revealed severe hypoalbuminemia and transudative ascitic fluid with normal other liver function tests and a negative liver screen. Computed tomography revealed widespread ascites and pleural effusions with no features of malignancy or portal hypertension, and a small bowel barium series showed features of fistulating small bowel Crohn's disease. An ileo-colonoscopy confirmed the presence of terminal ileal inflammatory stricture. The patient's clinical condition and serum albumin improved with a combination of diuretics, elemental diet, antibiotics and oral 5-aminosalicylic acid therapy.

  18. Intractable ascites in systemic mastocytosis treated by portal diversion.

    PubMed

    Bonnet, P; Smadja, C; Szekely, A M; Delage, Y; Calmus, Y; Poupon, R; Franco, D

    1987-02-01

    A 50-year-old male presented with intractable ascites due to systemic mastocytosis. The diagnosis of systemic mastocytosis was established by histology of the bone marrow which showed mast cell infiltration and fibrosis. Ascites was related to portal hypertension which was documented by esophageal varices at endoscopy and by an increase of wedged-free hepatic venous pressure gradient. Liver biopsy disclosed dense fibrosis of hepatic arterial and portal venule walls, resulting in complete obstruction of some portal radicles. Peliosis hepatis and fibrous deposits in the walls of hepatic venules were also present. Because of intractable ascites and significant malnutrition, a portacaval shunt was performed which cleared ascites and dramatically improved the general condition of the patient.

  19. Diagnostic usefulness of the random urine Na/K ratio in predicting therapeutic response for diuretics in cirrhotic patients with ascites.

    PubMed

    Mohii, El Sayed M; El Mansy, Ismail M; Salah, Mohamed; Khedr, Mohamed Abd Elhamid

    2013-12-01

    Ascites is a major complication of liver cirrhosis which carries a poor prognosis. Diuretics are used in treatment of ascites in addition to salt restriction. Monitoring of diuretic response can be achieved by measurement of 24 hours urinary sodium. This study evaluated the accuracy of using spot urinary sodium/potassium ratio as a reliable alternative to 24 hours urinary sodium in assessment of dietary sodium compliance in patients with liver cirrhosis receiving diuretics. Fifty patients presented with liver cirrhosis and ascites were divided into 2 groups: GI 14 (28%) patients diuretic resistant with 24 hours urinary sodium < 78 mEq) and GII 36 (72%) patients diuretic sensitive with 24 hours urinary sodium > 78 mEq. The results showed highly significant correlation between 24 hours urinary sodium and spot urine sodium/potassium ratio with sensitivity 87.5% specificity 56% and accuracy 70% at cutoff point of 1.8.

  20. [Isolation of Candida spp. from ascites in cirrhotic patients].

    PubMed

    Saludes, Paula; Araguás, Cristina; Sánchez-Delgado, Jordi; Dalmau, Blai; Font, Bernat

    2016-10-01

    The isolation of Candida spp. in ascites of cirrhotic patients is an uncommon situation in clinical practice. Factors that have been associated with increased susceptibility to primary fungal peritonitis are exposure to broad-spectrum antibiotics and immunosuppression, a typical situation of these patients. We report seven episodes of Candida spp. isolation in ascites of cirrhotic patients detected in our hospital during the past 15years.

  1. Coughing may lead to spontaneous chylothorax and chylous ascites.

    PubMed

    Adas, Gokhan; Karatepe, Oguzhan; Battal, Muharrem; Dogan, Yasar; Karyagar, Savas; Kutlu, Asim

    2007-12-31

    Chylous ascites is a rare form of ascites resulting from the accumulation of lymph in the abdominal cavity. It is due to an interruption in the lymphatic system. Surgical management is indicated in cases of recurrence or failure after conservative treatment. We report a case of spontaneous chylous peritonitis after chylothorax, which is a rare clinical event. The primary reason was unclear and the outcome of medical and surgical treatment was successful.

  2. 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

  3. Refractory duodenal ulcer.

    PubMed Central

    Bardhan, K D

    1984-01-01

    A refractory duodenal ulcer was arbitrarily defined as one that had failed to heal completely after treatment with cimetidine 1 g daily for three months. Of 66 patients with refractory duodenal ulcer, healing eventually occurred in 37 patients, after treatment for an average of 7.4 months. But 28 patients did not heal despite treatment for an average of 9.4 months; and one patient defaulted. In 41 patients the daily dose of cimetidine was increased to 2 g: the ulcers in 31 patients healed. In eight patients the daily dose was increased to 3 g and healing occurred in four patients. Eighteen patients required admission on 22 occasions because of severe symptoms despite treatment. Nine patients underwent surgery but in five the results were poor. Differences in clinical and endoscopic features between refractory and non-refractory ulcer patients were small. Acid and pepsin secretion were similar and gastrin concentrations normal. Blood levels of the drug and suppression of acid secretion were both satisfactory. Identification of refractory ulcer patients at the start of treatment was therefore not possible. Refractoriness could occur at any time during the course of the disease, previous treatment with cimetidine often having resulted in rapid healing, but subsequent relapses were also usually refractory. The cause of refractoriness remains unknown and the rather poor results of surgery in this series suggests that optimal management of these patients remains to be determined. Refractoriness probably indicates a changed natural history of the disease and in some patients a more poor prognosis. PMID:6428982

  4. 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

  5. Human umbilical cord mesenchymal stem cells improve liver function and ascites in decompensated liver cirrhosis patients.

    PubMed

    Zhang, Zheng; Lin, Hu; Shi, Ming; Xu, Ruonan; Fu, Junliang; Lv, Jiyun; Chen, Liming; Lv, Sa; Li, Yuanyuan; Yu, Shuangjie; Geng, Hua; Jin, Lei; Lau, George K K; Wang, Fu-Sheng

    2012-03-01

    Decompensated liver cirrhosis (LC), a life-threatening complication of chronic liver disease, is one of the major indications for liver transplantation. Recently, mesenchymal stem cell (MSC) transfusion has been shown to lead to the regression of liver fibrosis in mice and humans. This study examined the safety and efficacy of umbilical cord-derived MSC (UC-MSC) in patients with decompensated LC. A total of 45 chronic hepatitis B patients with decompensated LC, including 30 patients receiving UC-MSC transfusion, and 15 patients receiving saline as the control, were recruited; clinical parameters were detected during a 1-year follow-up period. No significant side-effects and complications were observed in either group. There was a significant reduction in the volume of ascites in patients treated with UC-MSC transfusion compared with controls (P < 0.05). UC-MSC therapy also significantly improved liver function, as indicated by the increase of serum albumin levels, decrease in total serum bilirubin levels, and decrease in the sodium model for end-stage liver disease scores. UC-MSC transfusion is clinically safe and could improve liver function and reduce ascites in patients with decompensated LC. UC-MSC transfusion, therefore, might present a novel therapeutic approach for patients with decompensated LC.

  6. 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.

  7. 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

  8. MicroRNA-155 is upregulated in ascites in patients with spontaneous bacterial peritonitis

    PubMed Central

    Lutz, Philipp; M´haimid, Mohamed; Pohlmann, Alessandra; Lehmann, Jennifer; Jansen, Christian; Schierwagen, Robert; Klein, Sabine; Strassburg, Christian P.; Spengler, Ulrich; Trebicka, Jonel

    2017-01-01

    MircoRNA’s (miR) have been recognised as important modulators of gene expression and potential biomarkers. However, they have been rarely investigated in bio fluids apart from blood. We investigated the association of miR-125b and miR-155 with complications of cirrhosis. Ascites was prospectively collected from patients with cirrhosis undergoing paracentesis at our department. miR’s were determined in the supernatant using qPCR and normalized by SV-40. Clinical parameters were assessed at paracentesis and during follow-up. 76 specimens from 72 patients were analysed. MiR’s were not associated to age, sex or aetiology of cirrhosis. MiR-125b levels differed between patients with low and high MELD score, and miR-125b levels showed an inverse correlation to serum creatinine (r2 = −0.23; p = 0.05). MiR-155 was elevated in patients with spontaneous bacterial peritonitis (SBP) (n = 10; p = 0.04). MiR-155 levels differed between patients with and without 30-day survival (p = 0.02). No association of ascites levels of investigated miR’s to size of varices, episodes of gastrointestinal bleeding or hepatorenal syndrome was observed. While miR-125b levels in ascites seem to be associated with liver and renal dysfunction, miR-155 might be implicated in local immune response in SBP. PMID:28074870

  9. The ascites N-glycome of epithelial ovarian cancer patients.

    PubMed

    Biskup, Karina; Braicu, Elena I; Sehouli, Jalid; Tauber, Rudolf; Blanchard, Véronique

    2017-03-22

    Epithelial ovarian cancer (EOC) is worldwide the sixth most lethal form of cancer occurring in women. More than one third of ovarian patients have ascites at the time of diagnosis and almost all of them have it when recurrence occurs. Although its effect on tumor cell microenvironment remains poorly understood, its presence is correlated with bad diagnosis. In previous studies, we proposed a novel glycan-based biomarker for the diagnosis of EOC, which showed an improved sensitivity and specificity at any stage of the disease and an improved discrimination between malignant and benign ovarian tumors. In this work, we report for the first time the N-glycome profiles of ascitic fluid from primary serous EOC patients and compare them with the serum N-glycomes of the same patients as well as of healthy controls. N-Glycans were digested from equivalent amount of ascites and serum from 18 EOC patients and from serum of 20 age-matched controls and measured by MALDI-TOF-MS. Ascites N-glycome showed increased antennarity, branching, sialylation and Lewis(X) motives compared to healthy serum. In addition, a correlation was established between ascites volume and degree of sialylation.

  10. 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.

  11. 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.

  12. Gut microflora in the pathogenesis of the complications of cirrhosis.

    PubMed

    Garcia-Tsao, Guadalupe; Wiest, Reiner

    2004-04-01

    The gut flora plays an important role in the pathogenesis of the complications of cirrhosis. Cirrhotic patients are prone to develop bacterial infections, mainly the 'spontaneous' infection of ascites or spontaneous bacterial peritonitis. Other complications of cirrhosis, such as variceal haemorrhage and ascites, occur mostly or solely as a consequence of portal hypertension. Portal pressure increases initially as a consequence of an increased intrahepatic resistance but, once collaterals have formed, high portal pressure is maintained by an increased splanchnic blood inflow secondary to vasodilatation. Splanchnic vasodilatation is the initiating event in the hyperdynamic circulatory state that aggravates the complications of cirrhosis. The gut flora plays a role in both the development of infections and in the hyperdynamic circulatory state of cirrhosis and, although less prominently, it also plays a role in the pathogenesis of hepatic encephalopathy. This chapter presents evidence regarding gut flora and its modification in the pathogenesis and management of these complications of cirrhosis.

  13. 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.

  14. A rational approach to the treatment of ascites

    PubMed Central

    Arroyo, V.; Rodés, J.

    1975-01-01

    A rational approach to the diuretic therapy of ascites is proposed. Fifty-five patients were classified according to their ability to excrete sodium and free water. Patients with a high urinary sodium excretion can be treated by low sodium intake alone. In most patients with a low sodium excretion but high free water clearance, distal diuretics (spironolactone or triamterene) with a low sodium diet will relieve ascites. Patients with low values for sodium excretion and free water clearance also have poor glomerular filtration rate and only a few of these will respond to diuretic therapy. PMID:1234341

  15. 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.

  16. SHS of refractory materials

    NASA Astrophysics Data System (ADS)

    Ismailov, M. B.; Gabayev, Zh. A.

    1993-09-01

    In the SHS production of refractory materials (concretes, coating mixtures) the basic problem is overcoming the scale factor. This is done by imparting a granular structure to the mass being synthesized. Requirements for the granular and chemical composition of the filler are obtained.

  17. 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

  18. 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.

  19. Midazolam and pentobarbital for refractory status epilepticus.

    PubMed

    Holmes, G L; Riviello, J J

    1999-04-01

    Status epilepticus, a serious, life-threatening emergency characterized by prolonged seizure activity, occurs most commonly in pediatric patients. Although initial therapies with agents such as diazepam, phenytoin, or phenobarbital generally terminate seizure activity within 30-60 minutes, patients with refractory status epilepticus (RSE) lasting longer require additional intervention. High-dose pentobarbital has been the most commonly prescribed agent for the management of RSE in children; however, midazolam has emerged as a new treatment option. This review compares the use of midazolam with pentobarbital in published reports of pediatric RSE. Both drugs effectively terminated refractory seizure activity, although pentobarbital use was complicated by hypotension, delayed recovery, pneumonia, and other adverse effects. Midazolam use was effective and well tolerated, affirming its value in pediatric RSE management.

  20. 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.

  1. 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

  2. Acupuncture for Refractory Epilepsy: Role of Thalamus

    PubMed Central

    Chen, Shuping; Wang, Shubin; Rong, Peijing; Liu, Junling; Zhang, Hongqi; Zhang, Jianliang

    2014-01-01

    Neurostimulation procedures like vagus nerve stimulation (VNS) and deep brain stimulation have been used to treat refractory epilepsy and other neurological disorders. While holding promise, they are invasive interventions with serious complications and adverse effects. Moreover, their efficacies are modest with less seizure free. Acupuncture is a simple, safe, and effective traditional healing modality for a wide range of diseases including pain and epilepsy. Thalamus takes critical role in sensory transmission and is highly involved in epilepsy genesis particularly the absence epilepsy. Considering thalamus serves as a convergent structure for both acupuncture and VNS and the thalamic neuronal activities can be modulated by acupuncture, we propose that acupuncture could be a promising therapy or at least a screening tool to select suitable candidates for those invasive modalities in the management of refractory epilepsy. PMID:25548594

  3. Rapid onset of massive ascites as the initial presentation of systemic lupus erythematosus.

    PubMed

    Weinstein, P J; Noyer, C M

    2000-01-01

    Ascites in systemic lupus erythematosus (SLE) is rarely massive, and either accompanies the typical manifestations of active disease or results from nephrotic syndrome, protein-losing enteropathy, constrictive pericarditis, and conditions unrelated to lupus. Marked ascites has been attributed to chronic lupus peritonitis, characterized by the insidious onset of massive, painless ascites and unrelated to disease activity. Regardless of the etiology, ascites typically has a gradual onset and occurs after a diagnosis of SLE has been made. We describe a young woman presenting with the rapid development of massive ascites as the initial manifestation of SLE.

  4. Status epilepticus: Refractory and super-refractory.

    PubMed

    Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha K

    2017-01-01

    Status epilepticus (SE) is an important neurological emergency. It is defined as seizures lasting for 5 minutes or more or recurrent seizures without recovery of consciousness to baseline between the attacks. Refractory SE (RSE) is defined as SE persisting despite sufficient dose of benzodiazepines and at least one antiepileptic drug (AED), irrespective of time. Super refractory SE (SRSE) is defined as SE that continues for 24 hours or more after the use of anesthetic therapy, including cases that recur on weaning of the anesthestic agent. RSE occurs in 23%-48% of the patients and SRSE in approximately 22% of the patients with SE. In general, RSE occurs in patients with new-onset seizures rather than in patients with chronic epilepsy. The etiology of RSE in developing countries is dominated by central nervous system (CNS) infections and head injury compared to stroke and drug withdrawal in the developed countries. The treatment of RSE and SRSE is not evidence based. Following benzodiazepines, the second line antiepileptic drugs include sodium valproate, phenytoin, levetiracetam, and anesthetic drugs such as midazolam, phenobarbital, and propofol. Most intravenous anesthetic drugs produce hypotension and respiratory suppression; therefore, patients with RSE are managed in intensive care units (ICUs). In RSE patients, electroencephalogram (EEG) burst suppression with interburst interval of 2-20 s or even flat EEG has been tried. Recently, concerns have been raised on the safety of burst suppression in RSE and SRSE. The paucity of ICUs in developing countries limits the use of these management protocols. There is a need to explore intravenous AEDs with safer cardiovascular and respiratory profile for the management of SE.

  5. Acute eosinophilic ascites: an unusual form of an unusual case.

    PubMed

    Kodan, Parul; Shetty, Meenakshi A; Pavan, M R; Kariappa, Ahalya; Mahabala, Chakrapani

    2015-01-01

    Eosinophilic gastroenteritis (EGE) is an uncommon disease characterised by eosinophilic infiltration in the gastrointestinal tract. EGE may involve more than one layer of the gastrointestinal tract. Clinical features depend on the layer and location which is involved. We report an unusual case of eosinophilic ascites associated with antinuclear antibody positivity, which is an unusual variety of serosal form of EGE.

  6. Hemodynamic Consequences of Malignant Ascites in Epithelial Ovarian Cancer Surgery∗

    PubMed Central

    Hunsicker, Oliver; Fotopoulou, Christina; Pietzner, Klaus; Koch, Mandy; Krannich, Alexander; Sehouli, Jalid; Spies, Claudia; Feldheiser, Aarne

    2015-01-01

    Abstract Malignant ascites (MA) is most commonly observed in patients scheduled for epithelial ovarian cancer (EOC) surgery and is supposed as a major risk factor promoting perioperative hemodynamic deterioration. We aimed to assess the hemodynamic consequences of MA on systemic circulation in patients undergoing cytoreductive EOC surgery. This study is a predefined post-hoc analysis of a randomized controlled pilot trial comparing intravenous solutions within a goal-directed algorithm to optimize hemodynamic therapy in patients undergoing cytoreductive EOC surgery. Ascites was used to stratify the EOC patients prior to randomization in the main study. We analyzed 2 groups according to the amount of ascites (NLAS: none or low ascites [<500 mL] vs HAS: high ascites group [>500 mL]). Differences in hemodynamic variables with respect to time were analyzed using nonparametric analysis for longitudinal data and multivariate generalized estimating equation adjusting the analysis for the randomized study groups of the main study. A total of 31 patients in the NLAS and 16 patients in the HAS group were analyzed. Although cardiac output was not different between groups suggesting a similar circulatory blood flow, the HAS group revealed higher heart rates and lower stroke volumes during surgery. There were no differences in pressure-based hemodynamic variables. In the HAS group, fluid demands, reflected by the time to reindication of a fluid challenge after preload optimization, increased steadily, whereas stroke volume could not be maintained at baseline resulting in hemodynamic instability after 1.5 h of surgery. In contrast, in the NLAS group fluid demands were stable and stroke volume could be maintained during surgery. Clinically relevant associations of the type of fluid replacement with hemodynamic consequences were particularly observed in the HAS group, in which transfusion of fresh frozen plasma (FFP) was associated to an improved circulatory flow and reduced

  7. 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.

  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.

  9. 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.

  10. Refractory myasthenia gravis - clinical profile, comorbidities and response to rituximab.

    PubMed

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27-53 years. In our study 25 patients (32.89%) belonged to the age group of 21-30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10(-8)) to 94.6% (p=2.2x10(-14)) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low.

  11. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt

    PubMed Central

    Grigorean, VT; Onose, G; Popescu, M; Strambu, V; Sandu, AM

    2009-01-01

    The aim of this study is the evaluation of laparoscopic treatment in abdominal complications following ventriculoperitoneal (VP) shunt. Methods: We report a retrospective study including 17 patients with abdominal complications secondary to VP shunt for hydrocephalus, laparoscopically treated in our department, between 2000 and 2007. Results: Patients' age ranged from 1 to 72 years old (mean age 25.8 years old). Male: female ratio was 1.4. Abdominal complications encountered were: shunt disconnection with intraperitoneal distal catheter migration 47.05% (8/17), infections 23.52% (4/17) such as abscesses and peritonitis, pseudocysts 11.76% (2/17), CSF ascites 5.88% (1/17), inguinal hernia 5.88% (1/17), and shunt malfunction due to excessive length of intraperitoneal tube 5.88% (1/17). Free–disease interval varies from 1 day to 21 years, depending on the type of complication, short in peritoneal irritation syndrome and abscesses (days) and long in ascites, pseudocysts(months– years). Laparoscopic treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the tube in shunt malfunction due to excessive length of intraperitoneal tube a nd hernioraphy. One diagnostic laparoscopy was performed in a peritoneal irritation syndrome, which found only CSF ascites. There were no conversions to open surgery. The overall mortality was of 5.88% and postoperative morbidity was of 11.76%. In 7 patients operated for abscesses, peritonitis, pseudocysts, and CSF ascites the shunting system was converted in to a ventriculocardiac shunt. Conclusions: Abdominal complication following VP shunt can be successfully performed laparoscopically. Abdominal surgery required, in selected cases, the repositioning of the distal catheter, frequently as a ventriculocardiac shunt. There are abdominal complications with no indication of

  12. 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

  13. 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

  14. Reabsorption of ascites and the factors that affect this process in cirrhosis.

    PubMed

    Akay, Sinan; Ozutemiz, Omer; Kilic, Murat; Karasu, Zeki; Akyildiz, Murat; Karasulu, Ercument; Baka, Meral; Doganavsargil, Basak; Ersoz, Galip; Ulukaya, Sezgin; Alper, Isik; Ates, Utku; Batur, Yucel

    2008-10-01

    Ascites is one of the main features of liver decompensation in cirrhosis, and it is considered to be a dynamic process. In this study, we aimed to (1) measure the reabsorption rate of ascites; (2) evaluate whether these findings were related to features of ascites, hemodynamics, and serum measurements; and (3) examine morphologic changes in the diaphragm of cirrhotic patients. In all, 42 cirrhotic patients with ascites were enrolled in the study to comprise our study group. Using the dextran 70 test, patient ascites volumes and reabsorption rates were measured. Biopsies from the peritoneal side of the diaphragm were also processed for scanning electron microscopy and lymphatic immunohistochemical studies from the cirrhotic patients and control cadavers. The mean ascites reabsorption rate was 4.5 +/- 4.5 (0.18-14.6) mL/min, which correlated significantly with the calculated ascites volume (r = 0.75, P < 0.001). The mean ascites viscosity was 1.07 +/- 0.07 (0.99-1.17) centipoise, which demonstrated a high degree of negative correlation with the ascites reabsorption rate (r = -0.77, P < 0.001). Patients with a history of spontaneous bacterial peritonitis had significantly lesser ascites reabsorption rates than patients without this particular history. The size of lymphatic stomata in scanning electron microscopy depictions was increased, and lymphatic lacunae were dilated in immunohistochemical studies in the cirrhotic patients with ascites. However, these findings were not uniform in every cirrhotic patient with ascites. The volume and viscosity of ascites seem to influence its reabsorption rate. Additionally, previous episodes of spontaneous bacterial peritonitis may be responsible for the decreased ascites reabsorption rates observed in certain patient populations.

  15. 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.

  16. Genetic parameters of body weight and ascites in broilers: effect of different incidence rates of ascites syndrome.

    PubMed

    Ahmadpanah, J; Ghavi Hossein-Zadeh, N; Shadparvar, A A; Pakdel, A

    2017-02-01

    1. The objectives of the current study were to investigate the effect of incidence rate (5%, 10%, 20%, 30% and 50%) of ascites syndrome on the expression of genetic characteristics for body weight at 5 weeks of age (BW5) and AS and to compare different methods of genetic parameter estimation for these traits. 2. Based on stochastic simulation, a population with discrete generations was created in which random mating was used for 10 generations. Two methods of restricted maximum likelihood and Bayesian approach via Gibbs sampling were used for the estimation of genetic parameters. A bivariate model including maternal effects was used. The root mean square error for direct heritabilities was also calculated. 3. The results showed that when incidence rates of ascites increased from 5% to 30%, the heritability of AS increased from 0.013 and 0.005 to 0.110 and 0.162 for linear and threshold models, respectively. 4. Maternal effects were significant for both BW5 and AS. Genetic correlations were decreased by increasing incidence rates of ascites in the population from 0.678 and 0.587 at 5% level of ascites to 0.393 and -0.260 at 50% occurrence for linear and threshold models, respectively. 5. The RMSE of direct heritability from true values for BW5 was greater based on a linear-threshold model compared with the linear model of analysis (0.0092 vs. 0.0015). The RMSE of direct heritability from true values for AS was greater based on a linear-linear model (1.21 vs. 1.14). 6. In order to rank birds for ascites incidence, it is recommended to use a threshold model because it resulted in higher heritability estimates compared with the linear model and that BW5 could be one of the main components of selection goals.

  17. Cirrhosis and its complications: evidence based treatment.

    PubMed

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

    2014-05-14

    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.

  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. 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.

  20. 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

  1. 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.

  2. Chronic lymphocytic leukemia: treatment options for patients with refractory disease.

    PubMed

    Motta, Marina; Wierda, William G; Ferrajoli, Alessandra

    2009-09-01

    Patients with purine analogue-refractory chronic lymphocytic leukemia (CLL) have short survival and limited treatment options. Defining the best salvage strategies for this population is challenging, because limited data are available from clinical trials, and because studies have enrolled mixed populations (patients with recurrent and refractory disease or patients with refractory disease and Richter transformation). Moreover, patients with refractory CLL have a high incidence of unfavorable molecular and clinical features, such as high-risk genomic profiles, unmutated immunoglobulin heavy-chain genes, expression of zeta-chain-associated protein kinase 70, and bulky lymphadenopathies. These patients are also severely immunosuppressed because of the underlying disease and the treatments received, and experience a high rate of infectious complications that pose an additional difficulty in selecting treatment. Despite these challenges, in parallel with better characterizations of the biologic features of refractory CLL, the number of available treatment modalities for this population has increased. Several chemoimmunotherapy combinations have been developed, and novel agents with a different mechanism of action are being investigated in clinical trials. Furthermore, allogeneic stem cell transplantation with nonmyeloablative conditioning regimens is a therapeutic strategy that is increasingly offered to patients with refractory CLL.

  3. Pregnancy Complications

    MedlinePlus

    ... To receive Pregnancy email updates Enter email Submit Pregnancy complications Complications of pregnancy are health problems that ... pregnancy. Expand all | Collapse all Health problems before pregnancy Before pregnancy, make sure to talk to your ...

  4. Serum C-Reactive Protein in Children with Liver Disease and Ascites

    PubMed Central

    Kalvandi, Gholamreza; Honar, Naser; Geramizadeh, Bita; Ataollahi, Maryam; Rahmani, Asghar; Javaherizadeh, Hazhir

    2016-01-01

    Background The diagnosis of peritonitis as a complication of cirrhosis is an important clinical problem. Objectives The aim of this study was to evaluate serum C-reactive protein levels as a diagnostic factor for spontaneous bacterial peritonitis (SBP) in child patients with liver disease. Methods In this study, 150 children diagnosed with liver disease and ascites upon admission to Nemazee Teaching Hospital (Shiraz, Iran) were examined. Patients were divided into spontaneous bacterial peritonitis and sterile ascetic fluid groups according to the PMN count ≥ 250/mm3 in the ascetic fluids. Routine laboratory tests were conducted and quantitative C-reactive protein (CRP) levels were measured for all of the patients. Accuracy, sensitivity, and specificity of CRP was evaluated for diagnosis of SBP. Results Of 150 cirrhotic patients, 109 patients presented without SBP (52.29% male, mean age: 5.02 ± 4.49 years) and 41 patients presented with SBP (51.21% male, mean age: 4.71 years). Cell counts, protein levels, albumin levels, and lactate dehydrogenize (LDH) levels of the ascetic fluid and serum samples in the SBP group were higher than the rates for those without SBP (P < 0.05(. The mean ± SD of CRP in the SBP group (36.89 ± 23.43) increased significantly compared to the rate among those without SBP (21.59 ± 15.43, P = 0.001). The percentages for sensitivity and specificity of CRP, the diagnosis of SBP based on the PMN count ≥ 250/mm3, and cultured ascites were 69.23%, 90.25%, 88.43%, and 84.32%, respectively. The areas under the curve of CRP for SBP based on the PMN count ≥ 250/mm3 and cultured ascites was 0.94 (CI 95%: 0.90 to 0.96) and 0.85 (CI 95%: 0.84 to 0.92), respectively (P < 0.001). Conclusions Our study showed that CRP is a marker with high sensitivity and specificity for the diagnosis of SBP in cirrhotic children. PMID:27795726

  5. Antitumour activity of Bauhinia variegata on Dalton's ascitic lymphoma.

    PubMed

    Rajkapoor, B; Jayakar, B; Murugesh, N

    2003-11-01

    The antitumour activity of the ethanol extract of Bauhinia variegata (EBV) has been evaluated against Dalton's ascitic lymphoma (DAL) in Swiss albino mice. A significant enhancement of mean survival time of EBV-treated tumour bearing mice was found with respect to control group. EBV treatment was found to enhance peritoneal cell counts. After 14 days of inoculation, EBV is able to reverse the changes in the haemotological parameters, protein and PCV consequent to tumour inoculation.

  6. 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.

  7. 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.

  8. Modulation of ConA-induced inflammatory ascites by histamine - short communication.

    PubMed

    Baintner, Károly

    2015-03-01

    The early phase of the ConA-induced inflammatory ascites was studied, with special reference to histamine. Concanavalin A (ConA), a cell-surface binding lectin was injected i.p. (25 mg/kg bw) to mice. After 1 h the animals were killed, the ascitic fluid collected and measured. Other agents were injected s.c., 10 min before the ConA-challenge. Exogenous histamine markedly inhibited the ConA-induced ascites. Release of endogenous vasoactive agents from the mast cells by Compound 48/80 had a similar, but slight effect. Cromolyn, a mast cell stabilizing agent, and chloropyramine, a histamine H1 receptor antagonist was ineffective. Although histamine increases endothelial permeability, it did not enhance the formation of ascitic fluid, on the contrary, it inhibited the ConA-induced ascites, presumably due to its known hypotonic effect. It is concluded that ConA-induced ascites is not mediated by mast cell histamine.

  9. 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.

  10. 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

  11. 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

    2012-12-11

    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

  12. 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

  13. 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.

  14. Preventing and Treating Acute Kidney Injury Among Hospitalized Patients with Cirrhosis and Ascites: A Narrative Review.

    PubMed

    Tapper, Elliot B; Bonder, Alan; Cardenas, Andres

    2016-05-01

    Acute kidney injury in the setting of ascites and cirrhosis is a medical emergency characterized by significant morbidity and mortality. Clinicians other than gastroenterologists are often the front line against acute kidney injury for patients with ascites. Owing to the specifics of cirrhotic physiology, the treatment and prevention of acute kidney injury in the setting of ascites has unique features, widespread knowledge of which will benefit our patients with cirrhosis. Early detection and treatment of infection, maximization of cardiac output, and avoidance of medications that limit cardiorenal adaptations to arterial underfilling are part of a multipronged strategy to protect the renal function of our patients with cirrhosis and ascites.

  15. 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.

  16. Refractory giardiasis in Spanish travellers.

    PubMed

    Muñoz Gutiérrez, Jose; Aldasoro, Edelweiss; Requena, Ana; Comin, Ana M; Pinazo, Maria Jesús; Bardají, Azucena; Oliveira, Inés; Valls, Maria Eugenia; Gascon, Joaquim

    2013-01-01

    Drug failure is a common cause of symptom persistence after treatment of imported Giardia duodenalis. In this retrospective study we describe a high prevalence of refractory giardiasis in people attended in a travel clinic in Spain, especially those with infections acquired in Asia. Moreover, we discuss various treatment strategies to tackle G. duodenalis that is refractory to nitroimidazoles.

  17. Spontaneous Bacterial Empyema in Liver Cirrhosis: An Underdiagnosed Pleural Complication

    PubMed Central

    Allam, Naglaa A. H.

    2008-01-01

    Spontaneous bacterial empyema, defined as spontaneous infection of the pleural fluid, represents a distinct complication of hepatic hydrothorax with a different pathogenesis, clinical course and treatment strategy from those of empyema secondary to pneumonia. Nearly 40% of episodes of spontaneous empyema are not associated with spontaneous bacterial peritonitis (SBP) or even ascites. The condition portends a poor prognosis, and is frequently under-diagnosed. This article reviews the pathogenesis, diagnosis and management of spontaneous bacterial empyema. PMID:19568497

  18. Spontaneous bacterial empyema in liver cirrhosis: an underdiagnosed pleural complication.

    PubMed

    Allam, Naglaa A H

    2008-01-01

    Spontaneous bacterial empyema, defined as spontaneous infection of the pleural fluid, represents a distinct complication of hepatic hydrothorax with a different pathogenesis, clinical course and treatment strategy from those of empyema secondary to pneumonia. Nearly 40% of episodes of spontaneous empyema are not associated with spontaneous bacterial peritonitis (SBP) or even ascites. The condition portends a poor prognosis, and is frequently under-diagnosed. This article reviews the pathogenesis, diagnosis and management of spontaneous bacterial empyema.

  19. Prolonged treatment of refractory status epilepticus in a child.

    PubMed

    Sahin, M; Riviello, J J

    2001-02-01

    Barbiturate anesthesia, which is commonly used for refractory status epilepticus, is an effective treatment, but with many significant complications. The relationship between the duration of this extreme therapy and the ultimate outcome of refractory status epilepticus has not been well studied. We report a 7-year-old girl who presented with refractory status epilepticus secondary to presumed encephalitis with a focal lesion on cranial magnetic resonance imaging. She was treated for 70 days with high-dose antiepileptic drugs and recovered with a residual seizure disorder. This case suggests that, if the status epilepticus is due to a reversible cause such as encephalitis, neurologic recovery may occur despite this very prolonged course of extreme therapy.

  20. Fulminant ulcerative colitis complicated by treatment-refractory bacteremia

    PubMed Central

    Krease, Michael; Stroup, Jeff; Som, Mousumi

    2016-01-01

    Severe ulcerative colitis is defined by more than six bloody stools daily and evidence of toxicity, demonstrated by fever, tachycardia, anemia, or an elevated erythrocyte sedimentation rate. Fulminant disease represents a subset of severe disease with signs and symptoms suggestive of increased toxicity. Treatment of severe colitis includes intravenous corticosteroid administration, with consideration of intravenous infliximab 5 mg/kg. Failure to show improvement after 3 to 5 days is an indication for colectomy or treatment with intravenous cyclosporine. We report a 23-year-old Hispanic woman with decompensated cirrhosis presenting with new-onset fulminant ulcerative colitis and resulting polymicrobial bacteremia, requiring colectomy for infection source control and colitis treatment. PMID:27695178

  1. 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.

  2. 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

  3. 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.

  4. Cytochemical and immunocytochemical characterization of Yoshida ascites sarcoma cells.

    PubMed

    Nicotina, P A; Ruggeri, P; Ferlazzo, G; Fimiani, V

    1991-01-01

    Some cytochemical and immunocytochemical investigations were carried out on actively growing Yoshida ascites sarcoma cells. These cells displayed an intense granular alpha-naphthylacetate esterase (ANAE) staining while the alpha-naphthylbutyrate esterase (ANBE) reaction was in part fluoride-sensitive and marked particularly in the large-size malignant cells. Acid phosphatase as well as peroxidase activities were not detected. The lack of immunoreactive lysozyme and alpha 1-antitrypsin suggested a poor differentiation of the above-mentioned tumor cells, but fibronectin and S-100 protein where highly expressed, as in tumors arising from the mononuclear phagocyte system.

  5. Congenital Chylous Ascites and Ehlers-Danlos Syndrome Type VI

    PubMed Central

    Pohl, John; Esty, Brittany; Sempler, Jessica K.; Carey, John C.; O’Gorman, Molly A.

    2016-01-01

    We report the first observation of a patient with contgenital chylous ascites (CCA) and Ehlers-Danlos syndrome type VI due to primary lymphatic defect with additional vascular anomaly. CCA is a rare condition, and there is limited understanding of its pathophysiology and treatment options. We also review the patient’s treatment course mitigated with octreotide and total parenteral nutritional support, as there are no current established guidelines for CCA. Early recognition of possible association with Ehlers-Danlos syndrome is important for quick intervention and successful management of pediatric patients. PMID:28119937

  6. Bowel sounds analysis: a novel noninvasive method for diagnosis of small-volume ascites.

    PubMed

    Liatsos, Christos; Hadjileontiadis, Leontios J; Mavrogiannis, Christos; Patch, David; Panas, Stavros M; Burroughs, Andrew K

    2003-08-01

    Ascites is more difficult to detect when only a small quantity is present. The aim of this pilot study was to determine the optimal bowel sound characteristics in order to distinguish no ascites from small-volume ascites by advanced processing of bowel sound wave patterns. This analysis results in the definition of the normal range of bowel sound patterns, thus providing a novel, simple, and noninvasive way of determining on abnormal pattern, which may reflect presence of small volume ascites. Cirrhotic patients with radiologically proven small-volume ascites and a control group were subjected to bowel sound recordings. The latter were analyzed using a denoising wavelet transform-based filter and a higher-order crossings-based technique in a blinded fashion for linearly distinguishing the two classes. Scatter plots of third-order zero crossings reflect distinct changes seen in the denoised bowel sound pattern between patients and controls due to altered transmission path, providing a distinct separation of all cirrhotic patients with small ascites from controls (P < 0.0001). We conclude that the proposed bowel sounds analysis appears to provide new information regarding the changes of the bowel sound patterns due to the presence of small-volume ascites, potentially contributing towards a safe, effective, noninvasive, and easily implemented alternative method for the diagnosis of small volume ascites at the bedside.

  7. Incarceration of umbilical hernia: a rare complication of large volume paracentesis.

    PubMed

    Khodarahmi, Iman; Shahid, Muhammad Usman; Contractor, Sohail

    2015-09-01

    We present two cases of umbilical hernia incarceration following large volume paracentesis (LVP) in patients with cirrhotic ascites. Both patients became symptomatic within 48 hours after the LVP. Although being rare, given the significantly higher mortality rate of cirrhotic patients undergoing emergent herniorrhaphy, this complication of LVP is potentially serious. Therefore, it is recommended that patients be examined closely for the presence of umbilical hernias before removal of ascitic fluid and an attempt should be made for external reduction of easily reducible hernias, if a hernia is present.

  8. Incarceration of umbilical hernia: a rare complication of large volume paracentesis

    PubMed Central

    Khodarahmi, Iman; Shahid, Muhammad Usman; Contractor, Sohail

    2015-01-01

    We present two cases of umbilical hernia incarceration following large volume paracentesis (LVP) in patients with cirrhotic ascites. Both patients became symptomatic within 48 hours after the LVP. Although being rare, given the significantly higher mortality rate of cirrhotic patients undergoing emergent herniorrhaphy, this complication of LVP is potentially serious. Therefore, it is recommended that patients be examined closely for the presence of umbilical hernias before removal of ascitic fluid and an attempt should be made for external reduction of easily reducible hernias, if a hernia is present. PMID:26629305

  9. Intrathecal ziconotide for refractory pain.

    PubMed

    Doggrell, Sheila A

    2004-07-01

    For cancer and AIDS patients, 10-30% of pain is refractory to strong opioids, requiring intraspinal administration for pain management. Ziconotide is a selective N-type calcium channel blocker, which inhibits neurotransmitter release, and following intrathecal administration will affect primary nociceptive afferents. In 108 patients with previously unmanaged refractory pain despite the use of systemic or intrathecal opioids, in the initial titration phase, the mean Visual Analogue Scale of Pain Intensity scores improved more in the ziconotide group (53%) than the placebo group (18%). Serious adverse effects were more common in the ziconotide group (31%) than placebo group (10%) in the initial titration phase. In the 48 patients receiving ziconotide, who proceeded to the maintenance phase, the benefit of ziconotide was continued. Until a new approach with a better effectiveness/adverse effects profile than ziconotide for refractory pain emerges, further optimisation of ziconotide for use in the treatment of refractory pain should be undertaken.

  10. 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

  11. Multi-generational genome wide association studies identify chromosomal regions associated with ascites phenotype.

    PubMed

    Tarrant, K J; Dey, S; Kinney, R; Anthony, N B; Rhoads, D D

    2017-02-21

    Ascites is a multi-faceted disease commonly observed in fast growing broilers, which is initiated when the body is insufficiently oxygenated. A series of events follow, including an increase in pulmonary artery pressure, right ventricle hypertrophy, and accumulation of fluid in the abdominal cavity and pericardium. Advances in management practices along with improved selection programs have decreased ascites incidence in modern broilers. However, ascites syndrome remains an economically important disease throughout the world, causing estimated losses of $100 million per year. In this study, a 60 K Illumina SNP BeadChip was used to perform a series of genome wide association studies (GWAS) on the 16th and 18th generation of our relaxed (REL) line descended from a commercial elite broiler line beginning in 1995. Regions significantly associated with ascites incidence were identified on chromosome 2 around 70 megabase pairs (Mbp) and on chromosome Z around 60 Mbp. Five candidate single nucleotide polymorphisms (SNP) were evaluated as indicators for these 2 regions in order to identify association with ascites and right ventricle to total ventricle weight (RVTV) ratios. Chromosome 2 SNP showed an association with RVTV ratios in males phenotyped as ascites resistant and ascites susceptible (P = 0.02 and P = 0.03, respectively). The chromosome Z region also indicates an association with resistant female RVTV values (P = 0.02). Regions of significance identified on chromosomes 2 and Z described in this study will be used as proposed candidate regions for further investigation into the genetics of ascites. This information will lead to a better understanding of the underlying genetics and gene networks contributing to ascites, and thus advances in ascites reduction through commercial breeding schemes.

  12. Malignant ascites in ovarian cancer and the role of targeted therapeutics.

    PubMed

    Smolle, Elisabeth; Taucher, Valentin; Haybaeck, Johannes

    2014-04-01

    Ovarian cancer (OC) is the eighth most lethal gynecological malignancy and the main cause of gynecological cancer death in industrialized countries. Malignant ascites is often found in OC, with about 10% of patients suffering from recurrent OC. Tumor cells in OC-associated malignant ascites promote disease recurrence and patient mortality is mainly associated with widespread metastasis to serosal surfaces and accompanying peritoneal effusions. Targeted therapies have recently been developed as novel therapeutic options for malignant ascites. The tri-functional anti-epithelial cell adhesion molecule and anti-cluster of differentiation 3 monoclonal antibody catumaxumab has been assessed in the therapy of malignant ascites, and proven to significantly reduce the ascitic flow rate when applied into the peritoneal cavity. The anti-angiogenic targeted agent bevacizumab has also shown good effects in the symptomatic treatment of malignant ascites, significantly prolonging the time until the next paracentesis. Vascular endothelial growth factor (VEGF) Trap, or aflibercept, is a fusion protein that inhibits VEGF-receptor binding. Aflibercept has proven to be effective in reduction of ascites, diminishing clinical symptoms of ascites and prolonging the time to next paracentesis. All three agents we review in the present article are effective in symptomatic control of ascites, leading to a rapid reduction of effusion and prolonging the time interval between paracenteses. However, no improvement in overall survival was observed in any of the clinical trials reported. We, thus, conclude that further investigations on larger patient series are needed to clarify whether the reduction of ascites by these targeted agents leads to a prolongation in tumor-related survival or not.

  13. Immunogenicity of ascites tumor cells following in vitro hyperthermia

    SciTech Connect

    Dickson, J.A.; Jasiewicz, M.L.; Simpson, A.C.

    1982-06-01

    The concept that host immunization may be achieved by heat-induced antigenic modifications of cancer cells and/or the release of immunogenic products by dead or dying tumor cells following in vitro heating was examined. Ehrlich ascites cells were used, inasmuch as it was claimed that in vitro hyperthermia increased the immunogenicity of these cells. Tumor cell populations of different viability were obtained by heating Ehrlich cells at 42.5 degrees, 45 degrees, or 60 degrees C. Viable and nonviable cells were separated by Ficoll-Hypaque density centrifugation; viable nonreplicating cells were obtained by treatment with mitomycin C. Cell populations of different viability after heating were left to die slowly over 3 days at 37 degrees C. Swiss TO mice were then given injections of the treated cells and/or medium. No survival benefit occurred in mice inoculated with any of these different components and then challenged with viable tumor cells. Injection of irradiated cells, however, did produce host immunity. Similarly, D23 rat hepatoma ascites cells produced host immunity after 15,000 rad but not after heating. The claim that in vitro hyperthermia increases the immunogenicity of tumor cells was not confirmed.

  14. A huge renal cyst mimicking ascites: a case report

    PubMed Central

    2014-01-01

    Background Renal cysts are common in old patients, and usually remain untreated. Giant renal cyst measuring more than 15 cm in diameter and containing more than 1500 mls of serous fluid are rarely seen. We report a case of a 75-year-old man with a giant right renal cyst. Case presentation A 75-year-old man presented with a five years history of suprapubic pain, abdominal distension. He had no urological symptoms. Physical examination revealed a distended abdomen with shifting dullness. Routine hematology, biochemistry, and serum tumor markers were within normal limits. Erroneously diagnosed as ascites on ultrasonographic examination. Abdominal paracentesis of supposed ascites was performed. The diagnosis of giant renal cyst was finally made by Computed tomography (CT) and patient underwent continuous percutaneous catheter drainage with negative pressure, whereby 8 liters of fluid were removed with negative cytology. Subsequent Computed tomography after 6 months revealed disparition of the cysts, and the patient remained asymptomatic. Conclusion Giant renal cysts are uncommon; we conclude that the CT remains the best exam in patients evaluated for giant renal cyst. This to the best of our knowledge is the largest renal cyst in the medical literature. Studies are needed with particular attention to the factors associated with renal cyst enlargement. PMID:24428865

  15. Ultraviolet Radiation Effects on Ehrlich Ascites Tumor Cells

    PubMed Central

    Freed, Jerome J.; Engle, James L.; Rudkin, George T.; Schultz, Jack

    1959-01-01

    A flying spot ultraviolet microscope, employing a fast scan and pulsed operation of the raster, has been used to induce radiation damage in ascites tumor slide cultures, and to study by time-lapse cinematography the progressive stages of cell damage. The cells observed came from a strain (EF7) of the Ehrlich ascites carcinoma. Irradiated cells were found to show a characteristic syndrome of damage, involving blebbing at the cell surface, while control cells in the adjacent areas of the preparation remained unchanged. The end of the blebbing period is marked by swelling of the cells, and the time taken for this phenomenon to occur was used as a measure of the severity of the damage. It was found that the time required for swelling is dependent on the size of the dose employed, as well as on the sensitivity of the cells. This latter sensitivity was found to decline as the physiological age of the tumor increased. If ultraviolet illumination below 255 mµ is excluded, no symptoms of damage occur, even when very large doses are used. These observations are discussed in relation to the nature of the system in the cell which is affected. PMID:13654439

  16. Neostigmine in the treatment of refractory constipation in critically ill children.

    PubMed

    González, Rafael; López-Herce, Jesús; García, Ana; Botrán, Marta; Solana, Maria Jose; Urbano, Javier

    2011-08-01

    Constipation is a common complication in critically ill children and it is occasionally resistant to the drugs typically used in treatment. Neostigmine has been used in some cases of refractory constipation in critically ill adults. There is no reference to its use in critically ill children. We describe 3 cases of refractory constipation in critically ill children treated with intravenous neostigmine by continuous infusion. Two patients responded well. There were no adverse effects. We conclude that continuous intravenous neostigmine can be effective in critically ill children with refractory constipation. Further studies are necessary to determine the dose and safety of the treatment.

  17. Parameter on "refractory" periodontitis. American Academy of Periodontology.

    PubMed

    2000-05-01

    The American Academy of Periodontology has developed the following parameter on the treatment of "refractory " periodontitis. Patients should be informed of the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. No treatment is very likely to result in further progression of the disease and eventual tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

  18. 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. PMID:27635296

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

    ClinicalTrials.gov

    2017-02-10

    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

  20. 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

  1. Radiation Effects in Refractory Alloys

    NASA Astrophysics Data System (ADS)

    Zinkle, Steven J.; Wiffen, F. W.

    2004-02-01

    In order to achieve the required low reactor mass per unit electrical power for space reactors, refractory alloys are essential due to their high operating temperature capability that in turn enables high thermal conversion efficiencies. One of the key issues associated with refractory alloys is their performance in a neutron irradiation environment. The available radiation effects data are reviewed for alloys based on Mo, W, Re, Nb and Ta. The largest database is associated with Mo alloys, whereas Re, W and Ta alloys have the least available information. Particular attention is focused on Nb-1Zr, which is a proposed cladding and structural material for the reactor in the Jupiter Icy Moons Orbiter (JIMO) project. All of the refractory alloys exhibit qualitatively similar temperature-dependent behavior. At low temperatures up to ~0.3TM, where TM is the melting temperature, the dominant effect of radiation is to produce pronounced radiation hardening and concomitant loss of ductility. The radiation hardening also causes a dramatic decrease in the fracture toughness of the refractory alloys. These low temperature radiation effects occur at relatively low damage levels of ~0.1 displacement per atom, dpa (~2×1024 n/m2, E>0.1 MeV). As a consequence, operation at low temperatures in the presence of neutron irradiation must be avoided for all refractory alloys. At intermediate temperatures (0.3 to 0.6 TM), void swelling and irradiation creep are the dominant effects of irradiation. The amount of volumetric swelling associated with void formation in refractory alloys is generally within engineering design limits (<5%) even for high neutron exposures (>>10 dpa). Very little experimental data exist on irradiation creep of refractory alloys, but data for other body centered cubic alloys suggest that the irradiation creep will produce negligible deformation for near-term space reactor applications.

  2. Extremely refractory Kawasaki disease with disseminated intravascular coagulation.

    PubMed

    Koh, Young Kwon; Lee, Jae Hee; Park, Yeong Bong

    2017-03-07

    Disseminated intravascular coagulation is a rare complication of Kawasaki disease and appears in <0.1% of Kawasaki disease patients. We report a case of refractory Kawasaki disease complicated with disseminated intravascular coagulation and giant coronary aneurysm. A 5-month-old boy presented with Kawasaki disease with coagulopathy. Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration. Despite all efforts to treatment, the patient had giant coronary aneurysms and died suddenly.

  3. Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent

    PubMed Central

    Spira, Daniel; Wiskirchen, Jakub; Lauer, Ulrich; Ketelsen, Dominik; Nikolaou, Konstantin; Wiesinger, Benjamin

    2016-01-01

    Background The transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications. Objectives To describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success. Patients and Methods Twenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded. Results The portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation. Conclusion The sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS

  4. Prognostic significance of new onset ascites in patients with pancreatic cancer

    PubMed Central

    Zervos, Emmanuel E; Osborne, Dana; Boe, Brian A; Luzardo, German; Goldin, Steven B; Rosemurgy, Alexander S

    2006-01-01

    Background The purpose of this study was to determine risk factors for development of malignant ascites and its prognostic significance in patients with pancreatic cancer. Methods A prospective database was queried to identify patients with pancreatic cancer who develop ascites. Stage at presentation, size, and location of primary tumor, treatment received and length of survival after onset of ascites were determined. Results A total of 15 patients were identified. Of which 4 patients (1 stage II, 3 stage III) underwent pancreaticoduodenectomy and manifested with ascites 2, 3, 24 and 47 months after surgery (tumor size 2.9 ± 1.32 cm). All but one of the remaining 11 patients (tumor size 4.4 ± 3.38 cm) presented with metastatic disease, and all developed malignant ascites 9 months after diagnosis, dying 2 months later. Resected patients lived longer before the onset of ascites, but not after. Conclusion Once diagnosed, ascites in pancreatic cancer patients heralds imminent death. Limited survival should be considered when determining the aggressiveness of further intervention. PMID:16569225

  5. 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.

  6. High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis

    PubMed Central

    Spadaro, Aldo; Tortorella, Vincenza; Morace, Carmela; Fortiguerra, Agostino; Composto, Paola; Bonfiglio, Caterina; Alibrandi, Angela; Luigiano, Carmelo; Caro, Giuseppe De; Ajello, Antonino; Ferraù, Oscar; Freni, Maria Antonietta

    2008-01-01

    AIM: To measure plasma D-dimer levels in cirrhotic patients with and without ascites, assessing the effect of ascites resolution in D-dimer concentration. METHODS: Seventy consecutive cirrhotic patients (M = 44, F = 26, mean age 65 years, SD ± 13), observed from October 2005 to March 2006 were enrolled. Circulating D-dimer levels were measured using a latex-enhanced, immunoturbidimetric test. In patients with ascites (n = 42) the test was repeated after ascites resolution. RESULTS: Ascites was present in 42 patients (group A) and absent in 28 (group B). Group A patients had more advanced liver disease. Hepatocellular carcinoma (HCC) was diagnosed in 14 patients and was more frequent in group B. Above normal range D-dimers were found in 45/70 patients. High D-dimers were more frequent in group A than in group B (P = 0.001). High D-dimers were associated with presence of HCC (P = 0.048) only in group B. After ascites resolution, obtained in all patients, mean D-dimer values decreased in those 34 patients with high basal levels (P = 0.007), returning to normal in 17. CONCLUSION: In patients with liver cirrhosis, ascites and HCC are the main factors associated with increased fibrinolytic activity. PMID:18330946

  7. 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.

  8. Effect of dietary aspirin on ascites in broilers raised in a hypobaric chamber.

    PubMed

    Balog, J M; Huff, G R; Rath, N C; Huff, W E

    2000-08-01

    During the course of ascites development in broilers, many factors can interact to cause hypoxia. To counteract hypoxia, birds with ascites develop greatly increased hematocrit and red cell counts. Increasing hematocrits result in more viscous blood. Prostaglandins are involved in the regulation of constriction and dilation of pulmonary blood vessels and in the formation of blood clots. Dietary aspirin, a prostaglandin inhibitor, was used in an attempt to promote vasodilation and inhibit blood clotting in broilers, with the objective of determining the effect of aspirin on ascites progression. The experimental design consisted of two trials with a total of 1,360, 1-d-old male broiler chicks, which were placed at either local altitude (390 m above sea level) or in a hypobaric chamber that simulated an altitude of 2,900 m above sea level. At each elevation, five dietary treatments were employed: [control, 0.025% crystalline acetylsalicylic acid (aspirin), 0.05% aspirin, 0.10% aspirin, and 0.20% aspirin]. Bird and feed weights were recorded weekly. At the end of 5 wk, blood samples and organ weights were collected, and all birds were examined for signs of ascites. In both trials, birds raised at high altitudes were significantly lighter, had a higher incidence of ascites, and had differences in hematology, compared with birds raised at local elevation. Only in Trial 2, however, did dietary aspirin appear to have any effect on ascites incidence. At the 0.20% aspirin level, a reduction in ascites incidence approached significance compared with controls (34% vs. 56%, P < or = 0.06). Unfortunately, birds fed 0.20% aspirin also were significantly (P < or = 0.01) lighter than controls. Because slowing growth rate is known to reduce ascites, this decrease in BW may have been partially responsible for any beneficial effect on ascites development and progression obtained through feeding aspirin.

  9. Pregnancy complicated with agranulocytosis

    PubMed Central

    Wang, Hai; Sun, Jiang-Li; Zhang, Zheng-Liang; Pei, Hong-Hong

    2016-01-01

    induced by immunoregulations and termination of pregnancy may be effective for refractory pregnancy complicated with agranulocytosis, but further studies are needed to confirm this. PMID:28033275

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. Chronobiological organization of reproduction of Ehrlich's ascites tumor cells

    SciTech Connect

    Romanov, Qu, A.; Stepanenko, V.A.

    1986-01-01

    The rhythms of cell proliferation and DNA synthesis were studied in a hypotetraploid strain of Ehrlich's ascites tumor (EAT) and compared with data obtained previously on the hyperdiploid strain of EAT. Eighty-five noninbred male albino mice were used. An injection of tritium-thymidine, with specific radioactivity of 4.1 Ci/mmole, was given to the mice one hour before sacrifice. The results obtained are presented; it is shown that the number of DNA-synthesizing cells in the hypotetraploid strain during the 5th and 6th days of growth of EAT was 503 and 479 /sup 0//00, respectively. Fluctuations of the radioactive index during these days were not significant. Only a significant fall in the radioactive index toward noon on the seventh day of development of the hypotetraploid strain of EAT was observed.

  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.

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

    PubMed Central

    Spencer, T L; Lehninger, A L

    1976-01-01

    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

  17. 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.

  18. 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

  19. Further investigation of a quantitative trait locus for ascites on chromosome 9 in broiler chicken lines.

    PubMed

    Dey, Shatovisha; Krishna, Sriram; Anthony, Nicholas B; Rhoads, Douglas D

    2016-10-10

    Previously, we reported a genome wide association study (GWAS) that had shown association of a region between 11.8 and 13.6 Mbp on chromosome 9 with ascites phenotype in broilers. We had used microsatellite loci to demonstrate an association of particular genotypes for this region with ascites in experimental ascites lines and commercial broiler breeder lines. We identified two potential candidate genes, AGTR1 and UTS2D, within that chromosomal region for mediating the quantitative effect. We have now extended our analysis using SNPs for these genes to assess association with resistance or susceptibility to ascites in these same broiler lines. Surprisingly, in contrast to our previous GWAS and microsatellite data for this region, we find no association of the SNP genotypes or haplotypes in the region suggesting that the two genes might have limited association with the disease phenotype.

  20. 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.

  1. Risk Factors for Intractable Ascites After Adult-to-Adult Living Donor Liver Transplantation Using Left Lobe

    PubMed Central

    Matsudaira, Shinichi; Ishizaki, Yoichi; Yoshimoto, Jiro; Fujiwara, Noriko; Kawasaki, Seiji

    2017-01-01

    Background Intractable ascites is one of the causes of graft loss after adult-to-adult living donor liver transplantation (LDLT) using a small graft. Identification of factors associated with increasing posttransplant ascites has important implications for prevention and treatment. Methods All 59 consecutive adult patients who underwent left lobe LDLT without portal inflow modulation between October 2002 and February 2016 were prospectively enrolled. Factors associated with the average daily amount of ascites for 2 weeks after LDLT were assessed. Results The median daily amount of ascites during the 2 weeks was 1052 mL (range, 52-3480 mL). Although 16 of the 59 patients developed intractable ascites, exceeding 1500 mL daily (massive ascites group), the remaining 43 patients produced less than 1500 mL of ascites daily (nonmassive ascites group). The presence of pretransplant ascites (P = 0.001), albumin (P = 0.011), albumin/globulin ratio (P = 0.026), cold ischemia time (P = 0.004), operation time (P = 0.022), and pretransplant portal vein pressure (PVP) (P = 0.047) differed significantly between the 2 groups. Neither posttransplant PVP nor portal vein flow differed between the 2 groups. The variables associated with intractable ascites that remained significant after logistic regression analysis were pretransplant PVP (P = 0.047) and cold ischemia time (P = 0.049). After appropriate fluid resuscitation for intractable ascites, 58 (98%) of the 59 recipients were discharged from hospital after removal of the indwelling drains. Conclusions It is important to shorten the scold ischemia time to reduce massive ascites after LDLT. Pretransplant portal hypertension is more closely associated with ascites production than posttransplant hemodynamic status. PMID:28361122

  2. 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

  3. [Dielectric parameters of ascitic and pleural fluids in the microwave range in different nosologies].

    PubMed

    Romanov, A N; Kovrigin, A O; Grigorchuk, O G; Lubennikov, V A; Lazarev, A F

    2011-01-01

    The dielectric parameters of ascitic and pleural fluids formed in the human body in oncological and nononcological diseases of different nosology have been estimated in the range between 400 MHz and 1.2 GHZ. The dependence of refractive and absorption indices of ascitic and pleural liquids on the signal frequency and mass concentration of dissolved substances was found. Common regularities and distinctions in the behavior of their dielectric properties were revealed.

  4. Structural changes of the diaphragmatic peritoneum in patients with schistosomal hepatic fibrosis: its relation to ascites.

    PubMed

    Ismail, A H; Mohamed, F S

    1986-06-01

    The histopathologic changes of the peritoneum of the hemidiaphragm were studied in 30 patients with schistosomal liver disease and compared with ten control subjects. The diaphragmatic peritoneum of patients with ascites was markedly thickened with infiltration of inflammatory cells and collagen bundles resembling the interstitial changes of peripheral lymphedema. Obliteration of diaphragmatic lymphatic stomata with restricted lymph flow as well as excess lymph formation from portal hypertension are both major factors in the magnitude and intractability of ascites associated with schistosomal hepatic fibrosis.

  5. Approach to patients with refractory coeliac disease

    PubMed Central

    Nasr, Ikram; Nasr, Iman; Campling, Hannah; Ciclitira, Paul J.

    2016-01-01

    Refractory coeliac disease (RCD) is a recognised complication, albeit very rare, of coeliac disease (CD). This condition is described when individuals with CD continue to experience enteropathy and subsequent or ongoing malabsorption despite strict adherence to a diet devoid of gluten for at least 12 months and when all other causes mimicking this condition are excluded. Depending on the T-cell morphology and T-cell receptor (TCR) clonality at the β/γ loci, RCD can be subdivided into type 1 (normal intra-epithelial lymphocyte morphology, polyclonal TCR population) and type 2 (aberrant IELs with clonal TCR). It is important to differentiate between the two types as type 1 has an 80% survival rate and is managed with strict nutritional and pharmacological management. RCD type 2 on the other hand has a 5-year mortality of 50% and can be complicated by ulcerative jejunitis or enteropathy-associated T-cell lymphoma (EATL). Management of RCD type 2 has challenged many experts, and different treatment approaches have been adopted with variable results. Some of these treatments include immunomodulation with azathioprine and steroids, methotrexate, cyclosporine, alemtuzumab (an anti CD-52 monoclonal antibody), and cladribine or fludarabine sometimes with autologous stem cell transplantation. In this article, we summarise the management approach to patients with RCD type 2. PMID:27803799

  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. Management of chronic refractory cough.

    PubMed

    Gibson, Peter G; Vertigan, Anne E

    2015-12-14

    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.

  8. Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter

    PubMed Central

    Mortensen, Frank V.; Madsen, Hans Henrik Torp

    2015-01-01

    Background Malignant ascites is a pathological condition caused by intra- or extra-abdominal disseminated cancer. The object of treatment is palliation. In search of an effective and minimally invasive palliative treatment of malignant ascites placement of a permanent intra peritoneal catheter has been suggested. Purpose To evaluate our experiences with treatment of malignant ascites by implantation of a permanent PleurX catheter. Material and Methods A retrospective study was conducted, comprising 20 consecutive patients with terminal cancer, who had a permanent PleurX catheter implanted because of malignant ascites in the period from February to November 2014. Using the patients’ medical records, we retrieved data on patients and procedures. Results The technical success rate was 100%. Catheter patency was 95.2%, one catheter was removed due to dislocation. Ten patients (50.0%) experienced minor adverse events. No procedural difficulties were reported and there was no need for additional treatment of malignant ascites after catheter implantation. Median residual survival after catheter implantation was 27 days. Conclusion Implantation of a permanent PleurX catheter is a minimally invasive and effective procedure with only minor adverse events and a high rate of catheter patency in patients with malignant ascites caused by terminal cancer disease. PMID:26346641

  9. Effect of Glycyrrhiza on the Diuretic Function of Euphorbia kansui: An Ascites Mouse Model

    PubMed Central

    Lin, Ya; Zhang, Yanqiong; Shang, Erxin; Lai, Wenfang; Zhu, Hongwei; Fang, Yuhua; Qin, Qingxia; Zhao, Haiyu; Lin, Na

    2016-01-01

    We investigated the therapeutic role of the herbal combination Euphorbia kansui (GS) and Glycyrrhiza (GC) in ascites during hepatocellular carcinoma (HCC). The AVPR2 and AQP2 expression in kidney tissues of ascites mice in different groups was determined by immunohistochemistry, Western blot, and real-time PCR analyses. When the dose of GS was less than 0.70 g/kg at a ratio of GC : GS not exceeding 0.4 : 1, the combination of GS and GC exhibited synergistic effects on HCC ascites and significantly elevated the expression levels of AVPR2 and AQP2 (all P < 0.05). On the contrary, when GS ≥ 0.93 g/kg and GC ≥ 1.03 g/kg with the GC-to-GS ratio exceeding 1.11 : 1, the combination of GS and GC displayed antagonistic effects on HCC ascites and dramatically reduced the expression levels of AVPR2 and AQP2 (all P < 0.05). Furthermore, the administration of herbal pair GS and GC at different ratios did not exacerbate the pathological changes in liver and kidney tissues of HCC ascites mice. The different combinations of GS and GC exerted synergistic or antagonistic effects on HCC ascites, partially by regulating the expression of AVPR2 and AQP2. PMID:27247609

  10. Chromia refractory brick with carbon treatment

    DOEpatents

    Bennett, James P.; Kwong, Kyei-Sing

    2017-03-21

    The disclosure provides a refractory brick system comprising a chromia refractory brick for operation in the slagging environment of an air-cooled gasifier. The chromia refractory brick comprises a ceramically-bonded porous chromia refractory having a porosity greater than 9% and having carbon deposits residing within the pores. The brick may be further comprised of Al.sub.2O.sub.3. The air-cooled gasifier generates a liquefied slag in contact with the refractory brick and generally operates at temperatures between 1250.degree. C. and 1575.degree. C. and pressures between 300 psi to 1000 psi, with oxygen partial pressures generally between 10.sup.-4 and 10.sup.-10 atm. The refractory brick performs without substantial chromium carbide or chromium metal formation in the low oxygen partial pressure environment. The inclusion of carbon without chromium carbide formation provides for significant mitigation of slag penetration and significantly reduced refractory wear.

  11. Clinical features and course of refractory anemia with ring sideroblasts associated with marked thrombocytosis

    PubMed Central

    Broseus, Julien; Florensa, Lourdes; Zipperer, Esther; Schnittger, Susanne; Malcovati, Luca; Richebourg, Steven; Lippert, Eric; Cermak, Jaroslav; Evans, Jyoti; Mounier, Morgane; Raya, José Maria; Bailly, François; Gattermann, Norbert; Haferlach, Torsten; Garand, Richard; Allou, Kaoutar; Besses, Carlos; Germing, Ulrich; Haferlach, Claudia; Travaglino, Erica; Luno, Elisa; Pinan, Maria Angeles; Arenillas, Leonor; Rozman, Maria; Perez Sirvent, Maria Luz; Favre, Bernardine; Guy, Julien; Alonso, Esther; Ahwij, Nuhri; Jerez, Andrés; Hermouet, Sylvie; Maynadié, Marc; Cazzola, Mario; Girodon, François

    2012-01-01

    Background Refractory anemia with ring sideroblasts associated with marked thrombocytosis was proposed as a provisional entity in the 2001 World Health Organization classification of myeloid neoplasms and also in the 2008 version, but its existence as a single entity is contested. We wish to define the clinical features of this rare myelodysplastic/myeloproliferative neoplasm and to compare its clinical outcome with that of refractory anemia with ring sideroblasts and essential thrombocythemia. Design and Methods We conducted a collaborative retrospective study across Europe. Our database included 200 patients diagnosed with refractory anemia with ring sideroblasts and marked thrombocytosis. For each of these patients, each patient diagnosed with refractory anemia with ring sideroblasts was matched for age and sex. At the same time, a cohort of 454 patients with essential thrombocythemia was used to compare outcomes of the two diseases. Results In patients with refractory anemia with ring sideroblasts and marked thrombocytosis, depending on the Janus Kinase 2 V617F mutational status (positive or negative) or platelet threshold (over or below 600×109/L), no difference in survival was noted. However, these patients had shorter overall survival and leukemia-free survival with a lower risk of thrombotic complications than did patients with essential thrombocythemia (P<0.001) but better survival (P<0.001) and a higher risk of thrombosis (P=0.039) than patients with refractory anemia with ring sideroblasts. Conclusions The clinical course of refractory anemia with ring sideroblasts and marked thrombocytosis is better than that of refractory anemia with ring sideroblasts and worse than that of essential thrombocythemia. The higher risk of thrombotic events in this disorder suggests that anti-platelet therapy might be considered in this subset of patients. From a clinical point of view, it appears to be important to consider refractory anemia with ring sideroblasts and

  12. Refractory myasthenia gravis – clinical profile, comorbidities and response to rituximab

    PubMed Central

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27–53 years. In our study 25 patients (32.89%) belonged to the age group of 21–30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10–8) to 94.6% (p=2.2x10–14) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low. PMID:27790079

  13. Erotic complications.

    PubMed

    Slochower, J

    1999-12-01

    The author argues that erotic transference-countertransference dynamics present particular complexities when they develop between gender constellations other than male analyst and female patient. She addresses the dynamics of a complicated erotic transference in concert with an aversive countertransference response as it evolved between a female analyst and female patient. The intense erotic transference that developed defied classification as either maternallerotic or oedipallerotic, and instead included both features in a rapidly shifting process that was difficult to address analytically. The analyst's confused, often aversive, response to her patient's erotic wishes ultimately revealed a subtle re-enactment involving split-off and erotised experiences of emotional penetration and scrutiny. When these issues were addressed, the erotic transference dissolved, and the analyst's experience of her patient shifted rather dramatically. It is suggested that complex erotic transference sometimes contains within it evidence of previously repressed object experiences that were not primarily sexual in nature.

  14. Transport of calcium ions by Ehrlich ascites-tumour cells.

    PubMed

    Landry, Y; Lehninger, A L

    1976-08-15

    Ehrlich ascites-tumour cells accumulate Ca2+ when incubated aerobically with succinate, phosphate and rotenone, as revealed by isotopic and atomic-absorption measurements. Ca2+ does not stimulate oxygen consumption by carefully prepared Ehrlich cells, but des so when the cells are placed in a hypo-osmotic medium. Neither glutamate nor malate support Ca2+ uptake in 'intact' Ehrlich cells, nor does the endogenous NAD-linked respiration. Ca2+ uptake is completely dependent on mitochondrial energy-coupling mechansims. It was an unexpected finding that maximal Ca2+ uptake supported by succinate requires rotenone, which blocks oxidation of enogenous NAD-linked substrates. Phosphate functions as co-anion for entry of Ca2+. Ca2+ uptake is also supported by extra-cellular ATP; no other nucleoside 5'-di- or tri-phosphate was active. The accumulation of Ca2+ apparently takes place in the mitochondria, since oligomycin and atractyloside inhibit ATP-supported Ca2+ uptake. Glycolysis does not support Ca2+ uptake. Neither free mitochondria released from disrupted cells nor permeability-damaged cells capable of absorbing Trypan Blue were responsible for any large fraction of the total observed energy-coupled Ca2+ uptake. The observations reported also indicate that electron flow through energy-conserving site 1 promotes Ca2+ release from Ehrlich cells and that extra-cellular ATP increase permeability of the cell membrane, allowing both ATP and Ca2+ to enter the cells more readily.

  15. Internucleotide protein linkers in Ehrlich ascites cell DNA.

    PubMed

    Werner, D; Krauth, W; Hershey, H V

    1980-07-29

    DNA from Ehrlich ascites tumor cells is nicked or gapped by a reaction which is induced by proteases such as autodigested pronase, proteinase K, trypsin, chymotrypsin and subtilisin. The cleavage of the protease-sensitive sites is inhibited by protease inhibitors. The nicks or gaps induced by proteases can be demonstrated by nuclease S1 sensitivity of native DNA and by a change of the sedimentation rate of alkali-denatured DNA. The limit size of denatured DNA released after optimal protease treatment is 8.5 x 10(6) daltons (27 kilo bases). The molecular weight of the native DNA pieces released after nuclease S1 degradation of DNA containing the protease-induced nicks or gaps is in the same order indicating that the protease-sensitive sites are alternatively arranged on the opposite DNA strands at an average distance of 13.5 kilo base pairs. Since the protease-induced nicks or gaps in phosphatase-treated DNA are not attacked by Escherichia coli polymerase I, one or both ends liberated by the protease treatment must be blocked by a material other than phosphate groups. The results are most compatible with peptide/protein linkers joining adjacent single-strand DNA subunits. Alternative explanations such as alkali-stable RNA linkers, protein-protected RNA linkers, site-specific nuclease contaminations in the protease preparations or cellular nucleases activated by the protease treatment are eliminated by the results presented in this paper.

  16. Genetic parameters of ascites-related traits in broilers: effect of cold and normal temperature conditions.

    PubMed

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

    2005-02-01

    (1) Ascites syndrome is a growth-related disorder of broilers that occurs more often in fast-growing birds and at low temperatures. The objective of this study was to estimate genetic and phenotypic correlations among ascites-related traits measured either under cold or under normal temperature conditions, and to estimate genetic correlations between ascites-related traits measured under cold and normal conditions. (2) Several traits related to ascites were measured on more than 4000 chickens under cold conditions and on more than 700 chickens under normal conditions. (3) The heritability estimates for body weight (BW) measured under cold and normal conditions were 0.42 and 0.50, respectively, for haematocrit value 0.46 and 0.17, respectively, and for ratio of right to total ventricular weight 0.45 and 0.12, respectively. (4) The genetic correlation between BW and haematocrit value under cold conditions was -0.23 and between BW and ratio of right to total ventricular weight -0.27. Under normal conditions, however, these genetic correlations were 0.55 and 0.50, respectively. (5) These results demonstrate that the heritability estimates of ascites-related traits as well as genetic correlations between ascites-related traits and BW depend on the temperature conditions under which animals are kept. (6) Strong positive genetic correlations (around 0.8) were observed between total mortality, fluid in the abdomen and ratio of right to total ventricular weight under cold conditions. The genetic correlation between ratio of right to total ventricular weight under cold and normal conditions was 0.91. (7) These results suggest that the ratio of right to total ventricular weight measured under normal temperature conditions might serve as a good indicator trait for ascites.

  17. Effect of prebiotic on gut development and ascites incidence of broilers reared in a hypoxic environment.

    PubMed

    Solis de los Santos, F; Farnell, M B; Téllez, G; Balog, J M; Anthony, N B; Torres-Rodriguez, A; Higgins, S; Hargis, B M; Donoghue, A M

    2005-07-01

    Modern broilers have been genetically selected for an increased growth rate and improved feed conversion, but they are also more susceptible to ascites. Ascites occurs when there is an imbalance between available oxygen and the oxygen demand of the broiler. We hypothesized that promoting neonatal gut development with a prebiotic, such as Aspergillus meal (Prebiotic-AM), would enhance gut efficiency, decrease the oxygen demand of the gut, and reduce ascites incidence. In this study, we compared the effect of Prebiotic-AM on ascites incidence and gut development in commercial broilers reared at a local altitude (390 m above sea level) and a simulated high altitude (2,900 m above sea level). Half of the birds received a National Research Council recommended corn-soybean ration, and the other half received the same ration supplemented with 0.2% Prebiotic-AM. These 2 groups were further divided into a local altitude group and a simulated high altitude group for a total of 4 treatment combinations. Tissues were collected on d 1, 3, 7, 14, and 21 from the duodenum and lower ileum and placed in 10% buffered formalin for morphometric analysis. At a simulated high altitude, ascites incidence was 68% for birds fed the Prebiotic-AM supplement compared with 92% ascites incidence in birds given the control feed. The simulated high altitude decreased (P < 0.05) gut development, but prebiotic-treated birds reared in hypoxic conditions had similar gut development to control birds reared at local altitude. These data suggest that a feed ration supplemented with Prebiotic-AM may reduce the effect of hypoxia on broiler gut development and ascites incidence.

  18. Pancreatic ascites hemoglobin contributes to the systemic response in acute pancreatitis.

    PubMed

    Pérez, Salvador; Pereda, Javier; Sabater, Luis; Sastre, Juan

    2015-04-01

    Upon hemolysis extracellular hemoglobin causes oxidative stress and cytotoxicity due to its peroxidase activity. Extracellular hemoglobin may release free hemin, which increases vascular permeability, leukocyte recruitment, and adhesion molecule expression. Pancreatitis-associated ascitic fluid is reddish and may contain extracellular hemoglobin. Our aim has been to determine the role of extracellular hemoglobin in the local and systemic inflammatory response during severe acute pancreatitis in rats. To this end we studied taurocholate-induced necrotizing pancreatitis in rats. First, extracellular hemoglobin in ascites and plasma was quantified and the hemolytic action of ascitic fluid was tested. Second, we assessed whether peritoneal lavage prevented the increase in extracellular hemoglobin in plasma during pancreatitis. Third, hemoglobin was purified from rat erythrocytes and administered intraperitoneally to assess the local and systemic effects of ascitic-associated extracellular hemoglobin during acute pancreatitis. Extracellular hemoglobin and hemin levels markedly increased in ascitic fluid and plasma during necrotizing pancreatitis. Peroxidase activity was very high in ascites. The peritoneal lavage abrogated the increase in extracellular hemoglobin in plasma. The administration of extracellular hemoglobin enhanced ascites; dramatically increased abdominal fat necrosis; upregulated tumor necrosis factor-α, interleukin-1β, and interleukin-6 gene expression; and decreased expression of interleukin-10 in abdominal adipose tissue during pancreatitis. Extracellular hemoglobin enhanced the gene expression and protein levels of vascular endothelial growth factor (VEGF) and other hypoxia-inducible factor-related genes in the lung. Extracellular hemoglobin also increased myeloperoxidase activity in the lung. In conclusion, extracellular hemoglobin contributes to the inflammatory response in severe acute pancreatitis through abdominal fat necrosis and inflammation

  19. Successful treatment of massive ascites due to lupus peritonitis with hydroxychloroquine in old- onset lupus erythematosus.

    PubMed

    Hammami, Sonia; Bdioui, Fethia; Ouaz, Afef; Loghmari, Hichem; Mahjoub, Sylvia; Saffar, Hamouda

    2014-01-01

    Systemic lupus erythematous (SLE) is an auto-immune disease with multiple organ involvements that occurs mainly in young women. Literature data suggest that serositis is more frequent in late-onset SLE. However, peritoneal serositis with massive ascites is an extremely rare manifestation. We report a case of old-onset lupus peritonitis treated successfully by Hydroxychloroquine. A 77-year-old Tunisian woman was hospitalized because of massive painful ascites. Her family history did not include any autoimmune disease. She was explored 4 years prior to admission for exudative pleuritis of the right lung without any established diagnosis. Physical examination showed only massive ascites. Laboratory investigations showed leucopenia: 3100/mm3, lymphopenia: 840/mm3 and trace protein (0.03 g/24 h). Ascitic fluid contained 170 cells mm(3) (67% lymphocytes), 46 g/L protein, but no malignant cells. The main etiologies of exudative ascites were excluded. She had markedly elevated anti-nuclear antibody (ANA) titer of 1/1600 and a significantly elevated titer of antibody to double-stranded DNA (83 IU/mL) with hypo-complementemia (C3 levl was at 67 mg/dL). Antibody against the Smith antigen was also positive. Relying on these findings, the patient was diagnosed with SLE and treated with Hydroxychloroquine 200 mg daily in combination with diuretics. One month later, there was no detectable ascitic fluid and no pleural effusions. Five months later she remained free from symptoms while continuing to take chloroquine. This case was characterized by old age of onset of SLE, the extremely rare initial presentation with lupus peritonitis and massive painful ascites with dramatic response to only hydroxychloroquine treatment.

  20. Alloimmune refractoriness to platelet transfusions.

    PubMed

    Sandler, S G

    1997-11-01

    Patients who are transfused on multiple occasions with red cells or platelets may develop platelet-reactive alloantibodies and experience decreased clinical responsiveness to platelet transfusion. This situation, conventionally described as "refractoriness to platelet transfusions," is defined by an unsatisfactory low post-transfusion platelet count increment. If antibodies to HLAs are detected, improved clinical outcomes may result from transfusions of HLA-matched or donor-recipient cross-matched platelets. Because refractoriness is an expected, frequently occurring phenomenon, prevention of HLA alloimmunization is an important management strategy. Prevention strategies include efforts to decrease the number of transfusions, filtration of cellular components to reduce the number of HLA-bearing leukocytes, or pretransfusion ultraviolet B irradiation of cellular components to decrease their immunogenicity. Other investigational approaches include reducing the expression of HLAs on transfused platelets, inducing a transient reticuloendothelial system blockade by infusions of specialized immunoglobulin products, or transfusing semisynthetic platelet substitutes (thromboerythrocytes, thrombospheres) or modified platelets (infusible platelet membranes, lyophilized platelets).

  1. 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.

  2. Effect of cold stress on broilers selected for resistance or susceptibility to ascites syndrome.

    PubMed

    Balog, J M; Kidd, B D; Huff, W E; Huff, G R; Rath, N C; Anthony, N B

    2003-09-01

    Genetic selection for an ascites-resistant line of broilers is seen as a permanent solution to the ascites problem. Ascites-resistant and ascites-susceptible lines have been developed using sire family selection based on mortality data taken from siblings reared in a hypobaric chamber (simulated 2,900 m above sea level). The relaxed line is representative of the original commercial pureline stock randomly mated with no artificial selection pressure. The objectives of this study were to evaluate the differences between the lines when reared in floor pens and subjected to an ascites-inducing cold stress. Seven hundred eighty three straight run broilers were reared in floor pens at local elevation (390 m above sea level). Feed and water were available ad libitum. Birds were brooded at 32 C during the first week. The second week birds were maintained at 30 degrees C. Cold stress was applied for the remaining 4 wk at 14 degrees C. Mortalities were necropsied daily to determine cause of death. Birds and feed were weighed weekly. At 6 wk, five birds per pen were bled, and half the survivors in each pen (8 to 15 birds) were killed, necropsied, and scored for ascites. Blood gases, clinical chemistries, and blood cell counts were taken. Liver, spleen, split heart, and lung weights were recorded. Body weights were not different among the resistant, susceptible, and relaxed lines (P < 0.05). Feed conversion was better in the resistant line when compared to the susceptible and relaxed lines (P < 0.05). Ascites incidence, as measured by mortality and lesion score at necropsy, was higher in the susceptible and relaxed lines when compared to the resistant line; 18.8, 12.7, and 1.6% respectively (P < 0.001). Susceptible and relaxed lines showed more right ventricular hypertrophy when compared with the resistant line (P < 0.05). The results show that under severe cold stress at local altitude (390 m above sea level), the ascites-resistant line was growing as rapidly as the other

  3. Use of Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock.

    PubMed

    Tariq, Sohaib; Gass, Alan

    2016-01-01

    Cardiogenic shock is a condition marked by low cardiac output and end-organ hypoperfusion frequently requiring hemodynamic support, and it carries a high mortality. Extracorporeal membrane oxygenation (ECMO) is an effective tool in providing mechanical circulatory support in patients with cardiogenic shock refractory to conventional medical therapies. ECMO can be an essential bridge to recovery, ventricular assist device implantation or transplant. A multidisciplinary team approach is needed in managing such patients and intensive monitoring is required to avoid complications from ECMO. Nevertheless, randomized clinic trials are warranted to prove a survival benefit.

  4. Evaluation of between-line variation for within-line selection against ascites in broilers.

    PubMed

    de Greef, K H; Kwakernaak, C; Ducro, B J; Pit, R; Gerritsen, C L

    2001-01-01

    Within-line opportunities for selection against ascites were studied in a data set comprising a 10-line comparison. The study attempted to reveal whether contrasts between lines provide reliable candidate traits for within-line selection. Mortality was chosen as the reference trait. As no pedigree information was available, a trait was required that related mortality to the nonmortality data. By principal component analysis, such a trait (ASC_INDIC = ascites indicator) was developed from pathology data. The composite trait ASC_INDIC ranked lines well for their mortality figures (r = 0.96), from which it was concluded that ASC_INDIC represents an underlying continuous ascites trait. Between lines, blood gas traits seemed to be the most promising traits. Within lines, performance traits appeared to be highly correlated to ascites. Comparison of within-line variation to between-line contrasts revealed considerable differences. The high correlation of the blood gas traits with mortality was not present within lines. However, although the magnitude was considerably reduced, the nature of the blood gas traits in their relationship to ascites was similar within and between lines. The study primarily demonstrates that contrasts between lines carry systematic but limited information for within-line coherence. Therefore, line contrasts must be interpreted with care when aiming to study genetic variation and coherence within lines.

  5. Myxedema ascites with an extremely elevated CA125 Level: a case report.

    PubMed

    Kanehara, Hideo; Bando, Yukihiro; Tomita, Manabu; Kontani, Makoto; Takegoshi, Yasuo; Tanaka, Nobuyoshi

    2007-08-01

    Carbohydrate antigen 125 (CA125) is a tumor-marker frequently associated with ovarian malignancies; however, benign gynecologic conditions (e.g. ovarian cysts) commonly cause a smaller increase in CA125 levels. This report describes an elderly Japanese woman with high CA125 levels and massive ascites caused by hypothyroidism. A 67-year-old woman presented herself with a weight gain of about 12 kg and abdominal distension. Her serum CA125 level was markedly elevated (822 U/ml) and abdominal CT revealed a right ovarian cyst and massive ascites. Hormonal laboratory data showed severe primary hypothyroidism with a serum TSH of 594 IU/L and a free thyroxin level of 0.05 ng/dl. Ascitic fluid was found to be exudate with a high protein content of 42 g/L. Cytological analysis and FDG-PET showed no evidence of malignancy. The ascites completely disappeared and serum CA125 normalized after adequate hormonal replacement therapy. These data suggest that hypothyroidism should be considered in patients with ascites and elevated serum CA125.

  6. Refractory pulmonary sarcoidosis – proposal of a definition and recommendations for the diagnostic and therapeutic approach

    PubMed Central

    Korsten, Peter; Strohmayer, Katharina; Baughman, Robert P.; Sweiss, Nadera J.

    2015-01-01

    Patients with sarcoidosis undergo spontaneous remission or may be effectively controlled with glucocorticoids alone in many cases. Progressive and refractory pulmonary sarcoidoisis constitute more than 10% of patients seen at specialized centers. Pulmonary fibrosis and associated complications, such as infections and pulmonary hypertension are leading causes of mortality. No universal definition of refractoriness exists, we therefore propose classifying patients as having refractory disease when the following criteria are fulfilled: (1) progressive disease despite at least 10 mg of prednisolone or equivalent for at least three months and need for additional disease-modifying anti-sarcoid drugs due to lack of efficacy, drug toxicity or intolerability and (2) treatment started for significant impairment of life due to progressive pulmonary symptoms. Both criteria should be fulfilled. Treatment options in addition to or instead of glucocorticoids for these patients include second- (methotrexate, azathioprine, leflunomide) and third-line agents (infliximab, adalimumab). Other immunmodulating agents can be used, but the evidence is very limited. Newer agents with anti-fibrotic properties, such as pirfenidone or nintedanib, might hold promise also for the pulmonary fibrosis seen in sarcoidosis. Treating physicians have to actively look for potentially treatable complications, such as pulmonary hypertension, cardiac disease or infections before patients should be classified as treatment-refractory. Ultimately, lung transplantation has to be considered as treatment option for patients not responding to medical therapy. In this review, we aim to propose a new definition of refractoriness, describe the associated clinical features and suggest the therapeutic approach. PMID:26973429

  7. Caffeine causes pulmonary hypertension syndrome (ascites) in broilers.

    PubMed

    Kamely, M; Torshizi, M A Karimi; Rahimi, S; Wideman, R F

    2016-04-01

    Pulmonary hypertension syndrome (PHS), or ascites, is characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance accompanied by right ventricular hypertrophy (RVH) and fluid accumulation in the abdominal cavity. Experimental models are required for triggering PHS to study the pathogenesis of this syndrome and to select resistant genetic lines. Caffeine increases vascular resistance and promotes systemic hypertension in mammals, but a similar effect of caffeine on the pulmonary circulation had not previously been demonstrated. Two experiments were conducted to evaluate the impact of caffeine alone (Exp. 1) or in combination with cold temperature (Exp. 2) on parameters associated with PHS in young broiler chicks. In Exp. 1, 288 chicks were distributed among 24 pens and brooded at standard environmental temperatures, and on d 3 through 42 caffeine was added to the water at doses of 0 (control), 6.25, 12.5, 25, 50, and 100 mg/(kg BW·d). In Exp. 2, 192 chicks were distributed among 16 pens and brooded at cool environmental temperatures, and on d 3 through 42 caffeine was added to the water at doses of 0 (control), 15, 30, and 45 mg/(kg BW·d). In Exp. 1 caffeine administered at or above 12.5 mg/(kg BW·d) induced severe PHS and resulted in acute mortality and RVH ( < 0.05). Hematocrit also slightly increased by caffeine supplementation ( = 0.07). In Exp. 2 caffeine-treated broilers exposed to cold temperatures remarkably exhibited PHS incidences and developed RVH with right ventricular to total ventricular weight ratios of 30% or greater. Moreover, hematocrit significantly increased because of caffeine supplementation in cool ambient temperature ( = 0.002). Our data demonstrate that caffeine induces high incidences of PHS in broilers, which is exacerbated by exposure to low temperatures.

  8. Apoptogenic effects of black tea on Ehrlich's ascites carcinoma cell.

    PubMed

    Bhattacharyya, Arindam; Choudhuri, Tathagata; Pal, Suman; Chattopadhyay, Sreya; K Datta, Goutam; Sa, Gaurisankar; Das, Tanya

    2003-01-01

    Next to water, tea is the most ancient and widely consumed beverage in the world. Epidemiological studies have suggested a cancer protective effect, but the results obtained so far are not conclusive. In the current study, mechanisms of the apoptogenic effect of black tea extract were delineated. Black tea administration to Ehrlich's ascites carcinoma (EAC)-bearing Swiss albino mice caused a significant decrease in the tumor cell count in a dose-dependent manner. Flowcytometric analysis showed an increase in the number of cells in the sub-G(0)/G(1) population signifying tumor cell apoptosis by black tea. These results were further confirmed by nuclear staining that demonstrated distinct morphological features of apoptosis. Our data also revealed an increase in the expression of pro-apoptotic protein p53 in EAC. It is known that upon p53 induction, multiple downstream factors contribute to the decision making between growth arrest and apoptosis. Among those, pro-apoptotic gene Bax is up regulated during p53-mediated apoptosis. On the other hand, p53-mediated growth arrest involves p21 as a major effecter. In our system, increase in p53 expression was followed by moderate expression of p21/Waf-1 and high expression of Bax at protein levels. Interestingly, anti-apoptotic protein Bcl-2 was down regulated resulting in decrease in Bcl-2/Bax ratio. All these observations together signify that black tea-induced apoptogenic signals overrode the growth-arresting message of p21, thereby leading the tumor cells towards death.

  9. Refractory metal particles in refractory inclusions in the Allende meteorite

    NASA Technical Reports Server (NTRS)

    Fuchs, L. H.; Blander, M.

    1980-01-01

    SEM and X-ray analysis were used to study refractory metal particles in five calcium-aluminum-rich inclusions in the Allende meteorite, and a complex variety of compositions and large departures from equilibrium were found. It is suggested that these particles could have been primordial condensates which were isolated from the nebula and from each other at different times by cocondensing oxides. Selective diffusion and/or oxidation of the more oxidizable metals (Mo, W, Fe, and Ni), phase segregations into different alloy phases (fcc, bcc, hcp, and, possibly, ordered phases), and the formation of metastable condensates could have been involved in the genesis of these materials

  10. Renal infarction complicating fibromuscular dysplasia.

    PubMed

    Gavalas, M; Meisner, R; Labropoulos, N; Gasparis, A; Tassiopoulos, A

    2014-01-01

    Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and extracranial carotid arteries. We present 3 cases of renal infarction complicating renal artery FMD in 42-, 43-, and 46-year-old females and provide a comprehensive review of the literature on this topic. In our patients, oral anticoagulation therapy was used to treat all cases of infarction, and percutaneous angioplasty was used nonemergently in one case to treat refractory hypertension. All patients remained stable at 1-year follow-up. This is consistent with outcomes in previously published reports where conservative medical management was comparable to surgical and interventional therapies. Demographic differences may also exist in patients with renal infarction and FMD. A higher prevalence of males and a younger age at presentation have been found in these patients when compared to the general population with FMD.

  11. METHOD OF PREPARING COATED REFRACTORY WARE

    DOEpatents

    Perlman, M.L.; Lipkin, D.; Weissman, S.I.

    1959-07-21

    A method is presented for preparing a dense, refractory coating on a vessel adapted to the handling of molten metals such as uranium and plutonium. According to the invention, the inner surface of a heat stable container formed of a refractory metal of either niobium, molybdenum, tantalum, or tungsten is coated with molten thorium within 10 minutes so as to present alloying with the refractory metal and then exposed to a reactive atmosphere of nitrogen at a temperature of about 1750 deg for 30 minutes to form a refractory thorium nitride coating.

  12. Development of refractory concrete for extreme conditions

    NASA Astrophysics Data System (ADS)

    Pundiene, I.; Antonovich, V.; Stonys, R.; Demidova-Buiziniene, I.

    2011-12-01

    Comparative analysis is provided for the properties of medium-cement refractory concrete with microsilica based on mullite filler in relation to different type of deflocculant. The effect of different deflocculants on refractory concrete structure formation, hydration, rheology, strength and heat resistance is discussed. Corrosion resistance test, determined that samples with hybrid deflocculant showed better resistance for slag penetration than samples with only the sodium tripolyphosphate or polycarboxylate ether deflocculant. Moreover, a composition of hybrid deflocculant let to control the rate of the hydration process and to get features of refractory refractory concrete.

  13. The improvement of slagging gasifier refractories

    SciTech Connect

    Kwong, K.-S.; Bennett, J.P.; Powell, C.A.; Krabbe, R.A.

    2006-03-01

    Refractories play a vital role in slagging gasifier on-line availability and profitability for the next clean power generation system. A recent survey of gasifier users by USDOE indicated that a longer service life of refractories is the highest need among gasifier operators. Currently, Cr2O3 based refractories, the best of commercially available materials for use in slagging gasifiers, last between 3 and 24 months. Researchers at Albany Research Center (ARC) have identified structural spalling, caused by slag penetration, as one of the major failure mechanisms of Cr2O3 refractories through postmortem analysis. New Cr2O3 refractories with phosphate additives have been developed by ARC to decrease slag penetration and thus structural spalling. Laboratory physical property tests indicated that ARC developed refractories are superior to other commercial bricks. One of the ARC developed phosphate containing refractories has been installed in a slagging gasifier. Preliminary results of the performance of this refractory in the gasifier will be reported along with research to develop non-chromia refractories.

  14. Hepatic and cardiac oxidative stress and other metabolic changes in broilers with the ascites syndrome.

    PubMed

    Díaz-Cruz, A; Nava, C; Villanueva, R; Serret, M; Guinzberg, R; Piña, E

    1996-07-01

    The objective of this study was to evaluate the gluconeogenic response of in vitro stimulated hepatocytes from control broilers and broilers with clinical manifestations of the ascites syndrome. The basal rate of glucose synthesis from lactate was found to be threefold greater in sick birds than in the control group and stimulation obtained with epinephrine was found to be quantitatively similar in both groups. Under basal conditions, the hepatocytes from the sick broilers exhibited 60% more ammonium than the control birds. In addition, the quantification of thiobarbituric acid reactive substances, as indicators of cellular lipoperoxidation, showed an increase of over 100% in heart and liver of sick broilers fowl. In conclusion, the complex integrated response of gluconeogenesis to epinephrine is maintained in broilers with ascites, although their hepatocytes present changes compatible with those observed in cases of oxidative stress. It is not known whether this stress is a cause or a consequence of the ascites syndrome.

  15. Portal Hypertension and Ascites Due to an Arterioportal Fistula: Sequela of a Remote Traumatic Liver Laceration

    PubMed Central

    Hulkower, Benjamin M.; Butty, Sabah

    2016-01-01

    Arterioportal fistulas (APFs) are a group of vascular disorders, in which systemic arteries communicate with the portal circulation, presenting as a congenital syndrome or more commonly acquired from iatrogenic instrumentation or abdominal trauma. We report the case of a 58-year-old man who developed ascites without underlying risk factors for portal hypertension, which was attributed to an APF found on imaging, manifesting 43 years after sustaining a liver laceration. After angiographic embolization of the APF, the patient’s ascites resolved completely. The prolonged latent period between the patient’s abdominal trauma and eventual presentation with ascites highlights the need to consider vascular malformations in the differential diagnosis of unexplained noncirrhotic portal hypertension. PMID:27807573

  16. Artificial ascites and pneumoperitoneum to facilitate thermal ablation of liver tumors: a pictorial essay.

    PubMed

    Bhagavatula, Sharath K; Chick, Jeffrey F B; Chauhan, Nikunj R; Shyn, Paul B

    2017-02-01

    Image-guided percutaneous thermal ablation is increasingly utilized in the treatment of hepatic malignancies. Peripherally located hepatic tumors can be difficult to access or located adjacent to critical structures that can be injured. As a result, ablation of peripheral tumors may be avoided or may be performed too cautiously, leading to inadequate ablation coverage. In these cases, separating the tumor from adjacent critical structures can increase the efficacy and safety of procedures. Artificial ascites and artificial pneumoperitoneum are techniques that utilize fluid and gas, respectively, to insulate critical structures from the thermal ablation zone. Induction of artificial ascites and artificial pneumoperitoneum can enable complete ablation of otherwise inaccessible hepatic tumors, improve tumor visualization, minimize unintended thermal injury to surrounding organs, and reduce post-procedural pain. This pictorial essay illustrates and discusses the proper technique and clinical considerations for successful artificial ascites and pneumoperitoneum creation to facilitate safe peripheral hepatic tumor ablation.

  17. Utilization of ascites plasma very low density lipoprotein triglycerides by Ehrlich cells.

    PubMed

    Brenneman, D E; Spector, A A

    1974-07-01

    Much of the lipid present in the ascites plasma in which Ehrlich cells grow is contained in very low density lipoproteins (VLDL). Chemical measurements indicated that triglycerides were taken up by the cells during in vitro incubation with ascites VLDL. When tracer amounts of radioactive triolein were incorporated into the ascites VLDL, the percentage uptakes of glyceryl tri[1-(14)C]oleate and triglycerides measured chemically were similar. The cells also took up [2-(3)H]glyceryl trioleate that was added to VLDL, but the percentage of available (3)H recovered in the cell lipids was 30-40% less than that of (1 4)C from glyceryl tri[1-(1 4)C]oleate. This difference was accounted for by water-soluble (3)H that accumulated in the incubation medium, suggesting that extensive hydrolysis accompanied the uptake of VLDL triglycerides. Radioactive fatty acids derived from the VLDL triglycerides were incorporated into cell phospholipids, glycerides, and free fatty acids, and they also were oxidized to CO(2). Triglyceride utilization increased as the VLDL concentration was raised. These results suggest that one function of the ascites plasma VLDL may be to supply fatty acid to the Ehrlich cells and that the availability of fatty acid to this tumor is determined in part by the ascites plasma VLDL concentration. Although Ehrlich cells incorporate almost no free glycerol into triglycerides, considerable amounts of [2-(3)H]glyceryl trioleate radioactivity were recovered in cell triglycerides. This indicates that at least some VLDL triglycerides were taken up intact. The net uptake of VLDL protein and cholesterol was very small relative to the triglyceride uptake, suggesting that intact triglycerides are transferred from the ascites VLDL to the Ehrlich cells and that hydrolysis occurs after the triglyceride is associated with the cells.

  18. Ascitic and solid Ehrlich tumor inhibition by Chenopodium ambrosioides L. treatment.

    PubMed

    Nascimento, Flávia R F; Cruz, Gustavo V B; Pereira, Paulo Vitor S; Maciel, Márcia C G; Silva, Lucilene A; Azevedo, Ana Paula S; Barroqueiro, Elizabeth S B; Guerra, Rosane N M

    2006-04-25

    The leaves of Chenopodium ambrosioides L. [Chenopodiaceae] ('mastruz') have been indicated for the treatment of several diseases, among which the cancer. There are no results focusing the effect of C. ambrosioides treatment on tumor development in vivo. The aim of this study was to investigate the effect of treatment with C. ambrosioides on Ehrlich tumor development. Swiss mice were treated by intraperitoneal route (i.p.) with hydroalcoholic extract from leaves of C. ambrosioides (5 mg/kg) or with PBS (control group) 48 h before or 48 h later the Ehrlich tumor implantation. The tumor cells were implanted on the left footpad (solid tumor) or in the peritoneal cavity (ascitic tumor). To determine the solid tumor growth, footpad was measured each 2 days until the fourteenth day, when the feet were weighed. Ascitic tumor development was evaluated after 8 days of tumor implantation by quantification of the ascitic fluid volume and tumor cell number. The i.p. administration of C. ambrosioides extract before or after the tumor implantation significantly inhibited the solid and ascitic Ehrlich tumor forms. This inhibition was observed in ascitic tumor cell number, in the ascitic volume, in the tumor-bearing foot size and foot weight when compared to control mice. The treatments also increased the survival of tumor-bearing mice. In conclusion, C. ambrosioides has a potent anti-tumoral effect which was evident with a small dose and even when the treatment was given two days after the tumor implantation. This effect is probably related with anti-oxidant properties of C. ambrosioides.

  19. Polymorphonuclear counts in ascitic fluid and microorganisms producing spontaneous bacterial peritonitis: an under-recognized relationship.

    PubMed

    Ariza, Xavier; Lora-Tamayo, Jaime; Castellote, José; Xiol, Xavier; Ariza, Javier

    2013-10-01

    BACKGROUND AND AIMS. In cirrhotic patients with spontaneous bacterial peritonitis (SBP) higher polymorphonuclear (PMN) count in ascitic fluid have been reported in infections caused by Gram-negative bacilli (GNB) as opposed to Gram-positive cocci (GPC). However, the influence of other associated factors on the PMN count, such as the specific microorganism causing the episode of SBP, has not been well established. METHODS. Retrospective observational study of 194 episodes of positive ascitic and/or blood culture SBP in 159 patients with liver cirrhosis (2001-2009). Parameters associated with PMN count in ascitic fluid at diagnosis were evaluated. RESULTS. The multivariate analysis (model 1) showed that a virulent etiology of the infection [coefficient 3.941 (95% confidence interval (95 CI): 0.421-7.461)] and the model for end-stage liver disease (MELD) score [coefficient 0.196 (95 CI: 0.007-0.384)] were positively associated with the PMN count in ascites, while a nosocomial acquisition was inversely associated [coefficient -3.546 (95 CI: -6.855 - -0.238)]. A nonsignificant trend toward higher PMN count was found in GNB versus GPC, but there were differences between groups of microorganisms: pyogenic streptococci [median (p25-p75): 3211 (1615-8004)], Enterobacteriaceae [2958 (917-7690)], Vibrionaceae [9215 (375-17280)], nonfermenting GNB [1384 (565-3865)], viridans group streptococci [1044 (503-2354)] and enterococci [1050 (476-4655)](p = 0.005). No clear cut-offs of ascitic PMN count predicting a particular etiology could be calculated out of these data. CONCLUSIONS. In cirrhotic patients with SBP, the causing microorganism, the place of acquisition of the infection and the host liver condition were the main factors determining PMN count in ascitic fluid. Third-generation cephalosporin resistance was associated with low PMN count probably because this group included bacteria with inherent low virulence.

  20. Iron refractory iron deficiency anemia

    PubMed Central

    De Falco, Luigia; Sanchez, Mayka; Silvestri, Laura; Kannengiesser, Caroline; Muckenthaler, Martina U.; Iolascon, Achille; Gouya, Laurent; Camaschella, Clara; Beaumont, Carole

    2013-01-01

    Iron refractory iron deficiency anemia is a hereditary recessive anemia due to a defect in the TMPRSS6 gene encoding Matriptase-2. This protein is a transmembrane serine protease that plays an essential role in down-regulating hepcidin, the key regulator of iron homeostasis. Hallmarks of this disease are microcytic hypochromic anemia, low transferrin saturation and normal/high serum hepcidin values. The anemia appears in the post-natal period, although in some cases it is only diagnosed in adulthood. The disease is refractory to oral iron treatment but shows a slow response to intravenous iron injections and partial correction of the anemia. To date, 40 different Matriptase-2 mutations have been reported, affecting all the functional domains of the large ectodomain of the protein. In vitro experiments on transfected cells suggest that Matriptase-2 cleaves Hemojuvelin, a major regulator of hepcidin expression and that this function is altered in this genetic form of anemia. In contrast to the low/undetectable hepcidin levels observed in acquired iron deficiency, in patients with Matriptase-2 deficiency, serum hepcidin is inappropriately high for the low iron status and accounts for the absent/delayed response to oral iron treatment. A challenge for the clinicians and pediatricians is the recognition of the disorder among iron deficiency and other microcytic anemias commonly found in pediatric patients. The current treatment of iron refractory iron deficiency anemia is based on parenteral iron administration; in the future, manipulation of the hepcidin pathway with the aim of suppressing it might become an alternative therapeutic approach. PMID:23729726

  1. Refractories for lining blast furnaces

    SciTech Connect

    Fedoruk, R.M.; Baksheeva, V.S.; Karyakina, E.L.; Khmelenko, T.P.; Pitak, N.V.

    1986-01-01

    The authors develop and introduce a technology for the production of chamotte kaolin refractories with a porosity of not more than 12% and a mass proportion of not less than 42% A1/sub 2/O/sub 3/ on the basis of chamotte from high-grade Polozhe kaolin, and also additions to the batch of finely milled mullite-corundum chamotte. Using the new technology, a batch of goods designated ShPD-42 was produced for lining the shafts, bosh, and upper parts of blast furnaces of large capacity.

  2. Refractory disease in autoimmune diseases.

    PubMed

    Vasconcelos, Carlos; Kallenberg, Cees; Shoenfeld, Yehuda

    2011-09-01

    Refractory disease (RD) definition has different meanings but it is dynamic, according to knowledge and the availability of new drugs. It should be differentiated from severe disease and damage definitions and it must take into account duration of adequate therapy and compliance of the patient. It can be related to inadequate or inefficacious treatment or to pathogenesis. RD definition has multiple implications to clinical guidelines and to the use of off-label drugs. It should not be regarded as lost cases and prospective studies, registries and clinical trials should be planned.

  3. [A case of spontaneous bacterial peritonitis with ascites caused by hypoproteinemia after a massive bleeding from a gastric ulcer].

    PubMed

    Guji, A; Nishiya, H; Haga, T; Aoki, M; Nozue, N; Ono, Y; Kunii, O; Miyashita, H

    1993-01-01

    A case of spontaneous bacterial peritonitis (SBP) developed in an old man whose ascitic fluid was related neither to portal hypertension nor nephrotic syndrome, but with severe hypoalbuminemia emerged after a massive bleeding from a gastric ulcer in a malnutrition state. Ascitic fluid, increasing day by day, yielded Enterobacter cloacae and Bacteroides fragilis. Though autopsy was not carried out because of refusal of his family, neither liver necropsy, nor abdominal CT scan nor repeated abdominal ultrasonography showed findings suggesting existence of liver cirrhosis. In the presence of his ascites, the extent of a chemiluminescence (CL) response of polymorphonuclear cells from volunteers was significantly lower than that of his serum. This report shows that SBP can develop in a patient with ascites unrelated to portal hypertension when ascitic fluid induces little CL response.

  4. Brain on FIRES: Super Refractory Seizure in a 7 yr Old Boy

    PubMed Central

    Tavasoli, Alireza; GHARIB, Behdad; ALIZADEH, Houman; FARSHADMOGHADDAM, Hossein; MEMARIAN, Sara; ASHRAFI, Mahmoodreza; SHARIFZADE, Meisam

    2016-01-01

    We present a 7 yr old boy afflicted with super-refractory seizure that responded poorly to antiepileptic drugs and sustained a long course of hospitalization and complications of high doses of medications as well as longstanding stay in hospital. The differential diagnoses were, fever-induced refractory epileptic encephalopathy (FIRES), and infectious and autoimmune encephalitis. However, work-ups had not revealed any evidence of any specific diagnosis, so we assumed that he was afflicted by viral infectious encephalitis as he had, fever, vomiting, and prodromal symptoms of infectious (most probably viral) disease prior to onset of the seizure attacks. PMID:27843471

  5. [Managing of platelet transfusion refractoriness of haematological malignancies. Experience IPC-EFSAM].

    PubMed

    Dettori, I; Ladaique, P

    2014-11-01

    The platelet refractoriness is a complication of transfusion treatments potentially dramatic in onco-haematology. Chemo-treatment of haematological malignancies or packs of allogeneic bone marrow transplants require iterative platelet transfusion requirements. The discovery of a platelet refractoriness along with its support should be the most reactive as possible but also adapted to the cause. In the case of allo-immunization, it may be expected. The purpose of this presentation is to recall the different etiologies and perform a feedback on the support transfusion platelet of onco-haematology adult patients at Institut Paoli-Calmettes (IPC) in partnership with the EFSAM.

  6. Antineoplasic effect of aqueous extract of plectranthus amboinicus in ehrlich ascites carcinoma.

    PubMed

    Brandao, Eduardo M; Brandão, Paulo H D M; Souza, Ivone A; Paiva, Gerson S; de C Carvalho, Marcos; Lacerda, Claudio M

    2013-01-01

    There are 46,000 new cases of peritoneal carcinomatosis per year in the USA and 17,700 in Brazil. New media, including plant derivatives, are being tested in its treatment. Plectranthus amboinicus is a medicinal plant widely used in Brazil, especially in the northeast region, for the treatment of various diseases, including cancer. This present study evaluates the intraperitoneal use of aqueous extracts of Plectranthus amboinicus (AEPa) at a dose of 200 mg / kg for the treatment of the ascitic form of Ehrlich carcinoma. It is concluded also the AEPa produced antineoplastic effect in ascitic form of Ehrlich carcinoma.

  7. Antineoplasic Effect of Aqueous Extract of Plectranthus Amboinicus in Ehrlich Ascites Carcinoma

    PubMed Central

    Brandao, Eduardo M.; Brandão, Paulo H. D. M.; Souza, Ivone A.; Paiva, Gerson S.; de C. Carvalho, Marcos; Lacerda, Claudio M.

    2013-01-01

    There are 46,000 new cases of peritoneal carcinomatosis per year in the USA and 17,700 in Brazil. New media, including plant derivatives, are being tested in its treatment. Plectranthus amboinicus is a medicinal plant widely used in Brazil, especially in the northeast region, for the treatment of various diseases, including cancer. This present study evaluates the intraperitoneal use of aqueous extracts of Plectranthus amboinicus (AEPa) at a dose of 200 mg / kg for the treatment of the ascitic form of Ehrlich carcinoma. It is concluded also the AEPa produced antineoplastic effect in ascitic form of Ehrlich carcinoma. PMID:23983822

  8. Genetics Home Reference: iron-refractory iron deficiency anemia

    MedlinePlus

    ... refractory iron deficiency anemia iron-refractory iron deficiency anemia Enable Javascript to view the expand/collapse boxes. ... All Close All Description Iron-refractory iron deficiency anemia is one of many types of anemia , which ...

  9. Fecal microbiota transplantation for refractory Clostridium difficile colitis in solid organ transplant recipients.

    PubMed

    Friedman-Moraco, R J; Mehta, A K; Lyon, G M; Kraft, C S

    2014-02-01

    Fecal microbiota transplantation (FMT) has been shown to be safe and efficacious in individuals with refractory Clostridium difficile. It has not been widely studied in individuals with immunosuppression due to concerns about infectious complications. We describe two solid organ transplant recipients, one lung and one renal, in this case report that both had resolution of their diarrhea caused by C. difficile after FMT. Both recipients required two FMTs to achieve resolution of their symptoms and neither had infectious complications. Immunosuppressed individuals are at high risk for acquisition of C. difficile and close monitoring for infectious complications after FMT is necessary, but should not preclude its use in patients with refractory disease due to C. difficile. Sequential FMT may be used to achieve cure in these patients with damaged microbiota from antibiotic use and immunosuppression.

  10. Neuroimaging evaluation in refractory epilepsy

    PubMed Central

    Granados, Ana M; Orejuela, Juan F

    2015-01-01

    Purpose To describe the application of neuroimaging analysis, compared to neuropsychological tests and video-electroencephalogram, for the evaluation of refractory epilepsy in a reference centre in Cali, Colombia. Methods Between March 2013 and November 2014, 29 patients, 19 men and 10 women, aged 9–65 years and with refractory epilepsy, were assessed by structural and functional magnetic resonance imaging while performing tasks related to language, verbal and non-verbal memory. Also, volumetric evaluation was performed. A 1.5 Tesla magnetic resonance imaging scanner was used in all cases. Results Neuroimaging evaluation identified 13 patients with mesial temporal sclerosis. The remaining patients were classified as: 10 patients with neoplastic masses, two patients with cortical atrophy, two patients with scarring lesions and two patients with non-structural aetiology. Among patients with mesial temporal sclerosis, comparison between techniques for lateralising the epileptogenic foci was made; the κ index between functional magnetic resonance imaging and hippocampi volumetry was κ = 1.00, agreement between neuroimaging and video-electroencephalogram was good (κ = 0.78) and comparison with a neuropsychological test was mild (κ = 0.24). Conclusions Neuroimaging studies allow the assessment of functional and structural damage related to epileptogenic lesions and foci, and are helpful to select surgical treatment, conduct intraoperative neuronavigation techniques, predict surgical deficits and evaluate patient recovery. PMID:26427897

  11. Refractory Glass Seals for SOFC

    SciTech Connect

    Chou, Y. S.; Stevenson, Jeffry W.

    2011-07-01

    One of the critical challenges facing planar solid oxide fuel cell (SOFC) technology is the need for reliable sealing technology. Seals must exhibit long-term stability and mechanical integrity in the high temperature SOFC environment during normal and transient operation. Several different approaches for sealing SOFC stacks are under development, including glass or glass-ceramic seals, metallic brazes, and compressive seals. Among glass seals, rigid glass-ceramics, self-healing glass, and composite glass approaches have been investigated under the SECA Core Technology Program. The U.S. Department of Energy's Pacific Northwest National Laboratory (PNNL) has developed the refractory glass approach in light of the fact that higher sealing temperatures (e.g., 930-1000 degrees C) may enhance the ultimate in-service bulk strength and electrical conductivity of contact materials, as well as the bonding strength between contact materials and adjacent SOFC components, such as interconnect coatings and electrodes. This report summarizes the thermal, chemical, mechanical, and electrical properties of the refractory sealing glass.

  12. Haematological characteristics predicting susceptibility for ascites. 2. High haematocrit values in juvenile chickens.

    PubMed

    Scheele, C W; van Der Klis, J D; Kwakernaak, C; Buys, N; Decuypere, E

    2003-07-01

    1. Male broilers of two different genetic stocks, a pure broiler sire line (A) and commercially available Ross broilers (B), were used to study the effect of differences in haematocrit values in 12-d-old chickens on the development of ascitic symptoms. Body weight gain (BWG), feed intake (FI) and feed conversion ratio (FRC) were measured from 2 to 5 weeks of age. Mortality was recorded from 2 to 6 weeks. The birds were kept at a low ambient temperature to stimulate the incidence of ascites. 2. From each stock 32 birds with the highest (High Ht) and 32 birds with the lowest (Low Ht) haematocrit values in venous blood were selected at 12 d of age for an examination on susceptibility for the ascites syndrome at 5 weeks. 3. At 2 weeks 448 birds per stock (including High Ht and Low Ht birds) were allotted to 32 floor pens (1 High Ht and 1 Low Ht in each pen). Venous blood samples were taken weekly in High Ht and Low Ht birds for haematocrit measurements and at week 5 also thyroid hormone (T3, T4) concentrations in plasma were measured. At 5 weeks all High Ht and Low Ht birds were examined post-mortem and arterial pressure index, heart weight, lung weight and liver weight (all relative to body weight) were recorded. High values for arterial pressure index, relative heart and liver weights and low values for relative lung weights and plasma thyroid hormone were considered to be indicators for ascites susceptibility. 4. Stock A, with the highest ascites mortality, had lower values for BWG and FCR than stock B. Throughout, a clear difference in Ht values between High Ht and Low Ht birds was maintained. No significant effects of 12-d haematocrit values were found on the incidence of ascitic symptoms until week 5. High Ht values tended to correlate with low relative lung weights and low plasma T3 concentrations in High Ht birds. 5. Within the groups of selected birds, there was an effect of stock on ascitic symptoms (arterial pressure index, relative heart weight and T3

  13. Spectral reflecting characteristics of dinas refractory

    SciTech Connect

    Zapechnikov, V.N.; Pushkin, V.T.; Zen'kovskii, A.G.

    1987-09-01

    This article outlines a nondestructive testing format which uses spectral reflectance to assess the remaining service life, the thermal degradation, and the insulating effectiveness of refractories used as insulating liners in glass melters. Thermal as well as mechanical influences on the reflectance behavior of several refractories are discussed.

  14. Diabetes insipidus as a complication of Wegener's granulomatosis and its treatment with biologic agents.

    PubMed

    Cunnington, Joanna Rosalind; Jois, Ramesh; Zammit, Ivan; Scott, David; Isaacs, John

    2009-01-01

    Wegener's granulomatosis of the pituitary gland resulting in diabetes insipidus is a rare complication of the disease. Standard treatment for Wegener's granulomatosis involves a combination of prednisolone and cylophosphamide, however biologic agents are now being used in refractory cases. We report three cases of patients with diabetes insipidus as a complication of Wegener's granulomatosis who were treated with biologic agents. All three cases showed clinical response to treatment with biologic agents including rituximab and alemtuzumab and two cases demonstrated improvement in pituitary gland abnormalities by MRI. Clinicians should be aware that diabetes insipidus can present as a complication of Wegener's granulomatosis and that biologic therapies may be effective in refractory cases.

  15. Recent advances and developments in refractory alloys

    SciTech Connect

    Nieh, T.G.; Wadsworth, J.

    1993-11-01

    Refractory metal alloys based on Mo, W, Re, Ta, and Nb (Cb) find applications in a wide range of aerospace applications because of their high melting points and high-temperature strength. This paper, presents recent progress in understanding and applications of these alloys. Recent studies to improve the oxidation and mechanical behavior of refractory metal alloys, and particularly Nb alloys, are also discussed. Some Re structures, for extremely high temperature applications (> 2000C), made by CVD and P/M processes, are also illustrated. Interesting work on the development of new W alloys (W-HfC-X) and the characterization of some commercial refractory metals, e.g., K-doped W, TZM, and Nb-1%Zr, continues. Finally, recent developments in high temperature composites reinforced with refractory metal filaments, and refractory metal-based intermetallics, e.g., Nb{sub 3}Al, Nb{sub 2}Be{sub 17}, and MoSi{sub 2}, are briefly described.

  16. The Results of the Use of Ahmed Valve in Refractory Glaucoma Surgery

    PubMed Central

    Bikbov, Mukharram Mukhtaramovich

    2015-01-01

    ABSTRACT The treatment of refractory glaucoma (RG) is challenging. The commonly adopted strategy in RG treatment is a glaucoma drainage device (GDD) implantation, which despite its radical nature may not always provide the desired intraocular pressure (IOP) levels for a long term. This review is based on the scientific literature on Ahmed glaucoma valve (AGV) implantation for refractory glaucoma. The technique of AGV implantation is described and data for both the types, FP7 and FP8 performance are presented. The outcome with adjunct antimetabolite and anti-VEGF drugs are also highlighted. An insight is given about experimental and histological examinations of the filtering bleb encapsulation. The article also describes various complications and measures to prevent them. How to cite this article: Bikbov MM, Khusnitdinov II. The Results of the Use of Ahmed Valve in Refractory Glaucoma Surgery. J Curr Glaucoma Pract 2015;9(3):86-91. PMID:26997843

  17. Platelet refractoriness--practical approaches and ongoing dilemmas in patient management.

    PubMed

    Stanworth, Simon J; Navarrete, Cristina; Estcourt, Lise; Marsh, Judith

    2015-11-01

    Platelet refractoriness can represent a significant clinical problem that complicates the provision of platelet transfusions, is associated with adverse clinical outcomes and increases health care costs. Although it is most frequently due to non-immune platelet consumption, immunological factors are also often involved. Human leucocyte antigen (HLA) alloimmunization is the most important immune cause. Despite the fact that systematic reviews of the clinical studies evaluating different techniques for selecting HLA compatible platelets have not been powered to demonstrate improved clinical outcomes, platelet refractoriness is currently managed by the provision of HLA-matched or cross matched platelets. This review will address a practical approach to the diagnosis and management of platelet refractoriness while highlighting on-going dilemmas and knowledge gaps.

  18. Refractory for Black Liquor Gasifiers

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Laing

    2005-10-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  19. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Jun Wei

    2005-03-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  20. Direct and maternal genetic effects for ascites-related traits in broilers.

    PubMed

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

    2002-09-01

    The objective of the present study was to estimate heritabilities for ascites-related traits in broilers and to assess the importance of maternal genetic effects for these traits. Several traits related to ascites were measured on more than 4,000 broilers kept under cold conditions. Heritabilities were estimated using an animal model with a direct genetic effect and a model with direct and maternal genetic effects. Estimated heritabilities from the direct genetic effects model were 0.46 for hematocrit value, 0.42 for BW, 0.47 for right ventricular weight, 0.46 for total ventricular weight, 0.45 for ratio of right ventricular weight to the total ventricular weight, 0.32 for total mortality, and 0.18 for fluid accumulation in the heart sac. Maternal effects significantly influenced the traits BW, total ventricular weight, and total mortality. Direct and maternal heritabilities, respectively, for BW were 0.21 and 0.04, for total ventricular weights were 0.29 and 0.03, and for total mortality were 0.16 and 0.05. The heritability estimates for ascites-related traits and the significance of maternal genetic effects for most of these traits indicate that direct and maternal genetic effects play an important role in the development of the ascites syndrome.

  1. Graded atmospheric oxygen level effects on performance and ascites incidence in broilers.

    PubMed

    Beker, A; Vanhooser, S L; Swartzlander, J H; Teeter, R G

    2003-10-01

    The effects of graded atmospheric O2 concentration (12, 14, 16, 18, and 20.6%) on chick performance and propensity to develop ascites were investigated using commercial male broilers. Chicks were housed in calorimetry chambers for 2 wk with incoming air diluted with N to provide the desired O2 concentration at thermoneutral (TN) ambient temperature. Day 14 body weight, weight gain, feed consumption, and gain-to-feed ratio increased (P < 0.01) as O2 concentration incrementally rose from 12 to 20.6%. Body weight was 138 g for the lowest atmospheric O2 level compared to 371 g for 20.6% O2. The greatest treatment difference occurred between the 12 and 14% O2 concentrations. Growth depression appeared related to feed consumption. Ascites heart ratio (AHR), ascites score (AS), right ventricular mass (RVM), and hematocrit (HCT) all increased (P < 0.01) as O2 concentration decreased. Blood HCT appeared to be a more sensitive indicator of physiological change attributable to atmospheric O2 than AHR, AS, or RVM. The data reported herein suggests that 19.6% atmospheric O2 is the minimal allowable level for housing birds within a relatively stress-free, TN environment to avoid cardiac and HCT changes related to ascites.

  2. Congenital plaque-type glomuvenous malformations associated with fetal pleural effusion and ascites.

    PubMed

    Goujon, Elisa; Cordoro, Kelly M; Barat, Muriel; Rousseau, Thierry; Brouillard, Pascal; Vikkula, Miikka; Frieden, Ilona J; Vabres, Pierre

    2011-01-01

    Glomuvenous malformations are hereditary vascular anomalies, usually without extracutaneous involvement. We report two cases of extensive thoracic plaque-type glomuvenous malformation in newborns who had previously been diagnosed in utero with pleural effusion and ascites, suggesting a pathogenic link between the two conditions.

  3. Anti leukemia activity (Dunning ascitic) of 6-mercaptopurine and its metallo complexes in rats.

    PubMed

    Skinner, S M; Swatzell, J M; Lewis, R W

    1978-01-01

    Six-mercaptopurine and its Pt, Pd and Bi complexes were used at various dosage levels to treat Dunning ascitic leukemia in rats. Significant anticarcinogenic activity was found in all compounds with toxicity apparent at the highest dosage level of all but the platinum compound.

  4. Premature parturition, edema, and ascites in an alpaca infected with Anaplasma phagocytophilum

    PubMed Central

    Tinkler, Stacy H.; Firshman, Anna M.; Sharkey, Leslie C.

    2012-01-01

    An 8-year-old alpaca was presented for fever, anorexia, edema, ascites, and premature parturition. She was determined to have Anaplasma phagocytophilum infection based on positive blood polymerase chain reaction (PCR) and positive acute and convalescent serum titers. Antibiotics and supportive therapies were administered and the alpaca made a complete recovery. PMID:23633715

  5. Probabilistic neural network prediction of ascites in broilers based on minimally invasive physiological factors.

    PubMed

    Roush, W B; Cravener, T L; Kirby, Y K; Wideman, R F

    1997-11-01

    A Probabilistic Neural Network (PNN) was trained to predict ascites in broilers based on minimally invasive inputs (i.e., physiological factors that do not require the death of the bird). A PNN is a supervised, three-layer, artificial neural network that classifies input patterns (e.g., physiological data) into specific output categories (e.g., ascites or no ascites). The PNN inputs were O2 level in the blood, body weight, electrocardiogram (ECG), hematocrit, S wave, and heart rate of individual birds. These data were from three experiments that have been described previously (Roush et al., 1996a,b). The three data sets were pooled into a combined data set for a total of 170 observations. From the pooled data, a training set (117 birds), a calibration set (17 birds), and a verification set (36 birds) were extracted. The PNN was trained on the training data set. To prevent the PNN from overfitting the training data, the neural network was evaluated on its ability to make correct predictions of the calibration data set. At the point at which the neural network made the highest number of correct classifications for the calibration data set, the trained neural network was saved on the computer. When the PNN was applied to the complete data set, the sensitivity or proportion of the birds with ascites that the PNN correctly diagnosed was 0.97 (75/77 birds). The specificity or proportion of birds that the PNN made a correct diagnosis of not having ascites was 0.98 (91/93 birds). When the PNN was applied to the verification data set, which was not subjected to neural network training, the sensitivity was 0.95 (19/20) and the specificity was 0.88 (14/16 birds). Use of models developed with artificial neural networks may enhance the diagnosis of ascites in broilers. The results may be useful in choosing and developing broiler strains that do not have a propensity for ascites.

  6. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr.; Alireza Rezaie

    2003-12-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  7. Refractory for Black Liquor Gasifiers

    SciTech Connect

    William L. Headrick Jr; Alireza Rezaie; Xiaoting Liang; Musa Karakus; Jun Wei

    2005-12-01

    The University of Missouri-Rolla identified materials that permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project was to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study attempted to define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials were selected or developed that reacted with the gasifier environment to form protective surfaces in-situ; and

  8. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Jun Wei

    2005-01-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  9. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Jun Wei

    2005-04-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  10. Refractory for Black Liquor Gasifiers

    SciTech Connect

    Robert E. Moore; William L. Headrick; Alireza Rezaie

    2003-03-31

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  11. Refractory for Black Liquor Gasifiers

    SciTech Connect

    William L. Headrick Jr; Alireza Rezaie

    2003-12-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  12. Refractory for Black Liquor Gasifiers

    SciTech Connect

    William L. Headrick Jr; Alireza Rezaie

    2003-08-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  13. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Alireza Rezaie

    2004-10-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  14. Refractory for Black Liquor Gasifiers

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang

    2005-10-01

    The University of Missouri-Rolla identified materials that permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project was to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study attempted to define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials were selected/developed that either react with the gasifier environment to form protective surfaces in-situ; and

  15. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang

    2005-07-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  16. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Alireza Rezaie

    2004-07-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  17. Refractory for Black Liquor Gasifiers

    SciTech Connect

    William L. Headrick; Musa Karakus; Alireza Rezaie

    2004-03-30

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  18. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    SciTech Connect

    William L. Headrick Jr.; Alireza Rezaie

    2004-04-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective surfaces in

  19. NASA research on refractory compounds.

    NASA Technical Reports Server (NTRS)

    Gangler, J. J.

    1971-01-01

    The behavior and properties of the refractory carbides, nitrides, and borides are being investigated by NASA as part of its research aimed at developing superior heat resistant materials for aerospace applications. Studies of the zirconium-carbon-oxygen system show that zirconium oxycarbides of different compositions and lattice parameters can be formed between 1500 C and 1900 C and are stable below 1500 C. More applied studies show that hot working generally improves the microstructure and therefore the strength of TiC and NbC. Sintering studies on UN indicate that very high densities can be achieved. Hot pressing of cermets of HfN and HfC produces good mechanical properties for high temperature bearing applications. Attempts to improve the impact resistance of boride composites by the addition of a nickel or carbon yarn were not overly successful.

  20. NASA research on refractory compounds.

    NASA Technical Reports Server (NTRS)

    Gangler, J. J.

    1971-01-01

    The behavior and properties of the refractory carbides, nitrides, and borides are being investigated by NASA as part of its research aimed at developing superior heat resistant materials for aerospace applications. Fundamental studies on the electronic and defect structures of the carbides indicate that there is promise for improving the strength and ductility of these materials. Studies of the zirconium-carbon-oxygen system show that zirconium oxycarbides of different compositions and lattice parameters can be formed between 1500 and 1900 C and are stable below 1500 C. More applied studies show that hot working generally improves the microstructure and therefore the strength of TiC and NbC. Sintering studies on UN indicate that very high densities can be achieved. Hot pressing of cermets of HfN and HfC produces good mechanical properties for high temperature bearing applications.

  1. Primordial Compositions of Refractory Inclusions

    SciTech Connect

    Grossman, L; Simon, S B; Rai, V K; Thiemens, M H; Hutcheon, I D; Williams, R W; Galy, A; Ding, T; Fedkin, A V; Clayton, R N; Mayeda, T K

    2008-02-20

    Bulk chemical and oxygen, magnesium and silicon isotopic compositions were measured for each of 17 Types A and B refractory inclusions from CV3 chondrites. After bulk chemical compositions were corrected for non-representative sampling in the laboratory, the Mg and Si isotopic compositions of each inclusion were used to calculate its original chemical composition assuming that the heavy-isotope enrichments of these elements are due to Rayleigh fractionation that accompanied their evaporation from CMAS liquids. The resulting pre-evaporation chemical compositions are consistent with those predicted by equilibrium thermodynamic calculations for high-temperature nebular condensates but only if different inclusions condensed from nebular regions that ranged in total pressure from 10{sup -6} to 10{sup -1} bar, regardless of whether they formed in a system of solar composition or in one enriched in OC dust relative to gas by a factor of ten relative to solar composition. This is similar to the range of total pressures predicted by dynamic models of the solar nebula for regions whose temperatures are in the range of silicate condensation temperatures. Alternatively, if departure from equilibrium condensation and/or non-representative sampling of condensates in the nebula occurred, the inferred range of total pressure could be smaller. Simple kinetic modeling of evaporation successfully reproduces observed chemical compositions of most inclusions from their inferred pre-evaporation compositions, suggesting that closed-system isotopic exchange processes did not have a significant effect on their isotopic compositions. Comparison of pre-evaporation compositions with observed ones indicates that 80% of the enrichment in refractory CaO + Al{sub 2}O{sub 3} relative to more volatile MgO + SiO{sub 2} is due to initial condensation and 20% due to subsequent evaporation for both Type A and Type B inclusions.

  2. [Pulmonary complications of malaria: An update].

    PubMed

    Cabezón Estévanez, Itxasne; Górgolas Hernández-Mora, Miguel

    2016-04-15

    Malaria is the most important parasitic disease worldwide, being a public health challenge in more than 90 countries. The incidence of pulmonary manifestations has increased in recent years. Acute respiratory distress syndrome is the most severe form within the pulmonary complications of malaria, with high mortality despite proper management. This syndrome manifests with sudden dyspnoea, cough and refractory hypoxaemia. Patients should be admitted to intensive care units and treated with parenteral antimalarial drug treatment and ventilatory and haemodynamic support without delay. Therefore, dyspnoea in patients with malaria should alert clinicians, as the development of respiratory distress is a poor prognostic factor.

  3. Ascites syndrome and related pathologies in feed restricted broilers raised in a hypobaric chamber.

    PubMed

    Balog, J M; Anthony, N B; Cooper, M A; Kidd, B D; Huff, G R; Huff, W E; Rath, N C

    2000-03-01

    It has been demonstrated that the incidence of ascites can be significantly reduced through feed restriction. This method is thought to have an effect by slowing the growth rate of the birds. Interestingly, when birds are grown in a hypobaric chamber, ascites incidence increases while the overall growth rate of the birds is decreased. Unfortunately, the restriction programs practiced also have a detrimental effect on growth characteristics. An experiment was conducted to determine if the timing and duration of feed restriction can be used to reduce the incidence of ascites for broilers reared under high altitude and local elevation without having a negative impact on growth. A total of 600 commercial broiler males were used. Birds were divided, placing 360 birds in the hypobaric chamber at a simulated 2900 m (9,500 ft) above sea level, and 240 birds were placed at local elevation [390 m (1,300 ft) above sea level]. At each altitude there were four treatments: 1) fully fed controls; 2) feed available for 8 h/d for 6 wk (the duration of the study); 3) feed available for 8 h/d during the first 3 wk, then full feed for the remaining 3 wk; and 4) full feed for the first wk, then 3 wk of 8 h of feed availability, then 2 wk of full feed. Birds and feed were weighed weekly, and mortalities were necropsied to determine the cause of death. At the end of 6 wk, blood samples were taken, and the birds were weighed, necropsied, and scored for ascites, and organ weights were recorded. All feed restriction treatments significantly reduced ascites incidence, when compared with the fully fed controls. Treatment 2 birds were significantly lighter than any other group at both altitudes. The fully fed controls at local elevation were heavier than the fully fed controls at simulated high altitude, as seen in past experiments.

  4. Tolvaptan regulates aquaporin-2 and fecal water in cirrhotic rats with ascites

    PubMed Central

    Chen, Chao; Chen, Ren-Pin; Lin, Hai-Hua; Zhang, Wen-You; Huang, Xie-Lin; Huang, Zhi-Ming

    2016-01-01

    AIM: To investigate the role of tolvaptan in regulating aquaporin (AQP)-2 expression and fecal water content in cirrhotic rats with ascites. METHODS: Cirrhosis with ascites was induced in rats by repetitive dorsal injection of CCl4 for 14 wk. In total, 84 cirrhotic rats with ascites divided into three groups (vehicle, 3 mg/kg and 5 mg/kg tolvaptan), and then further divided into five subgroups (days 1, 2, 3, 4, and 5). Blood samples were obtained to measure vasopressin and sodium concentrations. Rats were killed and colonic mucosa was scraped for analysis of protein expression and AQP-2 transcriptional level. The whole layer was fixed for hematoxylin&eosin (HE) staining and feces were collected for determination of fecal water content. CONCLUSION: Compared with vehicle, vasopressin decreased significantly in the tolvaptan groups from day 2 to a similar level in each treatment group. AQP-2 showed significant upregulation in cirrhotic rats with ascites compared with an untreated control group (100% ± 22.9% vs 22.2% ± 10.23%, P < 0.01). After administration of tolvaptan, AQP-2 expression began to decrease significantly from day 2 in each treatment group, but no significant difference was finally found between the treatment groups. Fecal water content in the distal colon was increased by 5 mg/kg tolvaptan on day 1 (66.8% ± 9.3% vs 41.4% ± 6.3%, in the vehicle group, P < 0.05). Fecal water content returned to baseline at day 4 at the latest in both treatment groups, and did not correspond to the change in AQP-2 expression. HE staining of the colonic mucosa showed no mucosal damage related to tolvaptan. CONCLUSION: Upregulation of AQP-2 in the distal colon is found in cirrhotic rats with ascites. Tolvaptan inhibits its expression and may decrease water reabsorption and induce diarrhea. PMID:27022218

  5. Alpha-2A Adrenoceptor Agonist Guanfacine Restores Diuretic Efficiency in Experimental Cirrhotic Ascites: Comparison with Clonidine

    PubMed Central

    Sansoè, Giovanni; Aragno, Manuela; Mastrocola, Raffaella; Mengozzi, Giulio; Parola, Maurizio

    2016-01-01

    Background In human cirrhosis, adrenergic hyperfunction causes proximal tubular fluid retention and contributes to diuretic-resistant ascites, and clonidine, a sympatholytic drug, improves natriuresis in difficult-to-treat ascites. Aim To compare clonidine (aspecific α2-adrenoceptor agonist) to SSP-002021R (prodrug of guanfacine, specific α2A-receptor agonist), both associated with diuretics, in experimental cirrhotic ascites. Methods and Results Six groups of 12 rats were studied: controls (G1); controls receiving furosemide and potassium canrenoate (G2); rats with ascitic cirrhosis due to 14-week CCl4 treatment (G3); cirrhotic rats treated (over the 11th-14th CCl4 weeks) with furosemide and canrenoate (G4), furosemide, canrenoate and clonidine (G5), or diuretics and SSP002021R (G6). Three rats of each group had their hormonal status and renal function assessed at the end of 11th, 12th, 13th, and 14th weeks of respective treatments.Cirrhotic rats in G3 and G4 gained weight over the 12th-14th CCl4 weeks. In G4, brief increase in sodium excretion over the 11th-12th weeks preceded worsening of inulin clearance and natriuresis (diuretic resistance). In comparison with G4, the addition of clonidine (G5) or guanfacine (G6) to diuretics improved, respectively, sodium excretion over the 11th-12th CCl4 weeks, or GFR and electrolytes excretion over the 13th-14th CCl4 weeks. Natriuretic responses in G5 and G6 were accompanied by reduced catecholamine serum levels. Conclusions α2A-receptor agonists restore glomerular filtration rate and natriuresis, and delay diuretic-resistant ascites in experimental advanced cirrhosis. Clonidine ameliorates diuretic-dependent natriuresis just for a short time. PMID:27384184

  6. Body Posture Angle Affects the Physiological Indices of Patients With Liver Cirrhosis Ascites.

    PubMed

    Hsu, Wen-chuan; Ho, Lun-hui; Lin, Mei-hsiang; Chiu, Hsiu-ling

    2016-01-01

    The study objective was to compare the effect of different angles of lying positions on the physiological indices of patients with cirrhosis ascites. Chronic liver disease and cirrhosis were ranked 9th among the top 10 causes of death. Ascites is the most common cirrhosis comorbidity. Body posture can affect pulmonary ventilation and arterial oxygen partial pressure, making it an important clinical nursing intervention significantly affecting patient recovery. This was a quasi-experimental study design. From a medical center in Taiwan, 252 patients with cirrhosis ascites were recruited. Subjects were randomly divided into three groups by bed angle: 15°, 30°, and 45°. Physiological indices were measured at 5, 10, 15, 20, 25, and 30 minutes to determine any changes in heart rate, respiration rate, and oxygenation saturation. Data analysis included descriptive statistics and the generalized estimating equation for statistical analysis with significance set at α= 0.05. After controlling for confounding variables, the three groups differed significantly in heart rate at 20, 25, and 30 minutes, oxygenation saturations at 15 and 20 minutes, and respiration rate at 5 and 10 minutes (α< 0.05). Body posture can affect pulmonary ventilation and arterial oxygen partial pressure and is thus an important clinical nursing intervention that significantly affects the recovery of patients. When caring for patients with cirrhosis ascites, nurses should help patients to choose the most comfortable angle for them with no particular restrictions. Our results can be used to guide nurses in making a plan for health education and nursing that improves the quality of care for patients with chronic liver disease and cirrhosis patients with ascites.

  7. Evaluation of minimally invasive indices for predicting ascites susceptibility in three successive hatches of broilers exposed to cool temperatures.

    PubMed

    Wideman, R F; Wing, T; Kirby, Y K; Forman, M F; Marson, N; Tackett, C D; Ruiz-Feria, C A

    1998-10-01

    Broilers from three consecutive hatches were exposed to cool temperatures to amplify the incidence of pulmonary hypertension syndrome (PHS, ascites). The largest apparently healthy individuals on Day 42 were evaluated using minimally invasive diagnostic indices [percentage saturation of hemoglobin with oxygen, hematocrit (HCT), heart rate, electrocardiogram (ECG) Lead II, body weight), then they were subjected to the ongoing pressures of fast growth and cool temperatures to determine which of these indices are predictive of the subsequent onset of PHS. Approximately 20% of the males and females evaluated on Day 42 subsequently developed PHS by Day 51. When data for all hatches were pooled and broilers that subsequently developed ascites were compared with those that did not (nonascitic), body weights, heart rates, and percentage saturation of hemoglobin with oxygen were lower on Day 42 for ascitic than for nonascitic males, and HCT was higher in ascitic males and females than in nonascitic males and females, respectively. Comparisons of the ECG Lead II wave amplitudes for all hatches pooled indicated that RS-wave amplitude was larger in ascitic than in nonascitic males, and that S-wave amplitude was more negative in ascitic males and females than in nonascitic males and females. Necropsies conducted on Day 51 revealed higher right:total ventricular weight ratios in ascitic than in nonascitic broilers, whereas normalizing the left ventricle plus septum weight for differences in body weight generated similar values for ascitic and nonascitic males and females, respectively. These results support a primary role for pulmonary hypertension but not cardiomyopathy in the pathogenesis of ascites triggered by cool temperatures. Values obtained for minimally invasive diagnostic indices on Day 42 also establish predictive thresholds that can be used to evaluate the PHS susceptibility of large and apparently healthy male and female broilers.

  8. Repeated Dosing of 23.4% Hypertonic Saline for Refractory Intracranial Hypertension. A Case Report

    PubMed Central

    Valentino, Alden K; Nau, Karen M; Miller, David A; Hanel, Ricardo A; Freeman, WD

    2008-01-01

    Background: Hypertonic saline (HTS) at a concentration of 23.4% is an emerging therapy for intracranial hypertension. Compared to mannitol which can be given as a single bolus or as repeated bolus dosing, little data exists regarding safety or efficacy of repeated dosing of 23.4% HTS. We report the first case of 16 doses of 23.4% HTS over a 5 day period in a patient with refractory intracranial hypertension. Case Report: A 43-year-old woman with Fisher 3 subarachnoid hemorrhage and hydrocephalus requiring an external ventricular drain developed global cerebral edema on computed tomography. Medically refractory intracranial hypertension ensued which required repeated dosing of 23.4% HTS. Reductions in intracranial pressure (ICP) occurred after each dose of 23.4% HTS. No central nervous system complications occurred. Anasarca was the only observed complication, which responded to furosemide diuresis. Conclusion: Repeated dosing of 23.4% HTS was effective in reducing ICP in a case of medically refractory intracranial hypertension without major systemic complications. Prospective studies should address the safety and efficacy of repeat dose 23.4% HTS on serum sodium, intracranial pressure, and complications. PMID:22518235

  9. Refractory Orthostatic Hypotension Caused by a Recurrent Hemangioblastoma: Case Report and Review of the Literature

    PubMed Central

    Nangunoori, Raj; Singh, Anil; Aziz, Khaled

    2016-01-01

    Refractory orthostatic hypotension (OH) has been described following surgery for posterior fossa tumors. We present the case of a patient with refractory OH following attempted surgical resection. We also reviewed the available literature to describe pathophysiologic mechanisms for this rare entity. A 58-year-old female was found to have a hemangioblastoma at the cervicomedullary junction following workup for dysphagia and coordination difficulties. She underwent successful suboccipital craniotomy and gross total resection. However, the patient’s symptoms returned several years later and a magnetic resonance imaging (MRI) showed tumor recurrence. A surgical resection was attempted but could not be performed due to significant scarring. Following discharge, she returned to our care with severe syncopal episodes, refractory OH, and an inability to ambulate. Aggressive medical therapy resulted in a gradual improvement in her ability to ambulate and a reduction in her orthostatic episodes. Unfortunately she died due to sepsis from aspiration pneumonia several months later. A survey of the literature yielded a total of 10 reports (14 patients) with refractory OH as a result of tumors in the cervicomedullary region. Five of fourteen patients died from complications related to OH and brainstem compression while the remainder had some improvement and were discharged. Refractory OH can rarely be a presenting sign of a tumor in the cervicomedullary junction or can manifest following surgical resection of tumors in this region. Recognition of OH and the institution of medical therapy (sodium and fluid replacement) and pharmacotherapy may curb the significant morbidity associated with this condition. PMID:27158570

  10. Refractories from kaolins of the Angrenskoe deposit

    SciTech Connect

    Khodzhaev, T.K.; Valishev, R.S.; Karklit, A.K.

    1995-09-01

    Samples of kaolin from the Angrenskoe deposit have been investigated by specialists from the Tashkent Stromproekt Research Institute and the St. Petersburg Institute of Refractories. Semiindustrial batches of articles from Angrenskoe kaolin were produced by the experimental technological department of the St. Petersburg Institute of Refractories. It was established that the experimental articles meet the requirements of GOST 390 - 83 for chamotte articles of grades ShA and ShB. Angrenskoe kaolins can be a raw material for the production of chamotte and semiacid refractories for various purposes.

  11. Propofol Infusion Syndrome in Refractory Status Epilepticus: A Case Report and Topical Review

    PubMed Central

    Dam, Mette

    2016-01-01

    Propofol infusion syndrome (PRIS) is a fatal complication when doses of propofol administration exceed 4 mg/kg/h for more than 48 hours. Propofol overdosage is not uncommon in patients with refractory status epilepticus (RSE). We describe a case of refractory status epilepticus complicated by propofol infusion syndrome and collect from 5 databases all reports of refractory status epilepticus cases that were treated by propofol and developed the syndrome and outline whether refractory status epilepticus treatment with propofol is standardized according to international recommendations, compare it with alternative medications, and discuss how this syndrome can be treated and prevented. A total of 21 patients who developed this syndrome reported arrhythmia in all cases (100%), rhabdomyolysis in 9 cases (42%), lactic acidosis in 13 cases (62%), renal failure in 8 cases (38%), lipemia in 7 cases (33%), and elevated hepatic enzymes in 6 cases (28%). 13 patients died (66%). Propofol is still given in a dosage higher than what is internationally recommended, and new treatment modalities such as renal replacement therapy, blood exchange, and extracorporeal membrane oxygenation seem to be promising. In conclusion, propofol should be carefully titrated, the maximal infusion rate needs to be reassessed, and combination of different sedative agents may be considered. PMID:27493812

  12. Refractories for Industrial Processing. Opportunities for Improved Energy Efficiency

    SciTech Connect

    Hemrick, James G.; Hayden, H. Wayne; Angelini, Peter; Moore, Robert E.; Headrick, William L.

    2005-01-01

    Refractories are a class of materials of critical importance to manufacturing industries with high-temperature unit processes. This study describes industrial refractory applications and identifies refractory performance barriers to energy efficiency for processing. The report provides recommendations for R&D pathways leading to improved refractories for energy-efficient manufacturing and processing.

  13. Refractory-metal compound impregnation of polytetrafluoroethylene

    NASA Technical Reports Server (NTRS)

    Leibecki, H. F.

    1969-01-01

    Process impregnates polytetrafluoroethylene /PTFE/ with rhenium or molybdenum compounds. The refractory metals impregnated PTFE combines chemical inertness with electrical conductivity. They are useful for electro-chemical cells, chemical processing equipment, catalysts, electrostatic charge removal, RF gasketing, and cable shielding.

  14. Isoprenaline and canine cardiac refractory periods.

    PubMed

    Lhoste, F; Giudicelli, J F; Boissier, J R

    1976-09-01

    Atrioventricular refractory periods and their modifications induced by variable doses of sioprenaline have been investigated in dogs. Premature atrial stimuli (St2) were applied at variable intervals following regular stimuli (St1) which ensured atrial pacing. Atrial (AERP), nodoventricular (NERP) and global (GERP) effective refractory periods, as well as the global functional refractory period (GFRP) were determined before, during and after infusion of the drug. In low doses, isoprenaline did not significantly alter these various parameters. This confirms its lack of dromotropic effect on the healthy heart. In contrast, high doses of the drug significantly reduced the refractory periods, probably by simple correction of the negative dromotropic effects resulting from overstimulation. Also when the infusion was stopped, marked but reversible conduction depression was observed. It would appear that this reflects 'exhaustion' of cell metabolism induced by the drug.

  15. Testing Consent Order on Refractory Ceramic Fibers

    EPA Pesticide Factsheets

    This notice announces that EPA has signed signed an enforceable testing consent order under the Toxic Substances Control Act (TSCA), 15 U.S.C. section 2601 at seq., with three of the primary producers of refractory ceramic fibers (RCF).

  16. Genetic and phenotypic relationships between blood gas parameters and ascites-related traits in broilers.

    PubMed

    Closter, A M; van As, P; Groenen, M A M; Vereijken, A L J; van Arendonk, J A M; Bovenhuis, H

    2009-03-01

    Ascites, also called pulmonary hypertension syndrome, is a metabolic disorder in chickens that have an insufficient pulmonary vascular capacity. The tendency of broilers to develop ascites is heritable, and successful selection against this susceptibility would benefit from good and easy-to-measure indicator traits. Blood gas parameters have been suggested as indicator traits for ascites susceptibility. Therefore, the aim of the present study was to estimate the heritability of blood gas parameters and the genetic and phenotypic correlations between blood gas parameters, heart ratio (postmortem indicator for ascites), and BW at 2 different ages. For this purpose, blood gas parameters, including the partial pressure of carbon dioxide in venous blood (pvCO(2)), the partial pressure of oxygen in venous blood (pvO(2)), and blood oxygen saturation, were measured at an average age of 22 d in nearly 3,000 broilers. To challenge the resistance of the birds to ascites, they were kept under cold conditions. Heritability for heart ratio was 0.43, and the heritability estimates were low: 0.02 for pvCO(2), 0.03 for pvO(2), and 0.07 for blood oxygen saturation. The estimated heritability for pH was 0.15, for bicarbonate was 0.19, and for total carbon dioxide content was 0.19. The genetic correlations between heart ratio and total carbon dioxide content (0.31 +/- 0.15) and between heart ratio and bicarbonate (0.31 +/- 0.15) were moderate and positive. For pvO(2), the genetic correlation with heart ratio was stronger and negative (-0.62 +/- 0.21); however, this correlation could not be estimated accurately because of the low heritability of pvO(2). For pvCO(2), the genetic correlation with the heart ratio was close to zero (-0.04 +/- 0.45). Phenotypic correlations between traits were, in general, similar to the genetic correlations. Heritabilities for blood gas parameters and the genetic correlations between blood gas parameters and the heart ratio estimated in the present study

  17. Method of making a composite refractory material

    DOEpatents

    Morrow, M.S.; Holcombe, C.E.

    1995-09-26

    A composite refractory material is prepared by combining boron carbide with furan resin to form a mixture containing about 8 wt. % furan resin. The mixture is formed into a pellet which is placed into a grit pack comprising an oxide of an element such as yttrium to form a sinterable body. The sinterable body is sintered under vacuum with microwave energy at a temperature no greater than 2000 C to form a composite refractory material.

  18. Thalidomide for treatment of refractory epilepsy.

    PubMed

    Palencia, Guadalupe; Martinez-Juarez, Iris E; Calderon, Alejandra; Artigas, Carol; Sotelo, Julio

    2010-12-01

    We have experimentally shown that thalidomide has strong anticonvulsant properties. In an open label study, eight male patients with refractory epilepsy received thalidomide at daily-doses of 200 mg during 1 year, frequency of seizures before and during treatment were compared. The mean number of seizures before thalidomide administration was 26 ± 4 per month; it decreased to 7 ± 1 along thalidomide therapy. Our results indicate that thalidomide has strong therapeutic effects in refractory epilepsy.

  19. Forming Refractory Insulation On Copper Wire

    NASA Technical Reports Server (NTRS)

    Setlock, J.; Roberts, G.

    1995-01-01

    Alternative insulating process forms flexible coat of uncured refractory insulating material on copper wire. Coated wire formed into coil or other complex shape. Wire-coating apparatus forms "green" coat on copper wire. After wire coiled, heating converts "green" coat to refractory electrical insulator. When cured to final brittle form, insulating material withstands temperatures above melting temperature of wire. Process used to make coils for motors, solenoids, and other electrical devices to be operated at high temperatures.

  20. Method of making a composite refractory material

    DOEpatents

    Morrow, Marvin S.; Holcombe, Cressie E.

    1995-01-01

    A composite refractory material is prepared by combining boron carbide with furan resin to form a mixture containing about 8 wt. % furan resin. The mixture is formed into a pellet which is placed into a grit pack comprising an oxide of an element such as yttrium to form a sinterable body. The sinterable body is sintered under vacuum with microwave energy at a temperature no greater than 2000.degree. C. to form a composite refractory material.

  1. One-step purification of mouse monoclonal antibodies from ascitic fluid by DEAE Affi-Gel blue chromatography.

    PubMed

    Bruck, C; Portetelle, D; Glineur, C; Bollen, A

    1982-09-30

    Monoclonal antibodies can be purified directly from ascitic fluids by chromatography on a DEAE Affi-gel blue column. Optimal conditions were determined for the recovery of immunoglobulins free of contaminating protease and nuclease activities.

  2. A Case of Congenital Malignant Spinal Cord Glioma as a Cause of Congenital Ascites in a Neonate

    PubMed Central

    Omesi, Lenore; Chang, Sunny; Handel, Andrew; Hegedus, Monica; Maduekwe, Echezona

    2016-01-01

    Congenital ascites is rare, but when it occurs, urinary ascites secondary to posterior urethral valve obstruction is the most common, and tumors are the least. Among the tumors in the pediatric population, the central nervous system tumors are common, but spinal cord tumors are rare. We describe a very rare case of congenital malignant spinal cord glioma presenting as isolated congenital ascites secondary to neurogenic bladder. A female infant was diagnosed sonographically with isolated congenital ascites at 40 weeks' gestational age, with uneventful development prior to 40 weeks' gestational age. Magnetic resonance imaging of the spine done within the first week of life identified a lobulated spinal mass with heterogeneous enhancement within the conus medullaris. Spinal fluid analysis showed evidence of small round blue cells and the pathology from the excision biopsy of the mass confirmed a WHO grade III or IV malignant glioma. The postoperative course was uneventful with resolution of the ascites and spontaneous micturition. The patient was discharged home without an indwelling urinary catheter. We report the first documented case of a newborn infant with isolated congenital ascites from neurogenic bladder secondary to a spinal cord glioma. PMID:27597917

  3. Complications of multiple myeloma.

    PubMed

    Bladé, Joan; Rosiñol, Laura

    2007-12-01

    Multiple myeloma, also known as myeloma or plasma cell myeloma, is a progressive hematologic disease. Complications of multiple myeloma include renal insufficiency, hematologic complications (anemia, bone marrow failure, bleeding disorders), infections, bone complications (pathologic fractures, spinal cord compression, hyercalcemia), and neurologic complications (spinal cord and nerve root compression, intracranial plasmacytomas, leptomeningeal involvement, among others). This article reviews these various complications connected to multiple myeloma, examining their various causes and possible treatment.

  4. Chronic granulomatous disease presenting as aseptic ascites in a 2-year-old child.

    PubMed

    Moreau, J F; Ozolek, John A; Lin, P Ling; Green, Todd D; Cassidy, Elaine A; Venkat, Veena L; Buchert, Andrew R

    2013-01-01

    Chronic granulomatous disease (CGD) is a rare inherited immunodeficiency syndrome that results from abnormal nicotinamide adenine dinucleotide phosphate (NADPH) oxidase function. This defect leads to recurrent catalase-positive bacterial and fungal infections as well as associated granuloma formation. We review the case of a 2-year-old boy who presented with ascites and fever of an unknown origin as manifestations of CGD. Cultures were negative for infection throughout his course, and CGD was suspected after identification of granulomas on peritoneal biopsy. Genetic testing revealed a novel mutation in the CYBB gene underlying his condition. This paper highlights the importance of considering CGD in the differential diagnosis of fever of unknown origin and ascites in children.

  5. [Antineoplastic effect of hydrogel prospidin on Seidel ascites hepatoma used as a model].

    PubMed

    Bychkovskiĭ, P M; Iurkshtovich, T L; Kladiev, A A; Revtovich, M Iu

    2012-01-01

    Antineoplastic effect of hydrogel dextran phosphate, hydrogel prospidin, and prospidin in an injectable preparation has been assessed using Seidel ascites hepatoma as a model. Injectable and hydrogel prospidin in doses from 250, 500 to 1000 mg/kg and hydrogel phosphate dextran in doses of 500 and 1000 mg/kg were administered to rats intraperitoneally in a single dose in a volume of 1 or 2 ml per each 100 g of animal body weight. The study has shown that irrespective of rats with Seidel ascites hepatoma and significantly increase in the dosage of prospidin preparations and hydrogel dextran phosphate results in a longer average life expectancy of rats Compared with its injectable variant, hydrogel prospidin appears to produce more than twice as high antineoplastic effect, and is found to provide prolonged therapeutic effects, as well as cure of animals in more than 60 % of cases.

  6. The lymphatic vascular system in liver diseases: its role in ascites formation.

    PubMed

    Chung, Chuhan; Iwakiri, Yasuko

    2013-06-01

    The lymphatic system is part of the circulatory system and plays a key role in normal vascular function. Its failure plays a crucial role in the development and maintenance of various diseases including liver diseases. Lymphangiogenesis (the growth of lymphatic vessels) and changes in the properties of lymphatic vessels are associated with pathogenesis of tumor metastases, ascites formation, liver fibrosis/cirrhosis and portal hypertension. Despite its significant role in liver diseases and its importance as a potential therapeutic target for those diseases, the lymphatic vascular system of the liver is poorly understood. Therefore, how the lymphatic vascular system in general and lymphangiogenesis in particular are mechanistically related to the pathogenesis and maintenance of liver diseases are largely unknown. This article summarizes: 1) the lymphatic vascular system; 2) its role in liver tumors, liver fibrosis/cirrhosis and portal hypertension; and 3) its role in ascites formation.

  7. [Chronobiological analysis of thyroxine action on cell proliferation in the hypotetraploid strain of Ehrlich's ascitic tumor].

    PubMed

    Romanov, Iu A; Stepanenko, V A

    1989-11-01

    Experiments on white random-bred male mice were made to study the effect of L-thyroxine on cell proliferation of the hypotetraploid strain of Ehrlich's ascites carcinoma. It was shown that prolonged thyroxine administration (during 6 days of carcinoma growth) lead to synchronization of cell proliferation and the maximum values of the mitotic index was found 3 hours earlier then in the control experiments. At the same time thyroxine did not exert any noticeable effect on the average daily magnitudes of the number of DNA-synthesizing cells and did not change the pattern of modulations in the radioactive index. The changes in the mitotic index and radioactive index were asynchronous in control and experimental animals. Analogous results were found for hyperdiploid strain of Ehrlich's ascites tumor. Ploidy of cells did not influence the tipe rhythms of the cell proliferation and its reaction on the action of thyroxine.

  8. Changes of biochemical parameters and enzyme activities in broiler chickens with cold-induced ascites.

    PubMed

    Daneshyar, M; Kermanshahi, H; Golian, A

    2009-01-01

    An experiment with 250 one-day-old male broilers (Ross 308) was conducted to investigate the differences of some blood parameters of cold-induced ascitic and healthy broiler chicks in a 6-wk period. The chickens were divided into 2 groups of 5 replicates each. One group of these chickens was raised in normal temperature (NT) treatment and the other in cold temperature (CT) treatment to induce ascites. Mortality was necropsied daily to determine cause of death. At the end of the experiment (wk 6), 5 chickens from each replicate were randomly selected and slaughtered. The heart was removed; the right ventricle was dissected away from the left ventricle and septum. Weights of right and left ventricles were determined separately. Average BW gain and average feed intake were measured weekly, and weekly average feed conversion ratio was calculated. Serum glucose, total protein, cholesterol, triglyceride, activity of lactate dehydrogenase, as-partate aminotransferase, and alanine aminotransferase were determined. Throughout the study, the right ventricle-to-total ventricle ratio and total mortality percentage due to ascites of CT-treated birds at the end of experiment was greater (P < or = 0.05) than those of NT-treated ones. Fasting blood sugar of CT-treated birds in wk 4 and 6 was greater (P < or = 0.05) than NT-treated birds. Total blood protein of CT treatment was lower than NT-treated birds in every week and whole period, but this difference was only significant (P < or = 0.05) in wk 6. There was not a significant difference between 2 treatments for triglyceride and cholesterol, lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase. It was concluded that cold-induced ascites could affect serum protein and fasting blood sugar of broiler chickens.

  9. Use of low doses of clenbuterol to reduce incidence of ascites syndrome in broilers.

    PubMed

    Ocampo, L; Cortez, U; Sumano, H; Avila, E

    1998-09-01

    Beta-adrenergic agonists have been shown to be capable of improving growth performance in poultry when added to the feed at 1.0 ppm. However, no reference has been made concerning the cardiovascular responses when one of these agents is added to the feed at a lower concentration during the whole production cycle. The aim of this paper was to assess the effects on the ascites syndrome of 0.25 ppm clenbuterol in the feed, throughout 52 d, in broiler chicks. Results showed a lack of difference in growth and feed conversion rate between the untreated control groups and the experimental group. There were differences in mortality due to the ascites syndrome, abdominal fat:body weight ratio, and ventricular index. A statistically significant positive correlation was also found between ventricular index and mortality rate (r = 0.98). If adequate withdrawal times are ensured, the use of clenbuterol at 0.25 ppm is suggested to reduce mortality due to the ascites syndrome in broilers.

  10. Absence of trisomy 7 in nonneoplastic human ascitic and pleural fluid cells. An interphase cytogenetic study.

    PubMed

    Larramendy, M L; Björkqvist, A M; Tammilehto, L; Taavitsainen, M; Mattson, K; Knuutila, S

    1994-11-01

    Trisomy 7 is a frequent aneuploid change in lymphomas, adenocarcinomas, and malignant mesenchymal and neurogenic tumors. Moreover, it has been observed in cultured and uncultured non-neoplastic cells from brain, kidney, liver, lung, and atherosclerotic plaques, among other tissues, opening debate on the role of this change in normal and neoplastic tissue. We used nonradioactive in situ hybridization (ISH) with a biotinylated chromosome 7-specific alpha-satellite DNA probe to seek an extra copy of chromosome 7 in ascitic and pleural fluid interphase cells from 26 donors. The donors comprised 24 patients with nonmalignant clinical history, one patient with non-Hodgkin's malignant lymphoma (positive control), and one patient with chronic myeloid leukemia (CML, negative control). The highest frequency of fluid cells with three hybridization signals in patients without neoplasia was 0.5%, in contrast to the frequency of 40.5% noted in the fluid cells of the patient with non-Hodgkin's malignant lymphoma. The results demonstrate that the frequency of trisomic cells in pleural as well as in ascitic fluid is very low, making possible use of the cells in ascitic or pleural fluids in identification of malignancy.

  11. CRIg-expressing peritoneal macrophages are associated with disease severity in patients with cirrhosis and ascites

    PubMed Central

    Irvine, Katharine M.; Banh, Xuan; Gadd, Victoria L.; Wojcik, Kyle K.; Ariffin, Juliana K.; Jose, Sara; Lukowski, Samuel; Baillie, Gregory J.; Sweet, Matthew J.; Powell, Elizabeth E.

    2016-01-01

    Infections are an important cause of morbidity and mortality in patients with decompensated cirrhosis and ascites. Hypothesizing that innate immune dysfunction contributes to susceptibility to infection, we assessed ascitic fluid macrophage phenotype and function. The expression of complement receptor of the immunoglobulin superfamily (CRIg) and CCR2 defined two phenotypically and functionally distinct peritoneal macrophage subpopulations. The proportion of CRIghi macrophages differed between patients and in the same patient over time, and a high proportion of CRIghi macrophages was associated with reduced disease severity (model for end-stage liver disease) score. As compared with CRIglo macrophages, CRIghi macrophages were highly phagocytic and displayed enhanced antimicrobial effector activity. Transcriptional profiling by RNA sequencing and comparison with human macrophage and murine peritoneal macrophage expression signatures highlighted similarities among CRIghi cells, human macrophages, and mouse F4/80hi resident peritoneal macrophages and among CRIglo macrophages, human monocytes, and mouse F4/80lo monocyte-derived peritoneal macrophages. These data suggest that CRIghi and CRIglo macrophages may represent a tissue-resident population and a monocyte-derived population, respectively. In conclusion, ascites fluid macrophage subset distribution and phagocytic capacity is highly variable among patients with chronic liver disease. Regulating the numbers and/or functions of these macrophage populations could provide therapeutic opportunities in cirrhotic patients. PMID:27699269

  12. Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites

    PubMed Central

    El-Bokl, Mohammed Abdelhamid; Senousy, Bahaa Eldeen; El-Karmouty, Khaled Zakaria; Mohammed, Inas El-Khedr; Mohammed, Sherif Monier; Shabana, Sherif Sadek; Shalaby, Hassan

    2009-01-01

    AIM: To evaluate the accuracy of spot urinary Na/K and Na/creatinine (Cr) ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS: The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/Cr ratio and 24-h urinary sodium. Student’s t test was used to compare the interval variables and χ2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS: The best cutoff point for Na/K ratio was 2.5 (P < 0.001) and area under the curve (AUC) was 0.9, and for Na/Cr ratio, the best cutoff point was 35 (P < 0.001) and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio (87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively). CONCLUSION: Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites. PMID:19653340

  13. [Hydrothorax as a complication of a ventricle peritoneal shunt. A case report].

    PubMed

    Yéboles, Raúl M; Vázquez, Lorena; Seoane, Marta; Castro, Susana; Ruiz, Beatriz

    2017-02-24

    The ventricle peritoneal (VP) shunt is commonly used in the treatment of hydrocephalus. It is a relatively simple and effective technique, but around 70% of the patients with a VP shunt have a complication in their lifetime. Most of these complications are due to infection or mechanical dysfunction. The thoracic complications are rare. The present case is one of the small number of them found in the literature, describing hydrothorax as a complication of a VP shunt without catheter migration and without ascites. The case is presented of a 2 year-old girl with VP shunt. The patient was diagnosed with pleural effusion compatible with hydrothorax. After finding beta-2-transferrin in the pleural fluid, it was it was shown to be from cerebrospinal fluid. Cranial CT showed the catheter in a proper position, and the Xray and ultrasound showed the catheter correctly positioned in the peritoneum.

  14. Central line complications

    PubMed Central

    Kornbau, Craig; Lee, Kathryn C; Hughes, Gwendolyn D; Firstenberg, Michael S

    2015-01-01

    Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications. PMID:26557487

  15. Enteropathy-associated T-cell lymphoma type II complicated by autoimmune hemolytic anemia.

    PubMed

    Kato, Aiko; Takiuchi, Yoko; Aoki, Kazunari; Ono, Yuichiro; Arima, Hiroshi; Nagano, Seiji; Tabata, Sumie; Yanagita, Soshi; Matsushita, Akiko; Maruoka, Hayato; Wada, Masaya; Imai, Yukihiro; Ishikawa, Takayuki; Takahashi, Takayuki

    2011-01-01

    A 74-year-old man was admitted to hospital because of persistent fever, diarrhea, and abdominal pain. CT scanning showed extensive wall thickening of the colon. He was transferred to our hospital because he further developed ascites and paraaortic lymph node swelling. On presentation, he was extremely emaciated with superficial lymph node swelling, ascitic signs, and leg edema. Histological image of a biopsied mesenteric lymph node demonstrated diffuse infiltration of large abnormal T cells. Surface antigen analysis of abnormal cells in the ascites revealed positivity for CD3, CD8, CD56, and weak positivity for CD103. Polymerase chain reaction analysis showed monoclonal rearrangement of the T cell receptor (TCR) gene. The subtype of TCR was αβ. A diagnosis of enteropathy-associated T cell lymphoma (EATL) type II was made. The lymphoma involved the bone marrow. The patient also had severe hemolytic anemia with a positive Coomb's test result. An additional diagnosis for autoimmune hemolytic anemia (AIHA) was made, which was resistant to methylprednisolone therapy. We first treated him with only vincristine in addition to the steroid to avoid acute tumor lysis syndrome ; however, he died of septic shock that occurred soon after vincristine administration. To the best of our knowledge, this may be the first reported case of EATL complicated by AIHA.

  16. Comparison of three lines of broilers differing in ascites susceptibility or growth rate. 2. Egg weight loss, gas pressures, embryonic heat production, and physiological hormone levels.

    PubMed

    De Smit, L; Tona, K; Bruggeman, V; Onagbesan, O; Hassanzadeh, M; Arckens, L; Decuypere, E

    2005-09-01

    Ascites is a metabolic disorder that accounts for over 25% of overall mortality in the broiler industry. This disorder is manifested between wk 5 and 6 posthatch, but there are previous indications that predisposition may be identified during embryonic development. In this current study, we determined embryonic physiological and metabolic parameters that may be associated with ascites predisposition. For this purpose, we used broiler eggs from 3 lines that differed in ascites sensitivity. These included an ascites-sensitive dam line (DAS), an ascites-resistant dam line (DAR), and an ascites-sensitive sire line (SASL). Eggs were incubated for 21 d under standard conditions. The following parameters were measured during incubation: egg weights at setting, egg weight losses at 18 d, embryo body weights and embryo heart weights throughout development, air cell partial gas pressures (pCO2 and pO2) levels at d 18 and at internal pipping (IP); plasma triiodothyronine, thyroxine, and corticosterone levels at d 18, IP, and hatch; heat production from d 17 until hatch, hematocrit values at hatch, and posthatch growth rate to 7 d along with hematocrit values. The data obtained revealed that selection for ascites sensitivity or rapid growth rate had no consistent influence on some of these parameters such that they could be wholly associated with ascites sensitivity for predictive purposes. Whereas differences in embryonic developmental patterns were apparent throughout embryonic development, these differences in physiological and metabolic parameters may be due partly to genetic differences unrelated to ascites sensitivity.

  17. Intestinal Complications of IBD

    MedlinePlus

    ... that only affects the colon). LOCAL COMPLICATIONS OF CROHN’S DISEASE INTESTINAL OBSTRUCTION The most common complication of Crohn’s disease, obstruction may arise from swelling and the formation ...

  18. Complications of Sinusitis

    MedlinePlus

    ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ...

  19. Skin Complications of IBD

    MedlinePlus

    ... Home > Resources > Skin Complications of IBD Go Back Skin Complications of IBD Email Print + Share After arthritis, ... about 5% of people with inflammatory bowel disease. SKIN DISORDERS COMMONLY SEEN IN IBD ERHTHEMA NODOSUM The ...

  20. Eye Complications in IBD

    MedlinePlus

    ... Home > Resources > Eye Complications in IBD Go Back Eye Complications in IBD Email Print + Share Approximately 10% ... doctor’s attention sooner rather than later. TYPES OF EYE DISORDERS UVEITIS One of the most common eye ...

  1. Extraintestinal Complications: Kidney Disorders

    MedlinePlus

    ... Extraintestinal Complications: Kidney Disorders Go Back Extraintestinal Complications: Kidney Disorders Email Print + Share The kidneys filter the ... but some less serious ones occur more frequently. Kidney stones These are probably the most commonly encountered ...

  2. Pregnancy Complications: Anemia

    MedlinePlus

    ... Close X Home > Complications & Loss > Pregnancy complications > Anemia Anemia E-mail to a friend Please fill in ... anemia at a prenatal care visit . What causes anemia? Usually, a woman becomes anemic (has anemia) because ...

  3. Pregnancy Complications: Liver Disorders

    MedlinePlus

    ... X Home > Complications & Loss > Pregnancy complications > Liver disorders Liver disorders Now playing: E-mail to a friend ... have blood on them (razors, toothbrushes). Acute fatty liver of pregnancy What is acute fatty liver of ...

  4. To Study the Incidence, Predictive Factors and Clinical Outcome of Spontaneous Bacterial Peritonitis in Patients of Cirrhosis with Ascites

    PubMed Central

    Kaur, Jasmine; Kazal, Harbans Lal

    2015-01-01

    Objective To study the prevalence and predictive factors of spontaneous bacterial peritonitis (SBP) in patients of cirrhosis with ascites and to study the clinical characteristics and prognosis of patients with SBP. Materials and Methods The present study was conducted on 122 cases admitted in Department of Medicine, through emergency, in Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. Cases of cirrhosis (irrespective of aetiology) with ascites between the ages of 18-75 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures, before initiation of antibiotic therapy and was sent for biochemical analysis, culture and cytological analysis. Results Mean age of patients enrolled was 50.30± 10.98 years. 85% were male and 15% were female. Alcohol (73.8%) was the leading cause of cirrhosis followed by HCV (37.7%) and HBV (4.9%). Of the 122 patients studied, 27 (20.4%) patients were diagnosed as having SBP and its variants. Monomicrobial Bacterascites (BA) was present in 5 patients and Culture Negative Neutrocytic Ascites (CNNA) was present in 22 patients. Escherichia coli were the most common isolated organism followed by Klebsiella. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score and high MELD score. Conclusion Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Bedside inoculation of 10-20ml of ascitic fluid into culture bottle at patient bedside will yield better results. Early diagnosis and treatment will reduce the mortality rate in these patients. PMID:26393155

  5. Refractory Behaviors of Magnetite-Kaolin Bricks

    NASA Astrophysics Data System (ADS)

    Adeosun, S. O.; Akpan, E. I.; Gbenebor, O. P.; Taiwo, O. O.; Eke, I. J.

    2016-11-01

    In this work, the suitability of using kaolin-magnetite-plastic clay to produce refractory bricks has been experimentally explored. Thirty bricks of different compositions were produced and fired at 1200°C. The density, shrinkage moisture content, loss on ignition, porosity and permeability of the bricks were examined. Results show that the bricks remained stable during firing and thus possess good insulating characteristics. The highest (2.23 g/cm3) and lowest (2.00 g/cm3) bulk densities obtained in this study are higher than the highest bulk density reported for Al dross-filled refractories (1.23 g/cm3). The bricks also possessed very low effective moisture content (10-23%) and very high compression modulus (16-100 MPa) desirable in insulating refractory bricks with high resistance to abrasion.

  6. [Platelet allo-antibodies identification strategies for preventing and managing platelet refractoriness].

    PubMed

    Basire, A; Picard, C

    2014-11-01

    Platelet refractoriness is a serious complication for patients receiving recurrent platelet transfusions, which can be explained by non-immune and immune causes. Human Leukocyte Antigens (HLA) allo-immunization, especially against HLA class I, is the major cause for immune platelet refractoriness. To a lesser extent, allo-antibodies against specific Human Platelet Antigen (HPA) are also involved. Pregnancy, transplantation and previous transfusions can lead to allo-immune reaction against platelet antigens. After transfusion, platelet count is decreased by accelerated platelet destruction related to antibodies fixation on incompatible platelet antigens. New laboratory tests for allo-antibodies identification were developed to improve sensibility and specificity, especially with the LUMINEX(®) technology. The good use and interpretation of these antibodies assays can improve strategies for platelet refractoriness prevention and management with a patient adapted response. Compatible platelets units can be selected according to their identity with recipient typing or immune compatibility regarding HLA or HPA antibodies or HLA epitope compatibility. Prospective studies are needed to further confirm the clinical benefit of new allo-antibodies identification methods and consensus strategies for immune platelet refractoriness management.

  7. Lenalidomide in Treating Young Patients With Relapsed or Refractory Solid Tumors or Myelodysplastic Syndromes

    ClinicalTrials.gov

    2014-06-10

    Childhood Myelodysplastic Syndromes; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Refractory Anemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Ringed Sideroblasts; Refractory Cytopenia With Multilineage Dysplasia; Secondary Myelodysplastic Syndromes; Unspecified Childhood Solid Tumor, Protocol Specific

  8. EXTRASOLAR REFRACTORY-DOMINATED PLANETESIMALS: AN ASSESSMENT

    SciTech Connect

    Jura, M.; Xu, S. E-mail: sxu@astro.ucla.edu

    2013-02-01

    Previously published observations of 60 externally polluted white dwarfs show that none of the stars have accreted from intact refractory-dominated parent bodies composed mainly of Al, Ca, and O, although planetesimals with such a distinctive composition have been predicted to form. We propose that such remarkable objects are not detected by themselves because, unless they are scattered outward from their initial orbit, they are engulfed and destroyed during the star's asymptotic giant branch evolution. As yet, there is at most only weak evidence supporting a scenario where the composition of any extrasolar minor planet can be explained by blending of an outwardly scattered refractory-dominated planetesimal with an ambient asteroid.

  9. PROCESS OF PRODUCING REFRACTORY URANIUM OXIDE ARTICLES

    DOEpatents

    Hamilton, N.E.

    1957-12-01

    A method is presented for fabricating uranium oxide into a shaped refractory article by introducing a uranium halide fluxing reagent into the uranium oxide, and then mixing and compressing the materials into a shaped composite mass. The shaped mass of uranium oxide and uranium halide is then fired at an elevated temperature so as to form a refractory sintered article. It was found in the present invention that the introduction of a uraninm halide fluxing agent afforded a fluxing action with the uranium oxide particles and that excellent cohesion between these oxide particles was obtained. Approximately 90% of uranium dioxide and 10% of uranium tetrafluoride represent a preferred composition.

  10. Refractory Oxide Coatings on Sic Ceramics

    NASA Technical Reports Server (NTRS)

    Lee, Kang N.; Jacobson, Nathan S.; Miller, Robert A.

    1994-01-01

    Silicon carbide with a refractory oxide coating is potentially a very attractive ceramic system. It offers the desirable mechanical and physical properties of SiC and the environmental durability of a refractory oxide. The development of a thermal shock resistant plasma-sprayed mullite coating on SiC is discussed. The durability of the mullite/SiC in oxidizing, reducing, and molten salt environments is discussed. In general, this system exhibits better behavior than uncoated SiC. Areas for further developments are discussed.

  11. Persistent and refractory thrush with unknown cause.

    PubMed

    Wang, Lili; Liu, Dongjuan; Zhao, Xin; Wu, Lanyan; Zhou, Yu; Chen, Qianming; Zeng, Xin; Jin, Xin

    2015-03-01

    Oral thrush is considered as the opportunistic infection, which is caused by fungus Candida albicans. Various kinds of immunodeficiency diseases, such as HIV infection, immunosuppressive therapy, use of broad-spectrum antibiotics, and invasive surgical procedures such as solid organ or bone marrow transplantation, lead to increased susceptibility to fungal infections, but persistent and refractory thrush, with typical clinical signs of oral fungal infection and without any other sign of immunodeficiencies, has not been reported so far. We describe a case of persistent and refractory thrush with Klinefelter syndrome (47, XXY) as the unusual cause.

  12. Refractory High-Entropy Alloys (Postprint)

    DTIC Science & Technology

    2010-06-23

    AFRL-RX-WP-JA-2015-0119 REFRACTORY HIGH-ENTROPY ALLOYS (POSTPRINT) D.B. Miracle AFRL/RXCM O.N. Senkov UES, Inc. G.B. Wilks...AUTHOR(S) D.B. Miracle - AFRL/RXCM O.N. Senkov - UES, Inc. G.B. Wilks - General Dynamics, Corp. C.P. Chuang and P.K. Liaw - The University...intermetRefractory high-entropy alloys O.N. Senkov a,b,*, G.B. Wilks a,c, D.B. Miracle a, C.P. Chuang d, P.K. Liawd aAir Force Research Laboratory

  13. HIGH TEMPERATURE REFRACTORY COATING FOR GRAPHITE MOLDS

    DOEpatents

    Stoddard, S.D.

    1958-10-21

    An improved foundry mold coating for use with graphite molds used in the casting of uranium is presented. The refractory mold coating serves to keep the molten uranium from contact with graphite of the mold and thus prevents carbon pickup by the molten metal. The refractory coating is made by dry mixing certain specific amounts of aluminum oxide, bentonite, Tennessee ball clay, and a soluble silicate salt. Water is then added to the mixture and the suspension thus formed is applied by spraying onto the mold.

  14. Spontaneous Bacterial Peritonitis and Anasarca in a Female Patient with Ovarian Hyperstimulation Syndrome Complicated by Respiratory and Kidney Failure

    PubMed Central

    Khalil, Muhammad Abdul Mabood; Ghazni, Muhammad Salman; Tan, Jackson; Naseer, Nazish; Khalil, Muhammad Ashhad Ullah

    2016-01-01

    Ovarian hyperstimulation syndrome (OHSS) was first described in 1960. It may occur as a complication of gonadotropin hormone therapy during assisted pregnancy or for primary infertility. A 26-year-old female patient with polycystic ovarian syndrome and primary infertility was treated to conceive. She received intravenous gonadotropin-releasing hormone (GnRH) along with follicle-stimulating hormone in an outside private clinic. She presented to the emergency department with abdominal and chest pain, loose stool, vomiting, shortness of breath and decreasing urine output. She was found to have edema, ascites, effusion and acute kidney injury (AKI). Considering the symptoms preceding the drug history and anasarca, a diagnosis of severe OHSS was made. Ascites was further complicated by spontaneous bacterial peritonitis (SBP), which had already been reported before. We speculate that low immunity due to decreased immunoglobulin in patients with OHSS makes them prone to SBP. In our case, septicemia secondary to SBP and fluid loss due to capillary leakage from OHSS resulted in AKI and respiratory failure. This critically ill patient was treated in a special care unit, and she fully recovered with supportive measures. Severe OHSS may present as anasarca including ascites which can develop SBP leading to sepsis and multiorgan failure. PMID:27721728

  15. Refractory Materials for Flame Deflector Protection System Corrosion Control: Refractory Ceramics Literature Survey

    NASA Technical Reports Server (NTRS)

    Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Curran, Jerome P.; Kolody, Mark; Perusich, Stephen; Whitten, Mary C.; Trejo, David; Zidek, Jason; Sampson, Jeffrey W.; Coffman, Brekke E.

    2009-01-01

    Ceramics can be defmed as a material consisting of hard brittle properties produced from inorganic and nonmetallic minerals made by firing at high temperatures. These materials are compounds between metallic and nonmetallic elements and are either totally ionic, or predominately ionic but having some covalent character. This definition allows for a large range of materials, not all applicable to refractory applications. As this report is focused on potential ceramic materials for high temperature, aggressive exposure applications, the ceramics reviewed as part of this report will focus on refractory ceramics specifically designed and used for these applications. Ceramic materials consist of a wide variety of products. Callister (2000) 1 characterized ceramic materials into six classifications: glasses, clay products, refractories, cements, abrasives, and advanced ceramics. Figure 1 shows this classification system. This review will focus mainly on refractory ceramics and cements as in general, the other classifications are neither applicable nor economical for use in large structures such as the flame trench. Although much work has been done in advanced ceramics over the past decade or so, these materials are likely cost prohibitive and would have to be fabricated off-site, transported to the NASA facilities, and installed, which make these even less feasible. Although the authors reviewed the literature on advanced ceramic refractories 2 center dot 3 center dot 4 center dot 5 center dot 6 center dot 7 center dot 8 center dot 9 center dot 10 center dot 11 center dot 12 after the review it was concluded that these materials should not be ' the focus of this report. A review is in progress on materials and systems for prefabricated refractory ceramic panels, but this review is focusing more on typical refractory materials for prefabricated systems, which could make the system more economically feasible. Refractory ceramics are used for a wide variety of applications

  16. Complications of Strabismus Surgery

    PubMed Central

    Olitsky, Scott E.; Coats, David K.

    2015-01-01

    All surgeries carry risks of complications, and there is no way to avoid ever having a complication. Strabismus surgery is no different in this regard. There are methods to reduce the risk of a complication during or after surgery, and these steps should always be taken. When a complication occurs, it is important to first recognize it and then manage it appropriately to allow for the best outcome possible. This article will discuss some of the more common and/or most devastating complications that can occur during or after strabismus surgery as well as thoughts on how to avoid them and manage them should they happen. PMID:26180463

  17. Complications of mandibular fractures.

    PubMed

    Zweig, Barry E

    2009-03-01

    Before any definitive treatment of mandibular fractures, the patient needs to be evaluated for more potentially life-threatening injuries. Complications can and do occur with treatment of mandibular fractures and can occur during any of the phases of treatment. The development of an accurate diagnosis and appropriate treatment plan is vital in achieving optimal success and decreasing complications. Knowledge of the anatomy and the principles of bone healing is also an important factor in preventing complications. To limit long-term untoward effects, complications should be recognized early and the appropriate treatment should be started before a minor complication becomes a complex one that is more difficult to manage.

  18. Refractory thermowell for continuous high temperature measurement of molten metal

    DOEpatents

    Thiesen, Todd J.

    1992-01-01

    An apparatus for the continuous high temperature measurement of materials in vessels lined with rammed or cast refractory materials. A refractory housing member is integral with the refractory lining of the vessel and contains a plurality of high temperature sensing means, such as thermocouples. A face of the housing is flush with the refractory lining and contacts the high temperature material contained in the vessel. Continuous temperature measurement is achieved by a means which is coupled to the thermocouples for indicating the temperature.

  19. Modification of surface properties of copper-refractory metal alloys

    DOEpatents

    Verhoeven, John D.; Gibson, Edwin D.

    1993-10-12

    The surface properties of copper-refractory metal (CU-RF) alloy bodies are modified by heat treatments which cause the refractory metal to form a coating on the exterior surfaces of the alloy body. The alloys have a copper matrix with particles or dendrites of the refractory metal dispersed therein, which may be niobium, vanadium, tantalum, chromium, molybdenum, or tungsten. The surface properties of the bodies are changed from those of copper to that of the refractory metal.

  20. Complications of prostate biopsy.

    PubMed

    Anastasiadis, Anastasios; Zapała, Lukasz; Cordeiro, Ernesto; Antoniewicz, Artur; Dimitriadis, Georgios; De Reijke, Theo

    2013-07-01

    Biopsy of the prostate is a common procedure with minor complications that are usually self-limited. However, if one considers that millions of men undergo biopsy worldwide, one realizes that although complication rate is low, the number of patients suffering from biopsy complications should not be underestimated and can be a clinically relevant problem for healthcare professionals. In this review, the authors present diagnosis and management of postbiopsy of prostate complications. Bleeding is the most common complication observed after prostate biopsy, but the use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication to prostate biopsy. Emerging resistance to ciprofloxacin is the most probable cause of the increasing risk of infectious complications after prostate biopsy. Even though extremely rare, fatal complications are possible and were described in case reports.

  1. Binding and cytotoxicity of Ricinus communis lectins to HeLa cells, Sarcoma 180 ascites tumor cells and erythrocytes.

    PubMed

    Oda, T; Aizono, Y; Funatsu, G

    1984-08-01

    The binding of Ricinus communis lectins to HeLa cells, Sarcoma 180 ascites tumor cells and human erythrocytes was studied in detail. Scatchard plots of binding of 125I-lectins to these cells gave biphasic lines except for HeLa cells at 0 degree C. The association constants of lectins for the three cell types at 37 degrees C were lower than those at 0 degree C. The numbers of total binding sites were estimated to be 7 to 16 X 10(7) per HeLa cell, 3 to 4 X 10(7) per Sarcoma 180 ascites tumor cell and 0.4 to 1 X 10(6) per erythrocyte. A fraction, 16 to 27% of the total amount of cell-bound lectin at 37 degrees C, appeared to be bound irreversibly as judged by non-removal on washing with 0.1 M lactose, whereas no lectin was irreversibly bound at 0 degree C. In the case of erythrocytes, no lectin became irreversibly bound even at 37 degrees C. The toxicity of lectins on HeLa cells and Sarcoma 180 ascites tumor cells was investigated. The toxicity of ricin D was 50 times for Sarcoma 180 ascites tumor cells and 140 times for HeLa cells as much as that for castor bean hemagglutinin. As to the sensitivities of both cell types to these lectins, it became apparent that Sarcoma 180 ascites tumor cells were more susceptible than HeLa cells.

  2. Ovarian cancer ascites enhance the migration of patient-derived peritoneal mesothelial cells via cMet pathway through HGF-dependent and -independent mechanisms.

    PubMed

    Matte, Isabelle; Lane, Denis; Laplante, Claude; Garde-Granger, Perrine; Rancourt, Claudine; Piché, Alain

    2015-07-15

    Ovarian cancer ascites consist of a proinflammatory environment that is characterized by the presence of abundant human peritoneal mesothelial cells (HPMCs). Cytokines and growth factors in ascites modulate cell activities of tumor cells. The expression of proinflammatory cytokines in ascites is associated with a more aggressive tumor phenotype. The effect of ascites on HPMCs is for the most part unknown but this interplay is thought to be important for epithelial ovarian cancer (EOC) progression. Here, we examine the components of ascites, which stimulate patient-derived HPMC migration, from women with advanced EOC. We show that ovarian cancer ascites enhanced the migration of HPMCs. This effect was inhibited by heat treatment, hepatocyte growth factor (HGF) blocking antibodies and a HGF receptor (cMet) inhibitor. In ovarian cancer ascites, HGF is present at high concentration compared to benign fluids. Ascites-mediated activation of cMet was associated with Akt and EKR1/2 phosphorylation. This response was partly inhibited by heat treatment and cMet inhibitor. Ascites-induced migration and a cMet phosphorylation were strongly inhibited by epidermal growth factor receptor (EGFR) inhibitor PD153035, suggesting the transactivation of cMet by EGFR. Our study suggests that HGF and ligands of EGFR are factors that mediate ovarian cancer ascites-mediated migration of HPMCs by activating cMet and possibly downstream ERK1/2 and Akt pathways. The study provides evidence for the first time that ascites not only support tumor growth but also enhance the migratory potential of cancer-associated mesothelial cells, which in turn may support cancer progression.

  3. Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy

    PubMed Central

    Ellis, R; Jenkins, A; Thompson, R; Ede, R

    2000-01-01

    BACKGROUND—Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.
AIMS—To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.
METHODS—Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.
RESULTS—Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.
CONCLUSION—Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.


Keywords: lithotripsy; bile duct calculi; extracorporeal lithotripsy PMID:11034593

  4. Self-Organizing Maps with Refractory Periods

    SciTech Connect

    Neme, Antonio; Mireles, Victor

    2008-11-06

    Self-organizing map (SOM) has been studied as a model of map formation in the brain cortex. However, the original model present several oversimplifications. For example, neurons in the cortex present a refractory period in which they are not able to be activated, restriction that should be included in the SOM if a better model is to be achieved. Although several modifications have been studied in order to include this biological restriction to the SOM, they do not reflect biological plausibility. Here, we present a modification in the SOM that allows neurons to enter a refractory period (SOM-RP) if they are the best matching unit (BMU) or if they belong to its neighborhood. This refractory period is the same for all affected neurons, which contrasts with previous models. By including this biological restriction, SOM dynamics resembles in more detail the behavior shown by the cortex, such as non-radial activity patterns and long distance influence, besides the refractory period. As a side effect, two error measures are lower in maps formed by SOM-RP than in those formed by SOM.

  5. Congenital monoblastic leukemia presenting as jaundice, pleural effusion, and ascites: case report and literature review.

    PubMed

    Wu, Xiling; Du, Lizhong; Wang, Xiumin

    2011-01-01

    Congenital leukemias are a rare group of hematologic neoplasms with a wide range of clinical signs and symptoms. Here we reported a neonate presenting with jaundice, pleural effusion and ascites. The total protein and serum albumin were markedly low at 48 and 12 g/L. Computerized tomography showed the density of liver was asymmetry with several hypoechoic regions. Initial blood routine examination revealed only thrombocytopenia while blood white cells increased to 30.0×10(9)/L with 17% blast cells several days later. Bone marrow biopsy showed the proportion of blasts and promonocytes increased and she was diagnosed as acute monoblastic leukemia.

  6. Maternal hyperthyroidism is associated with a decreased incidence of cold-induced ascites in broiler chickens.

    PubMed

    Akhlaghi, A; Zamiri, M J; Zare Shahneh, A; Jafari Ahangari, Y; Nejati Javaremi, A; Rahimi Mianji, G; Mollasalehi, M R; Shojaie, H; Akhlaghi, A A; Deldar, H; Atashi, H; Ansari Pirsaraei, Z; Zhandi, M

    2012-05-01

    A hypothesis was tested that providing the breeder hens with exogenous thyroxine (T(4)) would help their offspring to better survive the ascites-inducing condition during the growing period. In total, 132 broiler breeder hens were randomly assigned to one of 3 treatments: control (CON), hypothyroid [HYPO; 6-N-propyl-2-thiouracil (PTU)-treated], and hyperthyroid (HYPER; T(4)-treated). The hens were artificially inseminated, and the hatching eggs (n = 1,320) were incubated. No eggs in the HYPO group hatched. The 1-d-old male chicks (n = 288) from other groups were reared for 42 d under standard or low ambient temperature to induce ascites. Blood samples were drawn from the hens, embryos, and broilers for determination of T(4) and triiodothyronine (T(3)). The hematocrit was also determined in broilers. The PTU-treated hens had an increased BW along with lower plasma T(3) and T(4) concentrations. Plasma T(4) was higher in the HYPER hens compared with CON hens, but T(3) concentration was not different between these groups. The fertility rate was not affected by either hypo- or hyperthyroidism. The embryos in the HYPO group had lower plasma T(3) and T(4) concentrations at d 18 of embryonic development and internal pipping. Higher plasma T(4) was recorded in the HYPER birds at internal pipping, although plasma T(3) concentration was not affected at this stage. Maternal hyperthyroidism decreased the overall incidence of ascites in the cold-exposed chickens (10.0 vs. 33.4% for HYPER and CON groups, respectively). Although the effect of maternal PTU or T(4) treatment on plasma thyroid hormones and on the right ventricle-to-total ventricular weight ratio in the broilers was not significant, the cold-exposed healthy CON chicks showed higher hematocrit values, compared with the HYPER birds. It was concluded that maternal hyperthyroidism could decrease the incidence of cold-induced ascites in broiler chickens; however, probable causal mechanisms remain to be elucidated.

  7. Acute and chronic eggshell temperature manipulations during hatching term influence hatchability, broiler performance, and ascites incidence.

    PubMed

    Sozcu, A; Ipek, A

    2015-02-01

    The aim of the current study was to determine how a control temperature and acute and chronic high eggshell temperatures during the last three days of incubation, can affect hatchability, chick quality, and organ development on day of hatch as well as broiler performance and ascites incidence in later life. The eggshell temperature manipulations were applied during hatching term (days 19 to 21) as follows: control EST (37.3 to 38.0°C), acute high eggshell temperature manipulations (38.4- to 39.0°C for three hours daily) and chronic high eggshell temperature manipulations (38.4 to 39.0°C). The lowest hatchability and the highest cull chick rate were in the chronic high eggshell temperature manipulations group. Lower chick quality parameters correlated with lower chick weights and heavier residual yolk sac weights that were in the chronic high eggshell temperature manipulations group depending on hatch time. The live weights on the 1(st) day of the growing period were higher in the control and acute high eggshell temperature manipulations groups than the chronic high eggshell temperature manipulations group. At 6 wk of age, live weights of broilers were the highest in the control than in the acute and chronic high eggshell temperature manipulations groups. The total mortality was 2.5, 9.2, and 13.3%, the mortality due to ascites was 2.1, 8.3, and 12.9% in the control, acute ,and chronic high eggshell temperature manipulations groups, respectively. The right ventricular/total ventricular ratios for the control, acute and chronic high eggshell temperature manipulations groups were 0.22, 0.28, and 0.30%, respectively. In conclusion, short-term and long-term higher temperatures during the hatching term affect embryo development, incubation results, broiler performance, and ascites incidence. Although the acute high eggshell temperature manipulations did not affect the chick quality parameters at hatch, it negatively affected incubation results and broiler performance

  8. Antitumour activity of Prosopis cineraria (L.) Druce against Ehrlich ascites carcinoma-induced mice.

    PubMed

    Robertson, Stellaa; Narayanan, N; Raj Kapoor, B

    2011-04-01

    The antitumour activity of the hydroalcoholic extract of the leaf (PCL) and stem bark (PCB) of Prosopis cineraria (L.) in Swiss albino mice was evaluated against an Ehrlich ascites carcinoma (EAC) tumour model. The activity was assessed using survival time, peritoneal cells, haematological studies, lipid peroxidation, antioxidant enzymes such as superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase, solid tumour mass and in vitro cytotoxicity. PCL and PCB were found to be potent and possessed significant cytotoxicity towards EAC tumour cells.

  9. Transjugular Insertion of Biliary Stents (TIBS) in Two Patients with Malignant Obstruction, Ascites, and Coagulopathy

    SciTech Connect

    Amygdalos, Michael A.; Haskal, Ziv J.; Cope, Constantin; Kadish, Steven L.; Long, William B.

    1996-03-15

    Two patients with pancreatic malignancies presented with biliary obstruction which could not be treated from an endoscopic approach. Standard transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver disease. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previously placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valuable alternative approach for primary stent placement or revision in patients with contraindication to standard transhepatic drainage.

  10. Leiomyosarcoma of Inferior Vena Cava and Right Atrium with Ascites and Jaundice: A Case Report

    PubMed Central

    Hasheminasab Zavareh, Roshanak; Riahi Beni, Hassan; Iranpour, Aida; Alam Samimi, Mojgan; Sadeghipour, Alireza; Alavi Niakou, Seyedeh Nina

    2016-01-01

    Leiomyosarcoma is one of the soft tissue sarcomas that could originate from different parts of body and are mostly presented as retropritoneal mass. Leiomyosarcomas of vascular origin are particularly rare tumors occurring mainly in inferior vena cava (IVC). Here, we report the case of a 35-year-old male patient who presented with ascites and jaundice. Further evaluation revealed large hepatic and cardiac masses with extension to IVC. Since it was not possible to determine the point of origin of leiomyosarcoma, the patient received chemotherapy under diagnosis of metastatic leiomyosarcoma but unfortunately passed away. PMID:27928478

  11. Chylous ascites in a cheetah (Acinonyx jubatus) with venoocclusive liver disease.

    PubMed

    Terrell, Scott P; Fontenot, Deidre K; Miller, Michele A; Weber, Martha A

    2003-12-01

    An 11-yr-old female cheetah (Acinonyx jubatus) was diagnosed clinically with hepatic and renal disease and euthanatized after an extended illness. Postmortem examination revealed 8-10 L of milky white fluid in the abdominal cavity and markedly dilated lymphatic vessels within the intestinal mesentery. The abdominal fluid was a chylous effusion based on the cytologic predominance of lymphocytes and macrophages and comparison of cholesterol and triglyceride levels in the fluid and in serum. Gross and histopathologic lesions in the liver were consistent with a diagnosis of venoocclusive liver disease. Chylous ascites is uncommon with human chronic liver disease and is rarely identified in animals.

  12. High temperature barrier coatings for refractory metals

    NASA Technical Reports Server (NTRS)

    Malone, G. A.; Walech, T.

    1995-01-01

    Improvements in high temperature oxidation resistant metal coating technology will allow NASA and commercial entities to develop competitive civil space transport and communication systems. The success of investigations completed in this program will have a positive impact on broadening the technology base for high temperature materials. The work reported herein describes processes and procedures for successfully depositing coherent oxidation barrier coatings on refractory metals to prevent degradation under very severe operating environments. Application of the new technology developed is now being utilized in numerous Phase 3 applications through several prominent aerospace firms. Major achievements have included: (1) development of means to deposit thick platinum and rhodium coatings with lower stress and fewer microcracks than could be previously achieved; (2) development of processes to deposit thick adherent coatings of platinum group metals on refractory substrates that remain bonded through high temperature excursions and without need for intermediate coatings (bonding processes unique to specific refractory metals and alloys have been defined; (3) demonstration that useful alloys of refractory and platinum coatings can be made through thermal diffusion means; (4) demonstration that selected barrier coatings on refractory substrates can withstand severe oxidizing environments in the range of 1260 deg and 1760 deg C for long time periods essential to the life requirements of the hardware; and (5) successful application of the processes and procedures to prototype hardware. The results of these studies have been instrumental in improved thermal oxidation barrier coatings for the NASP propulsion system. Other Phase 3 applications currently being exploited include small uncooled thrusters for spacecraft and microsatellite maneuvering systems.

  13. Long-term efficacy of anti-CD20 antibodies in refractory lupus nephritis.

    PubMed

    Arce-Salinas, C Alejandro; Rodríguez-García, Felipe; Gómez-Vargas, J Iván

    2012-05-01

    Eight patients with refractory lupus nephritis received rituximab after failing standard sequential therapy and were followed for 104 weeks after the infusion. One patient died secondary to a complicated pregnancy but had stable renal function. Three patients received a re-infusion of rituximab approximately 12 months apart due to a renal flare; during the second year of follow-up, those patients progressed toward ESRD. The four remaining patients demonstrated improvements in SLEDAI score, CrCl, and proteinuria with maintenance of their standard immunosuppressive therapy and did not require a re-infusion of rituximab. Although rituximab as induction therapy for refractory lupus nephritis has been shown to have a good response, its efficacy in long-term assessments demonstrates disappointing results.

  14. Successful use of daily intravenous infusion of C1 esterase inhibitor concentrate in the treatment of a hereditary angioedema patient with ascites, hypovolemic shock, sepsis, renal and respiratory failure.

    PubMed

    Pham, Hoang; Santucci, Stephanie; Yang, William H

    2014-01-01

    Hereditary angioedema (HAE) is a rare autosomal dominant disease most commonly associated with defects in C1 esterase inhibitor (C1-INH). HAE manifests as recurrent episodes of edema in various body locations. Atypical symptoms, such as ascites, acute respiratory distress syndrome, and hypovolemic shock, have also been reported. Management of HAE conventionally involves the treatment of acute attacks, as well as short- and long-term prophylaxis. Since attacks can be triggered by several factors, including stress and physical trauma, prophylactic therapy is recommended for patients undergoing surgery. Human plasma-derived C1-INH (pdC1-INH) concentrate is indicated for the treatment of both acute HAE attacks and pre-procedure prevention of HAE episodes in patients undergoing medical, dental, or surgical procedures. We report the first case of a patient with HAE who experienced an abdominal attack precipitated by a retroperitoneal bleed while being converted from warfarin to heparin in preparation for surgery. Subsequently, the patient had a protracted course in hospital with other complications, which included hypovolemic shock, ascites, severe sepsis from nosocomial pneumonia, renal and respiratory failure. Despite intensive interventions, the patient remained in a critical state for months; however, after a trial of daily intravenous infusion of pdC1-INH concentrate (Berinert®, CSL Behring GmbH, Marburg, Germany), clinical status improved, particularly renal function. Therefore, pdC1-INH concentrate may be an effective treatment option to consider for critically-ill patients with HAE.

  15. Identification of bacterial pathogens in ascitic fluids from patients with suspected spontaneous bacterial peritonitis by use of broad-range PCR (16S PCR) coupled with high-resolution melt analysis.

    PubMed

    Hardick, Justin; Won, Helen; Jeng, Kevin; Hsieh, Yu-Hsiang; Gaydos, Charlotte A; Rothman, Richard E; Yang, Samuel

    2012-07-01

    Spontaneous bacterial peritonitis (SBP) can be a severe complication occurring in patients with cirrhosis and ascites, with associated mortality often as high as 40%. Traditional diagnostics for SBP rely on culture techniques for proper diagnosis, although recent reports suggest that the presence of bacterial DNA in peritoneal fluid in patients with cirrhosis and ascites is an indicator of SBP. A previously published broad-range PCR (16S PCR) coupled with high-resolution melt analysis (HRMA) was compared with standard culture techniques for diagnosis of SBP in 106 peritoneal fluid samples from patients with suspected SBP. The sensitivity and specificity for 16S PCR for detecting eubacterial DNA compared with those of standard culture techniques were 100% (17/17) and 91.5% (85/89), respectively. Overall, HRMA concordance with species identification was 70.6% (12/17), although the 5 samples that were discordant at the species level were SBP resulting from a polymicrobial infection, and species-level identification for polymicrobial infections is outside the capability of HRMA. Both the broad-range 16S PCR and HRMA analysis provide useful diagnostic adjunctive assays for clinicians in detecting and identifying pathogens responsible for SBP.

  16. Treatment of refractory retrobulbar granuloma with rituximab in a patient with ANCA-negative Wegener's granulomatosis: a case report.

    PubMed

    Ooka, Seido; Maeda, Akihiko; Ito, Hiroshi; Omata, Masami; Yamada, Hidehiro; Ozaki, Shoichi

    2009-01-01

    Retrobulbar granuloma is one of the serious complications in Wegener's granulomatosis and often shows resistance to conventional therapy during long-term treatment. The outcome of this complication includes visual loss, orbital and facial deformity, fistula formation, as well as infection. There has been increasing evidence that shows the efficacy of rituximab, a chimeric anti-B cell mAb, for the treatment of autoimmune diseases including Wegener's granulomatosis. We present a 22-year-old Japanese woman who was diagnosed with Wegener's granulomatosis complicated by refractory retrobulbar granuloma. She was admitted to our hospital with pain of the right eye and right proptosis during treatment with monthly IVCY for Wegener's granulomatosis. We diagnosed refractory retrobulbar granuloma by computed tomography (CT) scan and biopsy. She showed a refractory growth of retrobulbar granuloma in spite of negative ANCA. She was also complicated with pulmonary granulomatous lesions in bilateral apices. After approval by an institutional ethical committee and informed consent of this patient, rituximab 375 mg/m2 was intravenously administered weekly four times. Concomitant prednisolone 0.5 mg/kg was also administered for 2 weeks and gradually tapered. Treatment of rituximab resulted in prompt relief of symptoms in this case and the reduction of the granuloma. BVAS score also improved from 6 to 0 at 3 months and was kept in remission for 12 months. Circulating CD19-positive cells were kept less than 0.1% during the follow-up. There were no serious adverse events. This case suggests that rituximab is effective for refractory retrobulbar granuloma complicated in Wegener's granulomatosis even when ANCA titers are negative.

  17. Complications of Rhinitis.

    PubMed

    Keswani, Anjeni; Peters, Anju T

    2016-05-01

    Chronic rhinitis involves inflammation of the upper airways. An association with comorbid conditions, such as rhinosinusitis, asthma, and chronic obstructive pulmonary disease, has been commonly observed in epidemiologic studies. The underlying pathogenesis of these disorders may be similar. Complications of rhinitis include sleep disturbances, learning impairment, and decreased quality of life. It is vital to recognize the complications of rhinitis so that treatment strategies can address rhinitis as well as its comorbidities and complications in a coordinated manner.

  18. Comparison of three lines of broiler breeders differing in ascites susceptibility or growth rate. 1. Relationship between acoustic resonance data and embryonic or hatching parameters.

    PubMed

    Tona, K; Kemps, B; Bruggeman, V; Bamelis, F; De Smit, L; Onagbesan, O; De Baerdemaeker, J; Decuypere, E

    2005-09-01

    Ascites is a prevalent cardiovascular disease among modern broilers with negative impacts on production and animal welfare. The peak of mortality due to ascites occurs at the end of the growing period, but the etiology of this problem may start during embryonic development. A few recent reports have demonstrated that the signs of ascites susceptibility are manifested during the late stages of incubation. In the current study, we used a nondestructive method based on egg acoustic resonance parameters [resonant frequency (RF) and damping] to establish a relationship between embryo physiological events during early development in broiler eggs and susceptibility to ascites. The hatching eggs of 3 broiler lines differing in ascites susceptibility were used for this study: ascites-resistant dam line (DAR), ascites-sensitive dam line (DAS), and ascites-sensitive sire line (SASL). These lines were selected on the basis of fast growth, high breast meat yield, and ascites induction at low temperatures such that the order of ascites susceptibility in terms of mortality was SASL > DAS > DAR. Eggs were incubated under standard conditions in forced-draft incubators. We measured egg weights at setting, albumen pH, Haugh units (HU) at setting, and embryo weights at d 11 and 18, at internal pipping (IP), and at hatch. The durations of IP, external pipping (EP), and hatching were also determined. At 2 hourly periods during incubation, egg RF and damping were also measured. There were differences in egg weights between DAR and SASL vs. DAS, but albumen HU, albumen pH, and the ratio of yolk weight to egg weight were similar. There were differences in RF, damping, embryonic growth rates, and hatching events. Changes in resonant frequency and damping, which certainly suggest eggshell differences among lines, were not totally related to variations in physiological events during early and late embryonic development. A comparison between DAR and DAS, between DAS and SASL, or DAR and SASL

  19. The postanesthetic period. Complications.

    PubMed

    Malamed, S F

    1987-01-01

    Postanesthetic complications can occur even in the best of circumstances. Proper preparation of the staff, aggressive monitoring of the recovering patient, and early recognition and management of the complications are essential if the outcome is to be successful. In reviewing postanesthetic complications, two factors are present in the overwhelming majority of situations--hypoxia and hypercarbia--often the direct result of inadequate monitoring during the postanesthetic period. The anesthetic procedure is not over once the anesthetic agents are discontinued. The skillful anesthetist is aware of the possibilities of postoperative complications and prevents problems by employing enhanced monitoring techniques during the recovery phase.

  20. Postpancreatectomy Complications and Management.

    PubMed

    Malleo, Giuseppe; Vollmer, Charles M

    2016-12-01

    Although mortality rates after pancreatectomy have decreased, the incidence of postoperative morbidity remains high. The major procedure-related complications are pancreatic fistula, delayed gastric emptying, and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery defined leading complications in a standardized fashion, allowing unbiased comparison of operative results and management strategies. Risk factors for postoperative complications have been investigated and quantitative scoring systems established to estimate patient-specific risks. Management of postpancreatectomy complications has shifted from an operative to a conservative approach. Nevertheless, postoperative morbidities may have a profound impact on patient recovery and length of hospital stay and are associated with increased hospital costs.

  1. [Complications of body piercing].

    PubMed

    Friedrich, L; Madrid, C; Odman-Jaques, M; Yersin, B; Carnon, P N

    2014-03-19

    The trend of body piercing has grown in popularity in the past decade within the general population and especially among young adults. Complications of body piercing include local inflammation and infections, but severe complications are also possible and largely underestimated. People are usually not aware of the risks before making a piercing, and their medical history, medication and comorbidities are largely neglected by the people who realise the piercing. This article presents a review of the complications that a primary care physician may observe, for a patient who wishes to make a piercing, or presents complications due to the implementation of such a device.

  2. Neurologic Complications and Treatment.

    PubMed

    Welch, Kevin C

    2015-10-01

    Risk is inherent with all surgical procedures. Most endoscopic sinus surgery (ESS) is uncomplicated. Among the many complications inherent with ESS are the neurologic complications, which include cerebrospinal fluid rhinorrhea, traumatic soft tissue and vascular injuries, infection, and seizures. Despite intense review of a patient's preoperative scans, use of stereotactic image guidance, and an expert understanding of anatomy, neurologic complications occur. An understanding of these complications and how to manage them can help to reduce long-term patient injury as well as help prevent recurrence.

  3. Studies on responsiveness of hepatoma cells to catecholamines. IV. Lack of adrenergic activation of phosphorylase in rat ascites hepatoma cells.

    PubMed

    Miyamoto, K; Yanaoka, T; Sanae, F; Wakusawa, S; Koshiura, R

    1986-10-01

    Glycogen phosphorylase a activity in 7 rat ascites hepatoma cell lines treated with adrenergic agents, phenylephrine, epinephrine and isoproterenol, was investigated as compared with that in freshly isolated rat hepatocytes. Basal phosphorylase activities in hepatoma cells except AH7974 cells were lower than that in hepatocytes. Phosphorylase in hepatoma cells was not activated by any of the agents, while the enzyme activity in hepatocytes was clearly increased in a dose- and time-dependent manner. Phosphorylase in hepatocytes was sensitive to glucagon, but it was found to be insensitive to glucagon in all hepatoma cells. The present results suggest that rat ascites hepatoma cells may escape the glycogenolytic regulation by catecholamines and glucagon.

  4. A new boron compound (guanidine biboric acid adduct) as an antitumour agent against Ehrlich ascites carcinoma in mice.

    PubMed

    Ghosh, P; Sur, B; Bag, S P; Sur, P

    1999-01-01

    The inhibitory effects of a new boron compound of guanidine biboric acid adduct (GB) and guanidium chloride (L1) on the growth of ascites tumour in female Swiss mice were studied by monitoring the survival, tumour weight, tumour cell count, transplantability of Ehrlich ascites cells, precursor incorporation and the haematological parameters of the treated mice. 5-Fluorouracil, a known anticancer drug, was used as a positive control. The most important parameter was the survival time, which increased significantly when tumour-bearing mice were treated with the boron compound. Haematological parameters of the treated animals showed minimum toxic effects when boron was coupled with guanidine.

  5. Carfilzomib and pomalidomide in patients with relapsed and/or refractory multiple myeloma with baseline risk factors.

    PubMed

    Dimopoulos, M A; Sonneveld, P; Siegel, D; Palumbo, A; San-Miguel, J

    2015-11-01

    While survival times have increased over the last decade, most patients with multiple myeloma (MM) eventually relapse and become refractory to therapy. The treatment of patients with relapsed and/or refractory MM is frequently further complicated by the presence of pre-existing comorbidities that arise from an advanced disease state and of toxicities stemming from prior antimyeloma treatment. Carfilzomib and pomalidomide have recently been approved for the treatment of patients with relapsed and refractory MM. While these agents represent important additions to the available treatment options, the identification of patients who may best benefit from the use of each of therapy is still being investigated. A number of patient-related and disease-related factors may impact treatment efficacy and/or tolerability, and the clinical presentation and medical history of each patient must be carefully considered to optimize treatment. Here, we review results from carfilzomib and pomalidomide clinical trials in patients with relapsed and/or refractory MM who also have baseline comorbidities or treatment-induced or disease-induced complications (including the presence of renal impairment, cardiac risk factors, peripheral neuropathy, or high-risk chromosomal abnormalities) to evaluate the safety and efficacy of the two agents in these difficult-to-treat patients and to provide treatment recommendations specific to each scenario.

  6. Gastric and Duodenal Stents: Follow-Up and Complications

    SciTech Connect

    Pinto Pabon, Isabel Teresa; Paul Diaz, Laura; Ruiz de Adana, Juan Carlos; Lopez Herrero, Julio

    2001-05-15

    Purpose: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered.Methods: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy.Results: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE {+-} 4.6).Conclusions: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications.

  7. Preparation of human ovarian cancer ascites-derived exosomes for a clinical trial.

    PubMed

    Navabi, H; Croston, D; Hobot, J; Clayton, A; Zitvogel, L; Jasani, B; Bailey-Wood, R; Wilson, K; Tabi, Z; Mason, M D; Adams, M

    2005-01-01

    Despite initial response to chemotherapy, at least 50% of ovarian cancer patients will relapse within 18 months. Progression-free survival is related to tumour infiltration with cytotoxic T lymphocytes (CTL). We recently demonstrated that CD8+ T cell responses to recall antigens improve following tumour response to chemotherapy. Vaccination designed to expand CTL, specific for tumour-associated antigens, may be a means of improving outcome. We are planning a clinical trial in advanced ovarian cancer patients undergoing chemotherapy using a combination of a Toll-like receptor 3 (TLR3) agonist and tumour-associated ascites-derived exosomes. Tumour-derived exosomes are a potential source of tumour antigens able to induce CD8+ T cell responses when loaded on mature dendritic cells (DC). DC maturation can be achieved with Toll-like receptor (TLR) agonists, such as the GMP-grade synthetic double stranded RNA, poly[I]:poly[C12U] (Ampligen) which is a TLR-3 agonist. Here, we describe the development of a method suitable for the preparation of GMP-grade exosomes from the ascites fluid of ovarian cancer patients, and the methods used for the molecular and immunological characterisation of these exosomes preceding their use in a clinical trial.

  8. Calcium antagonist verapamil prevented pulmonary arterial hypertension in broilers with ascites by arresting pulmonary vascular remodeling.

    PubMed

    Yang, Ying; Qiao, Jian; Wang, Huiyu; Gao, Mingyu; Ou, Deyuan; Zhang, Jianjun; Sun, Maohong; Yang, Xin; Zhang, Xiaobo; Guo, Yuming

    2007-04-30

    Calcium signaling has been reported to be involved in the pathogenesis of hypertension. Verapamil, one of the calcium antagonists, is used to characterize the role of calcium signaling in the development of pulmonary arterial hypertension syndrome in broilers. The suppression effect of verapamil on pulmonary arterial hypertension and pulmonary vascular remodeling was examined in broilers, from the age of 16 days to 43 days. Our results showed that oral administration of lower dose of verapamil (5 mg/kg body weight every 12 h) prevented the mean pulmonary arterial pressure, the ascites heart index and the erythrocyte packed cell volume of birds at low temperature from increasing, the heart rate from decreasing, and pulmonary arteriole median from thickening, and no pulmonary arteriole remodeling in broilers treated with the two doses of verapamil at low temperature was observed. Our results indicated that calcium signaling was involved in the development of broilers' pulmonary arterial hypertension, which leads to the development of ascites, and we suggest that verapamil may be used as a preventive agent to reduce the occurrence and development of pulmonary arterial hypertension in broilers.

  9. The proton stoichiometry of electron transport in Ehrlich ascites tumor mitochondria.

    PubMed

    Villalobo, A; Lehninger, A L

    1979-06-10

    Initial rate measurements of the stoichiometric relationships between H+ ejection, K+ and Ca2+ uptake, and electron transport were carried out on mitochondria from Ehrlich ascites tumor cells grown in mice. With succinate as substrate and N-ethylmaleimide to prevent interfering H+ reuptake via the phosphate carrier, close to 8 H+ were ejected per oxygen atom reduced (H+/O ejection ratio = 8.0); with the NAD-linked substrates pyruvate or pyruvate + malate, the H+/O ejection ratio was close to 12. The average H+/site ratio (H+ ejected/2e-/energy-conserving site) was thus close to 4. The simultaneous uptake of charge-compensating cations, either K+ (in the presence of valinomycin) or Ca2+, was also measured, yielding average K+/site uptake ratios of very close to 4 and Ca2+/site ratios close to 2. It was also demonstrated that each calcium ion enters the respiring tumor mitochondria carrying two positive electric charges. These stoichiometric data observed in mitochondria from Ehrlich ascites tumor cells thus are in complete agreement with similar data on normal rat liver and rat heart mitochondria and suggest that the H+/site ratio of mitochondrial electron transport may be 4 generally. It was also observed that the rate of deltaH+ back-decay in anaerobic tumor mitochondria following oxygen pulses is some 6- to 8-fold greater than in rat liver mitochondria tested at equal amounts of mitochondrial protein.

  10. Inhibition of oxidative phosphorylation in ascites tumor mitochondria and cells by intramitochondrial Ca2+.

    PubMed

    Villalobo, A; Lehninger, A L

    1980-03-25

    Accumulation of Ca2+ (+ phosphate) by respiring mitochondria from Ehrlich ascites or AS30-D hepatoma tumor cells inhibits subsequent phosphorylating respiration in response to ADP. The respiratory chain is still functional since a proton-conducting uncoupler produces a normal stimulation of electron transport. The inhibition of phosphorylating respiration is caused by intramitochondrial Ca2+ (+ phosphate). ATP + Mg2+ together, but not singly, prevents the inhibitory action of Ca2+. Neither AMP, GTP, GDP, nor any other nucleoside 5'-triphosphate or 5'-diphosphate could replace ATP in this effect. Phosphorylating respiration on NAD(NADP)-linked substrates was much more susceptible to the inhibitory effect of intramitochondrial Ca2+ than succinate-linked respiration. Significant inhibition of oxidative phosphorylation is given by the endogenous Ca2+ present in freshly isolated tumor mitochondria. The phosphorylating respiration of permeabilized Ehrlich ascites tumor cells is also inhibited by Ca2+ accumulated by the mitochondria in situ. Possible causes of the Ca2+-induced inhibition of oxidative phosphorylation are considered.

  11. Unique proteome signature of post-chemotherapy ovarian cancer ascites-derived tumor cells

    PubMed Central

    Ahmed, Nuzhat; Greening, David; Samardzija, Chantel; Escalona, Ruth M.; Chen, Maoshan; Findlay, Jock K.; Kannourakis, George

    2016-01-01

    Eighty % of ovarian cancer patients diagnosed at an advanced-stage have complete remission after initial surgery and chemotherapy. However, most patients die within <5 years due to episodes of recurrences resulting from the growth of residual chemoresistant cells. In an effort to identify mechanisms associated with chemoresistance and recurrence, we compared the expression of proteins in ascites-derived tumor cells isolated from advanced-stage ovarian cancer patients obtained at diagnosis (chemonaive, CN) and after chemotherapy treatments (chemoresistant/at recurrence, CR) by using in-depth, high-resolution label-free quantitative proteomic profiling. A total of 2,999 proteins were identified. Using a stringent selection criterion to define only significantly differentially expressed proteins, we report identification of 353 proteins. There were significant differences in proteins encoding for immune surveillance, DNA repair mechanisms, cytoskeleton rearrangement, cell-cell adhesion, cell cycle pathways, cellular transport, and proteins involved with glycine/proline/arginine synthesis in tumor cells isolated from CR relative to CN patients. Pathway analyses revealed enrichment of metabolic pathways, DNA repair mechanisms and energy metabolism pathways in CR tumor cells. In conclusion, this is the first proteomics study to comprehensively analyze ascites-derived tumor cells from CN and CR ovarian cancer patients. PMID:27470985

  12. Methylation of tRNA by normal mouse liver and Erhlich ascites cell extracts

    SciTech Connect

    Smith, S.D.; Sitz, T.O.

    1986-05-01

    When Erhlich ascites tumor and normal mouse liver extracts were incubated with (/sup 3/H-CH/sub 3/)-S-adenosylmethionine and E. coli tRNA, the tumor extracts had a ten-fold higher methyltransferase activity than mouse liver extracts. However, only a two-fold higher methyltransferase activity was observed when methyl deficient mouse liver tRNA was used as a substrate. DEAE-Sephadex chromatography of alkaline hydrolysates of methyl deficient mouse liver tRNA (tRNA isolated from mice treated with ethionine) showed 70% of the /sup 3/H-methyl groups in the mononucleotide peak and 30% in alkaline stable di-, tri- and oligonucleotide peaks demonstrating methylation of both the base and ribose moieties. Perchloric acid digest of material isolated from the di-, tri- and oligonucleotide peaks confirm that the /sup 3/H-methyl groups are on the ribose moieties. In hydrolysates of E. coli tRNA /sup 3/H-methyl groups appeared in only the mononucleotide peak, i.e. only base methylation. These data, from Erhlich ascites cells, suggest that ribose methyltransferases may have greater RNA substrate specificity than the base methyltransferases and may act processively to produce alkaline stable oligonucleotides.

  13. Complications in percutaneous nephrolithotomy.

    PubMed

    Kyriazis, Iason; Panagopoulos, Vasilios; Kallidonis, Panagiotis; Özsoy, Mehmet; Vasilas, Marinos; Liatsikos, Evangelos

    2015-08-01

    Percutaneous nephrolithotomy (PCNL) is generally considered a safe technique offering the highest stone-free rates after the first treatment as compared to the other minimal invasive lithotripsy techniques. Still, serious complications although rare should be expected following this percutaneous procedure. In this work, the most common and important complications associated with PCNL are being reviewed focusing on the perioperative risk factors, current management, and preventing measures that need to be taken to reduce their incidence. In addition, complication reporting is being criticized given the absence of a universal consensus on PCNL complications description. Complications such as perioperative bleeding, urine leak from nephrocutaneous fistula, pelvicalyceal system injury, and pain are individually graded as complications by various authors and are responsible for a significant variation in the reported overall PCNL complication rate, rendering comparison of morbidity between studies almost impossible. Due to the latter, a universally accepted grading system specialized for the assessment of PCNL-related complications and standardized for each variation of PCNL technique is deemed necessary.

  14. A "Needling" Complication.

    PubMed

    Banerji, John S; Govier, Fred E

    2016-11-01

    Intracavernosal injection therapy with vasoactive agents for treatment of erectile dysfunction has been around for more than 3 decades since its advent in the early 1980s. Common complications include ecchymosis and hematoma at the site of injection, priapism, and fibrosis. We describe a rare but potentially dangerous complication of breakage of needle during administering of injections, and discuss its successful retrieval.

  15. COMPLICATIONS IN HIP ARTHROSCOPY

    PubMed Central

    Contreras, Marcos Emílio Kuschnaroff; Hoffmann, Rafael Barreiros; de Araújo, Lúcio Cappelli Toledo; Dani, William Sotau; José Berral, Francisco

    2015-01-01

    Objectives: To determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the sample through a learning curve; and to recognize the causes of complications in arthroscopic hip operations. Method: 150 consecutive cases that underwent hip arthroscopy between May 2004 and December 2008 were evaluated. The complications encountered were classified in three ways: organic system affected, severity and groups of 50 consecutive cases. The data were analyzed by means of descriptive statistics and Fisher's exact test. Results: We observed 15 complications in this study (10%): ten were neurological, two were osteoarticular, one was vascular-ischemic and two were cutaneous. In the classification of severity, three were classified as major, 12 as intermediate and none as minor. The incidence of complications over the course of the learning curve did not present any statistically significant difference (p = 0.16). Conclusions: Hip arthroscopy is a surgical procedure that involves low morbidity, but which presents complications in some cases. These complications are frequently neurological and transitory, and mainly occur because of joint traction. The complication rate did not decrease with progression of our sample. PMID:27022521

  16. Pregnancy Complications: Shoulder Dystocia

    MedlinePlus

    ... severe cases, which are rare, this can cause brain damage and even death. Complications for the mother include: Heavy bleeding after ... severe cases, which are rare, this can cause brain damage and even death. Complications for the mother include: Heavy bleeding after ...

  17. Refractory heparin induced thrombocytopenia with thrombosis (HITT) treated with therapeutic plasma exchange and rituximab as adjuvant therapy.

    PubMed

    Schell, Amy M; Petras, Melissa; Szczepiorkowski, Zbigniew M; Ornstein, Deborah L

    2013-10-01

    We report a case of refractory heparin-induced thrombocytopenia with thrombosis (HITT) with prolonged thrombocytopenia and multiple thrombotic complications that failed to improve despite aggressive treatment. A 60 year old female with a prior history of venous thromboembolism was admitted with an acute pulmonary embolism, and developed HITT after several days on heparin therapy. She suffered multiple complications including bilateral venous limb gangrene, acute renal failure, and refractory thrombocytopenia, leading us to use multimodality therapy including therapeutic plasma exchange (TPE) and rituximab immunosuppression. The patient had transient improvements in her thrombocytopenia with TPE, and rituximab was added in an attempt to reduce antibody production. She eventually required bilateral limb amputation, and only after removal of the gangrenous limbs did her platelet count show sustained improvement. We discuss the possible contribution of infection to her prolonged course.

  18. [Liposteroid therapy for refractory epileptic spasms].

    PubMed

    Shimono, Kuriko Kagitani; Imai, Katsumi; Idoguchi, Rie; Kamio, Noriko; Okinaga, Takeshi; Ozono, Keiichi

    2003-11-01

    Liposteroid was administered intravenously to 6 patients with refractory epileptic spasms. In one case, the spasms initially disappeared but then reappeared after three months. Another case had a transient and slight decrease of epileptic spasms. In the only patient in whom spasms disappeared, EEG abnormalities were greatly improved with diffuse spikes and waves changing into focal spikes. Two cases displayed hyperexcitability, insomnia and acting out behavior, and the therapy was discontinued in one of them. One case had appetite loss and another showed an increase in tonic seizures. No patient had serious adverse effects such as infection, edema, subdural hematoma and brain shrinkage. Although liposteroid therapy has been recommended as an easy, useful and safe alternative for ACTH, we found considerable adverse effects and only a small effect on refractory spasms, and conclude that the regimen should be modified.

  19. Catalytic, hollow, refractory spheres, conversions with them

    NASA Technical Reports Server (NTRS)

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

    1989-01-01

    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.

  20. Refractory gastroesophageal reflux disease: advances and treatment.

    PubMed

    Ates, Fehmi; Francis, David O; Vaezi, Michael F

    2014-08-01

    'Refractory gastroesophageal reflux disease' is one of the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive proton pump inhibitor therapy. The term should be replaced with 'refractory symptoms.' We must acknowledge that in many patients symptoms of reflux often overlap with non-GERD causes such as gastroparesis, dyspepsia, hypersensitive esophagus and functional disorders. Lack of response to aggressive acid suppressive therapy often leads to diagnostic testing. In majority of patients these tests are normal. The role of non-acid reflux in this group is uncertain and patients should not undergo surgical fundoplication based on this parameter. In patients unresponsive to acid suppressive therapy GERD is most commonly not causal and a search for non-GERD causes must ensue.

  1. An unusual case of refractory wheeze

    PubMed Central

    Ramesh, Venkat; Acharya, Vishak; Pai, Narasimha; Krishnan, Ananda

    2015-01-01

    A 37-year-old man presented with a history of episodic wheeze and breathlessness of 3 years’ duration refractory to treatment. Physical examination revealed diffuse expiratory polyphonic rhonchi while the remainder of the examination including the cardiac examination was reported as normal. Pulmonary function testing revealed mild obstruction with bronchodilator reversibility. The patient was discharged on a 6-month course of antitubercular treatment (ATT) as bronchial brush cytology (obtained via bronchoscopy) was positive for acid-fast bacilli. The patient presented after completing 6 months of ATT with persistent symptoms, a loud S1 and a mid-diastolic murmur at the apex. High-resolution CT of the chest showed bilateral dependent ground glass opacities. An echocardiogram revealed a left atrial myxoma, and normal RV size and pressures. The patient underwent successful surgical removal of the same, and made a complete recovery. Refractory wheeze is a very unusual presentation of a left atrial myxoma. PMID:25733086

  2. Method of nitriding refractory metal articles

    DOEpatents

    Tiegs, T.N.; Holcombe, C.E.; Dykes, N.L.; Omatete, O.O.; Young, A.C.

    1994-03-15

    A method of nitriding a refractory-nitride forming metal or metalloid articles and composite articles. A consolidated metal or metalloid article or composite is placed inside a microwave oven and nitrogen containing gas is introduced into the microwave oven. The metal or metalloid article or composite is heated to a temperature sufficient to react the metal or metalloid with the nitrogen by applying a microwave energy within the microwave oven. The metal or metalloid article or composite is maintained at that temperature for a period of time sufficient to convert the article of metal or metalloid or composite to an article or composite of refractory nitride. In addition, a method of applying a coating, such as a coating of an oxide, a carbide, or a carbo-nitride, to an article of metal or metalloid by microwave heating.

  3. Deep brain stimulation for refractory epilepsy

    PubMed Central

    Mandat, Tomasz; Kornakiewicz, Anna; Koziara, Henryk; Nauman, Paweł

    2012-01-01

    Deep brain stimulation (DBS) is a method of treatment utilized to control medically refractory epilepsy (RE). Patients with medically refractory epilepsy who do not achieve satisfactory control of seizures with pharmacological treatment or surgical resection of the epileptic focus and those who do not qualify for surgery could benefit from DBS. The most frequently used stereotactic targets for DBS are the anterior thalamic nucleus, subthalamic nucleus, central-medial thalamic nucleus, hippocampus, amygdala and cerebellum. The DBS is believed to be an effective method of treatment for various types of epilepsy among adults and adolescents. Side effects may be associated with implantation of electrodes and with the stimulation itself. An increasing number of publications and growing interest in DBS application for RE may result in standardization of the qualification and treatment protocol for RE with DBS. PMID:23185188

  4. Periclase-chromite refractories from fused materials

    SciTech Connect

    Slovikovskii, V.V.; Eroshkina, V.I.; Kononenko, G.V.; Nechistykh, G.A.; Simonov, K.V.

    1985-11-01

    Experiments were carried out to obtain high-grade fused chromitepericlase. It is shown that during the melting of batch consisting of raw magnesite and chromite ore the process of reducing the chromite ore to metallic ferrochromium is eliminated, which adversely affects both the content of Cr/sub 2/O/sub 3/ in the fused material, and also the commercial appearance of the resulting refractories. The authors developed a technology for preparing periclase-chromite refractories with chrommite-periclase constituents. The goods obtained possess good physicoceramic properties and a low content of silicites. The articles thus prepared were used to make the linings of the most critical parts of the converters which allowed an increase to be made in the duration of campaigns for the Kivset units of 1.5-2 times.

  5. Treatment of refractory hypertension with minoxidil.

    PubMed

    Larochelle, P; Beroniade, V; Hamet, P; Kuchel, O

    1980-01-01

    Twenty patients with hypertension refractory to conventional therapy were treated with minoxidil in combination with a diuretic and a beta-blocker. The mean supine initial blood pressure was 207/128 mm Hg, and the end-treatment pressure was 155/89 mm Hg. Five of the 7 patients with essential hypertension were adequately controlled, as were 8 of the 9 patients with renal failure and all 4 patients with renovascular hypertension. Thus, the overall controll rate was 85%. The duration of treatment ranged from 1 to 30 months, and the minoxidil dosage ranged from 5 to 60 mg/dry electrocardiographic changes characterized by T-wave inversion after starting minoxidil. These changes were reversible in 4 patients. Minoxidil was found to be an effective antihypertensive drug in these patients with refractory hypertension.

  6. Method of nitriding refractory metal articles

    DOEpatents

    Tiegs, Terry N.; Holcombe, Cressie E.; Dykes, Norman L.; Omatete, Ogbemi O.; Young, Albert C.

    1994-01-01

    A method of nitriding a refractory-nitride forming metal or metalloid articles and composite articles. A consolidated metal or metalloid article or composite is placed inside a microwave oven and nitrogen containing gas is introduced into the microwave oven. The metal or metalloid article or composite is heated to a temperature sufficient to react the metal or metalloid with the nitrogen by applying a microwave energy within the microwave oven. The metal or metalloid article or composite is maintained at that temperature for a period of time sufficient to convert the article of metal or metalloid or composite to an article or composite of refractory nitride. In addition, a method of applying a coating, such as a coating of an oxide, a carbide, or a carbo-nitride, to an article of metal or metalloid by microwave heating.

  7. METHOD OF MAKING A REFRACTORY MATERIAL

    DOEpatents

    Miller, H.I.

    1958-01-01

    This patent relates to a composition containing beryllia and the oxide of a fissile element such as uranium. The oxides are first ground and mixed, paraffin is added to the mixed powders, and the composition is then compacted and sintered to drive off the paraffin and produce a stuctually stable compact. The result is a coherent refractory arrangement of fissile nuclei dispersed among moderating nuclei. The composition, size, shape, etc., of the brick may be varied according to its intended use.

  8. Stochastic histories of refractory interstellar dust

    NASA Technical Reports Server (NTRS)

    Liffman, Kurt; Clayton, Donald D.

    1988-01-01

    Histories of refractory interstellar dust particles (IDPs) are calculated. The profile of a particle population is assembled from a large number of stochastic, or Monte Carlo, histories of single particles; the probabilities for each of the events that may befall a given particle are specified, and the particle's history is unfolded by a sequence of random numbers. The assumptions that are made and the techniques of the calculation are described together with the results obtained. Several technical demonstrations are presented.

  9. Extracorporeal life support for refractory ventricular tachycardia

    PubMed Central

    Joseph, Nicholas; Hofmann, James P.; Saranteas, Theodosios; Papadimos, Thomas J.

    2017-01-01

    Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT, cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical therapy. For patients with, out-of- hospital ventricular fibrillation (VF) and VT, Minnesota Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are cardiogenic shock related to acute myocardial infarction, myocarditis, post embolic acute cor pulmonale, drug intoxication and post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic antiarrhythmic drug therapy, facilitates the weaning of catecholamine administration, thereby ending the vicious cycle of catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional therapies are insufficient to support

  10. Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Jun, P.; Ko, N.U.; English, J.D.; Dowd, C.F.; Halbach, V.V.; Higashida, R.T.; Lawton, M.T.; Hetts, S.W.

    2014-01-01

    BACKGROUND AND PURPOSE CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases. MATERIALS AND METHODS We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008. RESULTS Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications. CONCLUSIONS Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy. PMID:20616179

  11. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis.

    PubMed

    Negroni, Ricardo; Tobón, Angela; Bustamante, Beatriz; Shikanai-Yasuda, Maria Aparecida; Patino, Hernando; Restrepo, Angela

    2005-01-01

    Eumycetoma and chromoblastomycosis are chronic, disfiguring fungal infections of the subcutaneous tissue that rarely resolve spontaneously. Most patients do not achieve sustained long-term benefits from available treatments; therefore, new therapeutic options are needed. We evaluated the efficacy of posaconazole, a new extended-spectrum triazole antifungal agent, in 12 patients with eumycetoma or chromoblastomycosis refractory to existing antifungal therapies. Posaconazole 800 mg/d was given in divided doses for a maximum of 34 months. Complete or partial clinical response was considered a success; stable disease or failure was considered a nonsuccess. All 12 patients had proven infections refractory to standard therapy. Clinical success was reported for five of six patients with eumycetoma and five of six patients with chromoblastomycosis. Two patients were reported to have stable disease. As part of a treatment-use extension protocol, two patients with eumycetoma who initially had successful outcome were successfully retreated with posaconazole after a treatment hiatus of > 10 months. Posaconazole was well tolerated during long-term administration (up to 1015 d). Posaconazole therapy resulted in successful outcome in most patients with eumycetoma or chromoblastomycosis refractory to standard therapies, suggesting that posaconazole may be an important treatment option for these diseases.

  12. Nanostructured refractory thin films for solar applications

    NASA Astrophysics Data System (ADS)

    Ollier, E.; Dunoyer, N.; Dellea, O.; Szambolics, H.

    2014-08-01

    Selective solar absorbers are key elements of all solar thermal systems. Solar thermal panels and Concentrated Solar Power (CSP) systems aim respectively at producing heat and electricity. In both cases, a surface receives the solar radiation and is designed to have the highest optical absorption (lowest optical reflectivity) of the solar radiation in the visible wavelength range where the solar intensity is the highest. It also has a low emissivity in the infrared (IR) range in order to avoid radiative thermal losses. Current solutions in the state of the art usually consist in deposited interferential thin films or in cermets [1]. Structured surfaces have been proposed and have been simulated because they are supposed to be more efficient when the solar radiation is not normal to the receiving surface and because they could potentially be fabricated with refractory materials able to sustain high operating temperatures. This work presents a new method to fabricate micro/nanostructured surfaces on molybdenum (refractory metal with a melting temperature of 2623°C). This method now allows obtaining a refractory selective surface with an excellent optical selectivity and a very high absorption in the visible range. This high absorption performance was obtained by achieving a double structuration at micro and nano scales thanks to an innovative process flow.

  13. How I treat refractory thrombotic thrombocytopenic purpura

    PubMed Central

    Sayani, Farzana A.

    2015-01-01

    Acquired thrombotic thrombocytopenic purpura (TTP) is characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA) without an obvious cause, and may include fever, mild renal failure, and neurologic deficits. It is characterized by a deficiency of the von Willebrand factor (VWF) cleaving enzyme, ADAMTS13 (a disintegrin and metalloproteinase, with a thrombospondin type 1 motif, member 13), resulting in formation of microthrombi in the high sheer environment of the microvasculature. This causes microvascular occlusion, MAHA, and organ ischemia. Diagnosis is based on the presence of clinical symptoms, laboratory aberrations consistent with MAHA, decreased ADAMTS13 activity, and possibly presence of anti-ADAMTS13 autoantibodies. Upfront treatment of acute TTP includes plasma exchange and corticosteroids. A significant number of patients are refractory to this treatment and will require further interventions. There are limited data and consensus on the management of the refractory TTP patient. Management involves simultaneously ruling out other causes of thrombocytopenia and MAHA, while also considering other treatments. In this article, we describe our management of the patient with refractory TTP, and discuss use of rituximab, increased plasma exchange, splenectomy, and immunosuppressive options, including cyclophosphamide, vincristine, and cyclosporine. We also review recent evidence for the potential roles of bortezomib and N-acetylcysteine, and explore new therapeutic approaches, including recombinant ADAMTS13 and anti-VWF therapy. PMID:25784681

  14. IMPROVED CORROSION RESISTANCE OF ALUMINA REFRACTORIES

    SciTech Connect

    John P. Hurley; Patty L. Kleven

    2001-09-30

    The initial objective of this project was to do a literature search to define the problems of refractory selection in the metals and glass industries. The problems fall into three categories: Economic--What do the major problems cost the industries financially? Operational--How do the major problems affect production efficiency and impact the environment? and Scientific--What are the chemical and physical mechanisms that cause the problems to occur? This report presents a summary of these problems. It was used to determine the areas in which the EERC can provide the most assistance through bench-scale and laboratory testing. The final objective of this project was to design and build a bench-scale high-temperature controlled atmosphere dynamic corrosion application furnace (CADCAF). The furnace will be used to evaluate refractory test samples in the presence of flowing corrodents for extended periods, to temperatures of 1600 C under controlled atmospheres. Corrodents will include molten slag, steel, and glass. This test should prove useful for the glass and steel industries when faced with the decision of choosing the best refractory for flowing corrodent conditions.

  15. Evolving ideas about the male refractory period.

    PubMed

    Turley, Kenneth R; Rowland, David L

    2013-08-01

    The male refractory period (MRP) continues to be a topic of discussion and debate within the field of sexual medicine. To date explanations rely on central descending (efferent) influences involving specific neurotransmitter systems. Herein we explore the issue of the male refractory period, identifying problems with current explanations, specifying the parameters of an adequate model, and suggesting possible mechanisms mediating this phenomenon. We review the literature regarding existing explanations for the MRP and look to other systems of physiological regulation that might provide a model for the conceptualization of the MRP. Our approach differs from traditional explanations in that it emphasizes the possible roles of various peripheral, rather than central, feedback (afferent) systems that affect peripheral autonomic functioning and response. Yet our approach is consistent with other peripheral regulatory feedback systems controlling autonomic response related to such processes as heart rate, respiration, and gut motility. Although direct empirical research supporting our approach is lacking, sufficient evidence exists to support the idea that such processes are not only possible but likely with respect to the male refractory period. We suggest several lines of research that might provide empirical support for this approach.

  16. Barrier Coatings for Refractory Metals and Superalloys

    SciTech Connect

    SM Sabol; BT Randall; JD Edington; CJ Larkin; BJ Close

    2006-02-23

    In the closed working fluid loop of the proposed Prometheus space nuclear power plant (SNPP), there is the potential for reaction of core and plant structural materials with gas phase impurities and gas phase transport of interstitial elements between superalloy and refractory metal alloy components during service. Primary concerns are surface oxidation, interstitial embrittlement of refractory metals and decarburization of superalloys. In parallel with kinetic investigations, this letter evaluates the ability of potential coatings to prevent or impede communication between reactor and plant components. Key coating requirements are identified and current technology coating materials are reviewed relative to these requirements. Candidate coatings are identified for future evaluation based on current knowledge of design parameters and anticipated environment. Coatings were identified for superalloys and refractory metals to provide diffusion barriers to interstitial transport and act as reactive barriers to potential oxidation. Due to their high stability at low oxygen potential, alumina formers are most promising for oxidation protection given the anticipated coolant gas chemistry. A sublayer of iridium is recommended to provide inherent diffusion resistance to interstitials. Based on specific base metal selection, a thin film substrate--coating interdiffusion barrier layer may be necessary to meet mission life.

  17. Pathophysiology of refractory obsessive-compulsive disorder

    PubMed Central

    Liu, Qingxiao; Tan, Bo; Zhou, Jing; Zheng, Zhong; Li, Ling; Yang, Yanchun

    2017-01-01

    Abstract Based on both functional and structural studies of excessive activity, fronto-striatal-thalamic-cortical and cortico-striatal circuits have been hypothesized to underlie the pathophysiology of obsessive-compulsive disorder (OCD). However, the neurobiological underpinnings of OCD refractory to medication and therapy remain controversial. This study aimed to evaluate neuroanatomical abnormalities of the whole brain and to evaluate visual processing in patients with refractory OCD. This study was comprised of 2 experiments. The neuroanatomical abnormalities of the whole brain were evaluated using a visual search in combination with overactive performance monitoring (Experiment I), and visual processing was evaluated using event-related potentials recorded from subjects during performance of a visual search task. We also examined the amplitudes and latency of the error-related negativity (ERN) using a modified flanker task (Experiment II). Standard low-resolution electromagnetic tomography analysis was applied to determine the special areas. Patients with refractory OCD had a significantly greater number of saccades and prolonged latencies relative to the healthy controls. Scalp map topography confirmed that visual cognitive and executive dysfunction was localized to the fusiform gyrus. Furthermore, we found that during a modified flanker task, ERNs had a greater amplitude and a prolonged latency relative to those of the healthy controls. Further data analysis suggested that cognitive dysfunction and compulsive behavior in OCD patients were linked to abnormalities within the dorsolateral prefrontal cortex (DLPFC). We identified abnormal activities within the fusiform gyrus and DLPFC that likely play important roles in the pathophysiology of OCD. PMID:28072701

  18. Refractory period after hyperventilation-induced asthma.

    PubMed

    Bar-Yishay, E; Ben-Dov, I; Godfrey, S

    1983-05-01

    Nine young asthmatic subjects undertook isocapnic hyperventilation while breathing air under different conditions. Each subject undertook 2 pairs of tests. Pair A consisted of 2 hyperventilation challenges performed while breathing cold (2.8 +/- 1.4 degrees C) dry (2.3 +/- 0.05 mg H2O/L) air. Pair B consisted of an initial warm (38.0 +/- 0.9 degrees C) saturated air challenge followed by a cold dry challenge. Tests were closely matched in terms of ventilation and respiratory heat loss in the cold dry tests. The subjects were rendered refractory by the first cold dry hyperventilation challenge, the fall in forced expiratory volume in one second (FEV1) after hyperventilation in the first test (delta FEV1 = 39 +/- 5%) being significantly greater than that after the second challenge of Pair A (delta FEV1 = 21 +/- 5%, p less than 0.005). In test Pair B, the warm humid hyperventilation challenge neither caused significant asthma (delta FEV1 6 +/- 3%) nor rendered the subjects refractory to the subsequent cold dry test (delta FEV1 38 +/- 4%). Because in a previous study it was shown that exercise while breathing warm humid air could induce a refractory period without itself causing asthma, we conclude that hyperventilation-induced asthma is not the same as exercise-induced asthma in most subjects.

  19. [Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture].

    PubMed

    Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

    2010-12-01

    The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. Treatment is somewhat empirical, given that uncertainties remain in our understanding of the pathophysiology of this vascular complication, which involves structural and biochemical changes in the endothelium and smooth muscle of vessels. Vasospasm that is refractory to treatment leads to cerebral infarction. Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.

  20. Slag-Refractory Interaction in Slagging Coal Gasifiers

    SciTech Connect

    Matyas, Josef; Sundaram, S. K.; Hicks, Brent J.; Edmondson, Autumn B.; Arrigoni, Benjamin M.

    2008-03-03

    The combustion chamber of slagging coal gasifiers is lined with refractories to protect the stainless steel shell of the gasifier from elevated temperatures and corrosive attack of the coal slag. Refractories composed primarily of Cr2O3 have been found most resistant to slag corrosion, but they continue to fail performance requirements. Post-mortem analysis of high-chromia refractory bricks collected from commercial gasifiers suggests that slag penetration and subsequent spalling of refractory are the cause of significantly shorter service life of gasifier refractories. Laboratory tests were conducted to determine the penetration depth of three slags representative of a wide variety of coals in the United States into chromia-alumina and two high-chromia refractories. Variables tested were refractory-slag combinations and two partial pressures of O2. Slag penetration depths were measured from spliced images of each refractory. Samples heated to 1470°C for 2 hrs had maximum penetration depths ranging from 1.99±0.15 mm to at least 21.6 mm. Aurex 95P, a high-chromia refractory containing 3.3% phosphorous pentoxide (P2O5), showed the least slag penetration of all refractories tested. P2O5 likely reacts with the slags to increase their viscosity and restrict molten slag penetration. Experimental data on the slag-refractory interaction will be incorporated into mathematical model that will be used to 1) identify critical conditions at which refractory corrosion sharply increases, and 2) predict the service life of a gasifier refractory.

  1. Post dengue neurological complication.

    PubMed

    Hasliza, A H; Tohid, H; Loh, K Y; Santhi, P

    2015-01-01

    Dengue infection is highly endemic in many tropical countries including Malaysia. However, neurological complications arising from dengue infection is not common; Gullain-Barre syndrome (GBS) is one of these infrequent complications. In this paper, we have reported a case in which a 39-year-old woman presented with a neurological complication of dengue infection without typical symptoms and signs of dengue fever. She had a history of acute gastroenteritis (AGE) followed by an upper respiratory tract infection (URTI) weeks prior to her presentation rendering GBS secondary to the post viral URTI and AGE as the most likely diagnosis. Presence of thrombocytopenia was the only clue for dengue in this case.

  2. Complications following hepatectomy.

    PubMed

    Russell, Maria C

    2015-01-01

    As the number of liver resections in the United States has increased, operations are more commonly performed on older patients with multiple comorbidities. The advent of effective chemotherapy and techniques such as portal vein embolization, have compounded the number of increasingly complex resections taking up to 75% of healthy livers. Four potentially devastating complications of liver resection include postoperative hemorrhage, venous thromboembolism, bile leak, and post-hepatectomy liver failure. The risk factors and management of these complications are herein explored, stressing the importance of identifying preoperative factors that can decrease the risk for these potentially fatal complications.

  3. Anatomical parameters of cardiopulmonary system in three different lines of chickens: further evidence for involvement in ascites syndrome.

    PubMed

    Hassanzadeh, Mohammad; Gilanpour, Hassan; Charkhkar, Saied; Buyse, Johan; Decuypere, Eddy

    2005-06-01

    The present study was designed to compare the anatomical parameters of the cardiopulmonary system in three different lines of chickens with different susceptibility to ascites syndrome. Eggs from three different genetic lines-commercial broiler and layer lines and one native to Iran--were incubated and hatched, and 1-day-old chicks used. The relative heart and lung weights, the volumes of the heart, lung and thorax cavity, the incidence of ascites, and the related physiological parameters in these chickens were followed. Lung weight as a percentage of body weight, the relative lung and heart volume, and the volumes of the thorax cavity, before and after removing heart and lung tissues, were lower in fast-growing broiler chickens compared with the layer and native chickens. Additionally, most of these parameters (e.g. relative lung weight, lung volume and thorax cavity) were significantly decreased with age in broiler chickens but were increased in layer and native chickens, which was concomitant with the incidence of ascites in broiler chickens. Our data indicate that all cardiopulmonary parameters investigated are extremely unfavourable to broiler chickens and suggest a reduction in gas exchange area in broilers, and therefore higher susceptibility to pulmonary hypertension and ascites.

  4. Contribution of the Kallikrein/Kinin System to the Mediation of ConA-Induced Inflammatory Ascites.

    PubMed

    Baintner, Károly

    2016-03-01

    Intraperitoneal administration of concanavalin A (ConA, 25 mg/kg b.w.), a cell-binding plant lectin was used for inducing inflammatory ascites, and potential inhibitors were tested in 1 h and 2.5 h experiments, i.e. still before the major influx of leucocytes. At the end of the experiment the peritoneal fluid was collected and measured. The ConA-induced ascites was significantly (p<0.01) and dose-dependently inhibited by icatibant (HOE-140), a synthetic polypeptide antagonist of bradykinin receptors. Aprotinin, a kallikrein inhibitor protein also had significant (p<0.01), but less marked inhibitory effect. L-NAME, an inhibitor of NO synthesis, and atropine methylnitrate, an anticholinergic compound, were ineffective. It is concluded, that the kallikrein/kinin system contributes to the mediation of the ConA-induced ascites by increasing subperitoneal vascular permeability, independent of the eventual vasodilation produced by NO. It is known, that membrane glycoproteins are aggregated by the tetravalent ConA and the resulting distortion of membrane structure may explain the activation of the labile prekallikrein. Complete inhibition of the ConA-induced ascites could not be achieved by aprotinin or icatibant, which indicates the involvement of additional mediators.

  5. A case of perforated sigmoid diverticulitis in which gram staining of ascitic fluid was useful for diagnosis.

    PubMed

    Tsuchida, Junko; Fujita, Shouhei; Kawano, Fumihiro; Tsukamoto, Ryoichi; Honjo, Kunpei; Naito, Shigetoshi; Ishiyama, Shun; Miyano, Shozo; Machida, Michio; Kitabatake, Toshiaki; Fujisawa, Minoru; Kojima, Kuniaki; Ogura, Kanako; Matsumoto, Toshiharu

    2014-01-01

    An 85-year-old woman was admitted to our hospital for steroid therapy for relapsing nephrotic syndrome. During hospitalization, she complained of sudden epigastric pain at night. Although there were signs of peritoneal irritation, CT showed a large amount of ascitic fluid, but no free intraperitoneal gas. Gram staining of ascitic fluid obtained by abdominal paracentesis showed Gram-negative rods, which raised a strong suspicion of gastrointestinal perforation and peritonitis. Therefore, emergency surgery was performed. Exploration of the colon showed multiple sigmoid diverticula, one of which was perforated. The patient underwent an emergency Hartmann's procedure. Imaging studies failed to reveal any evidence of gastrointestinal perforation, presenting a diagnostic challenge. However, a physician performed rapid Gram staining of ascitic fluid at night when laboratory technicians were absent, had a strong suspicion of gastrointestinal perforation, and performed emergency surgery. Gram staining is superior in rapidity, and ascitic fluid Gram staining can aid in diagnosis, suggesting that it should be actively performed. We report this case, with a review of the literature on the significance of rapid diagnosis by Gram staining.

  6. Ascitic fluid due to type II herpes simplex virus infection: report of a case with immunocytochemical confirmation.

    PubMed

    Yoshida, Keiko; Miyahira, Yoshimitsu; Ishida, Mitsuaki; Iwai, Muneo; Kagotani, Akiko; Arita, Namie; Iwamoto, Nozomi; Takikita, Mikiko; Kojima, Fumiyoshi; Okabe, Hidetoshi

    2013-04-01

    Herpes simplex virus (HSV) infection is usually observed in the oral cavity and external genitals, and HSV peritonitis is extremely rare. Herein, we report a case of type II HSV peritonitis successfully diagnosed by ascitic cytology. A 66-year-old Japanese man, who had been treated with steroid inhalation for 5 years due to chronic obstructive pulmonary disease, was suspected to have acute cholecystitis. Laparoscopic cholecystectomy and intraoperative cytological examination of ascitic fluid were performed. Cytological study of ascitic fluid revealed that abundant granular cell debris, degenerative cells and apoptotic bodies were present, as well as some single or multinucleated cells with ground glass nuclei. However, vivid mesothelial cells were rarely seen. Immunocytochemical staining for type II HSV was positive in single or multinucleated cells with ground glass nuclei. Therefore, a diagnosis of type II HSV peritonitis was made. This is the first reported case of type II HSV peritonitis successfully diagnosed by ascitic cytology. This report highlights that the presence of abundant cell debris, degenerative cells and apoptotic bodies, and the absence of vivid mesothelial cells are the key cytological findings to suspect HSV peritonitis, and the diagnosis can be confirmed by careful surveillance for characteristic nuclear findings of single or multinucleated cells. The frequency of opportunistic infection is increased because of the increased numbers of iatrogenic immunocompromised patients as seen in this case, therefore, cytological examination is a useful method for early detection of the causative agent of peritonitis including HSV.

  7. OPEC chemotherapy (vincristine, prednisolone, etoposide and chlorambucil) for refractory and recurrent Hodgkin's disease.

    PubMed

    Barnett, M J; Man, A M; Richards, M A; Waxman, J H; Wrigley, P F; Lister, T A

    1987-01-01

    Fifteen adults with refractory or recurrent Hodgkin's disease were treated with a combination of: vincristine, prednisolone, etoposide and chlorambucil (OPEC). All had previously received mustine, vinblastine, procarbazine and prednisolone (MVPP) and seven had subsequently been treated with alternative regimens. Responses were achieved in four, but complete remission in only one. Toxicity was considerable and five died of treatment related complications. Only two are alive (one in complete remission) more than three years after therapy. The toxicity of the OPEC regimen outweighed its benefit in this group of poor prognosis patients.

  8. Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus

    PubMed Central

    Reznik, Michael E.; Berger, Karen; Claassen, Jan

    2016-01-01

    Status epilepticus that cannot be controlled with first- and second-line agents is called refractory status epilepticus (RSE), a condition that is associated with significant morbidity and mortality. Most experts agree that treatment of RSE necessitates the use of continuous infusion intravenous anesthetic drugs such as midazolam, propofol, pentobarbital, thiopental, and ketamine, each of which has its own unique characteristics. This review compares the various anesthetic agents while providing an approach to their use in adult patients, along with possible associated complications. PMID:27213459

  9. Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy.

    PubMed

    Pereira, Keith; Carrion, Andres F; Martin, Paul; Vaheesan, Kirubahara; Salsamendi, Jason; Doshi, Mehul; Yrizarry, Jose M

    2015-12-01

    Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.

  10. Comprehensive Creep and Thermophysical Performance of Refractory Materials

    SciTech Connect

    Ferber, M.K.; Wereszczak, A.; Hemrick, J.A.

    2006-06-29

    Furnace designers and refractory engineers recognize that optimized furnace superstructure design and refractory selection are needed as glass production furnaces are continually striving toward greater output and efficiencies. Harsher operating conditions test refractories to the limit, while changing production technology (such as the conversion to oxy-fuel from traditional air-fuel firing) can alter the way the materials perform [1-3]. Refractories for both oxy- and air-fuel fired furnace superstructures (see Fig. 1) are subjected to high temperatures that may cause them to creep excessively or subside during service if the refractory material is not creep resistant, or if it is subjected to high stress, or both. Furnace designers can ensure that superstructure structural integrity is maintained if the creep behavior of the refractory material is well understood and well represented by appropriate engineering creep models. Several issues limit the abilities of furnace designers to (1) choose the optimum refractory for their applications, (2) optimize the engineering design, or (3) predict the service mechanical integrity of their furnace superstructures. Published engineering creep data are essentially nonexistent for almost all commercially available refractories used for glass furnace superstructures. The limited data that do exist are supplied by the various refractory suppliers. Unfortunately, the suppliers generally have different ways of conducting their mechanical testing, and they interpret and report their data differently. This inconsistency makes it hard for furnace designers to draw fair comparisons between competing grades of candidate refractories. Furthermore, the refractory suppliers' data are often not available in a form that can be readily used for furnace design or for the prediction and design of long-term structural integrity of furnace superstructures. As a consequence, the U.S. Department of Energy (DOE) Industrial Technology Program (ITP

  11. Neurological Complications of AIDS

    MedlinePlus

    ... the neurological complications of AIDS. Some disorders require aggressive therapy while others are treated symptomatically. Medicines range ... certain bacterial infections, and penicillin to treat neurosyphilis. Aggressive antiretroviral therapy is used to treat AIDS dementia ...

  12. Complications of Mumps

    MedlinePlus

    ... Serology Publications and Resources Multimedia MMWR Articles Outbreak Articles Related Links World Health Organization Medline Plus Complications of Mumps Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir ...

  13. Infection and Other Complications

    MedlinePlus

    ... is Lymphedema? What Causes Lymphedema What is the Lymphatic System? Signs and Symptoms Stage 0 Stage 1 Stage ... is Lymphedema? What Causes Lymphedema What is the Lymphatic System? Signs and Symptoms Infection and Other Complications NLN ...

  14. Atrial Fibrillation: Complications

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Complications Past Issues / Winter 2015 Table of Contents ... two major complications—stroke and heart failure. Atrial Fibrillation and Stroke Click to enlarge image This illustration ...

  15. Complications of Circumcision

    PubMed Central

    Krill, Aaron J.; Palmer, Lane S.; Palmer, Jeffrey S.

    2011-01-01

    In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events. PMID:22235177

  16. Chickenpox (Varicella) Complications

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Chickenpox (Varicella) Note: Javascript is disabled or is not ... message, please visit this page: About CDC.gov . Chickenpox Home About Chickenpox Signs & Symptoms Complications Transmission Prevention & ...

  17. Neurological Complications of AIDS

    MedlinePlus

    ... Patient & Caregiver Education » Fact Sheets Neurological Complications of AIDS Fact Sheet Table of Contents (click to jump ... Where can I get more information? What is AIDS? AIDS (acquired immune deficiency syndrome) is a condition ...

  18. Growth, carcass characteristics, and incidence of ascites in broilers exposed to environmental fluctuations and oiled litter.

    PubMed

    McGovern, R H; Feddes, J J; Robinson, F E; Hanson, J A

    2000-03-01

    The effects of diurnal temperature fluctuations and removal of respirable dust, by application of canola oil to straw litter, on growth, carcass traits, and the degree of ascites was evaluated with 1,200 male broilers studied in two replicated 6-wk trials. Each trial used four pens of 150 birds. The temperature treatment consisted of a fluctuation of 3 C in temperature above the required temperature during the day (0600 to 1800 h) and 3 C below the required temperature at night (1800 to 0600 h) for a 6 C change in daily temperature. The control temperature was constant. All pens had the same mean daily temperature. In each trial, one control temperature pen and one fluctuation temperature pen received bi-weekly applications of canola oil to the litter (1.1 L/m2 of oil over 6 wk). At 6 wk of age, 30 birds from each pen were killed for determination of breast muscle, fatpad, and heart weights. All birds were scored for lesions of ascites at time of processing. A score of 0 or 1 represented slight pericardial effusion, slight pulmonary congestion, and edema. A score of 4 represented birds with marked accumulation of ascitic fluid in one or more ceolomic cavities (other than the pericardium) and advanced liver lesions. A cross-sectional image of each 4-mm heart slice (cross-section of the ventricles) was digitally recorded, and with image analysis we determined the right ventricular area (RVA), left ventricular area (LVA), and total heart area (HA). The final BW of the broilers were significantly different, the oiled-litter treatment (2,249 g) had lower weight gain compared with the nonoiled litter treatment (2,293 g). There were no differences in fatpad weight, shank length, lung weight, and percentage breast muscle between the main treatments. The Pectoralis minor and Pectoralis major weight were significantly heavier in the temperature fluctuation treatment than in the control temperature treatment by 3.0 and 12.0 g, respectively. The birds subjected to the control

  19. Early complications. Respiratory failure.

    PubMed

    Zwischenberger, J B; Alpard, S K; Bidani, A

    1999-08-01

    Pulmonary complications following thoracic surgery are common and associated with significant morbidity and mortality. Respiratory failure after pneumonectomy occurs in approximately 5% to 15% of cases and significantly increases patient mortality. Strategies for ventilator support are based on the nature of the underlying complication and the pathophysiology of respiratory failure. This article describes the cause and pathophysiology of respiratory failure and pulmonary embolus postpneumonectomy. Diagnosis, management, and innovative therapies are also reviewed.

  20. Successful nutritional support for a dysphagic patient with massive cirrhotic ascites and intrathoracic stomach using percutaneous endoscopic gastrostomy (PEG).

    PubMed

    Moriwaki, Yoshihiro; Otani, Jun; Okuda, Junzo; Niwano, Toshiyuki; Sawada, Yoshiyuki; Nitta, Tachiko; Ohshima, Chiaki

    2014-01-01

    Although massive cirrhotic ascites is generally considered a contraindication for the placement of percutaneous endoscopic gastrostomy (PEG), such patients are usually poorly nourished. Preceding paracentesis of ascites is one method for controlling ascites and allowing the safe placement of PEG, but it often results in overuse of albumin. Preceding peritoneal-venous (P-V) shunting can avoid excessive use of albumin, but this introduces the risk of infectious contamination. We encountered an 88-y-old woman with massive cirrhotic ascites, a giant esophageal hernia with dislocation of the proximal stomach into the mediastinum, hypertrophy of the lateral segment of the liver, and malnutrition who had suffered from appetite loss and a swallowing disorder for 4 mo. She underwent PEG using a staged sequential introduction method using a Funada-style gastric wall fixation kit as follows: 1) full stretching and pushing out of the stomach from the mediastinum into the peritoneal cavity by deep insertion and a turning-over procedure of the endoscope, 2) full distention by air to adhere the gastric wall to the peritoneal wall without migration of the colon, 3) four-point square fixation under gastroenterological endoscopy without migration of the visceral organ, and 4) puncture of the needle introducer of the PEG tube in the center of the fixations under repeated gastroenterological endoscopy 3 d after the fixation. She underwent P-V shunting under local anesthesia on the 28th day after placement of PEG and enteral nutrition. Her case shows that we can achieve proper enteral nutritional support even for patients with massive cirrhotic ascites.

  1. Complications of auricular correction

    PubMed Central

    Staindl, Otto; Siedek, Vanessa

    2008-01-01

    The risk of complications of auricular correction is underestimated. There is around a 5% risk of early complications (haematoma, infection, fistulae caused by stitches and granulomae, allergic reactions, pressure ulcers, feelings of pain and asymmetry in side comparison) and a 20% risk of late complications (recurrences, telehone ear, excessive edge formation, auricle fitting too closely, narrowing of the auditory canal, keloids and complete collapse of the ear). Deformities are evaluated less critically by patients than by the surgeons, providing they do not concern how the ear is positioned. The causes of complications and deformities are, in the vast majority of cases, incorrect diagnosis and wrong choice of operating procedure. The choice of operating procedure must be adapted to suit the individual ear morphology. Bandaging technique and inspections and, if necessary, early revision are of great importance for the occurence and progress of early complications, in addition to operation techniques. In cases of late complications such as keloids and auricles that are too closely fitting, unfixed full-thickness skin flaps have proved to be the most successful. Large deformities can often only be corrected to a limited degree of satisfaction. PMID:22073079

  2. Complications in Hip Arthroscopy

    PubMed Central

    Nakano, Naoki; Khanduja, Vikas

    2016-01-01

    Summary Background Recent developments in hip arthroscopic techniques and technology have made it possible in many cases to avoid open surgical dislocation for treating a variety of pathology in the hip. Although early reports suggest favourable results’ using hip arthroscopy and it has been shown to be a relatively safe procedure, complications do exist and can sometimes lead to significant morbidity. Methods This is a review article. The aim of this manuscript is to present the most frequent and/or serious complications that could occur at or following hip arthroscopy and some guidelines to avoid these complications. Conclusion Most complications of hip arthroscopy are minor or transient but serious complications can occur as well. A lot of complication e.g. acetabular labral puncture go unreported. Appropriate education and training, precise and meticulous surgical technique with correct instrumentation, the right indication in the right patient and adherence to advice from mentors and experienced colleagues are all essential factors for a successful outcome. Level of evidence: V. PMID:28066747

  3. [Type 2 diabetes complications].

    PubMed

    Schlienger, Jean-Louis

    2013-05-01

    People with type 2 diabetes are at increased risk of many complications, which are mainly due to complex and interconnected mechanisms such as hyperglycemia, insulino-resistance, low-grade inflammation and accelerated atherogenesis. Cardi-cerebrovascular disease are frequently associated to type 2 diabetes and may become life threatening, particularly coronaropathy, stroke and heart failure. Their clinical picture are sometimes atypical and silencious for a long time. Type 2 diabetes must be considered as an independent cardiovascular risk factor. Nephropathy is frequent in type 2 diabetes but has a mixed origin. Now it is the highest cause of end-stage renal disease. Better metabolic and blood pressure control and an improved management of microalbuminuria are able to slowdown the course of the disease. Retinopathy which is paradoxically slightly progressive must however be screened and treated in these rather old patients which are globally at high ophthalmologic risk. Diabetic foot is a severe complication secondary to microangiopathy, microangiopathy and neuropathy. It may be considered as a super-complication of several complications. Its screening must be done on a routine basis. Some cancer may be considered as an emerging complication of type 2 diabetes as well as cognitive decline, sleep apnea syndrome, mood disorders and bone metabolism impairments. Most of the type 2 diabetes complications may be prevented by a strategy combining a systematic screening and multi-interventional therapies.

  4. Neurologic complications of vaccinations.

    PubMed

    Miravalle, Augusto A; Schreiner, Teri

    2014-01-01

    This chapter reviews the most common neurologic disorders associated with common vaccines, evaluates the data linking the disorder with the vaccine, and discusses the potential mechanism of disease. A literature search was conducted in PubMed using a combination of the following terms: vaccines, vaccination, immunization, and neurologic complications. Data were also gathered from publications of the American Academy of Pediatrics Committee on Infectious Diseases, the World Health Organization, the US Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System. Neurologic complications of vaccination are rare. Many associations have been asserted without objective data to support a causal relationship. Rarely, patients with a neurologic complication will have a poor outcome. However, most patients recover fully from the neurologic complication. Vaccinations have altered the landscape of infectious disease. However, perception of risk associated with vaccinations has limited the success of disease eradication measures. Neurologic complications can be severe, and can provoke fear in potential vaccines. Evaluating whether there is causal link between neurologic disorders and vaccinations, not just temporal association, is critical to addressing public misperception of risk of vaccination. Among the vaccines available today, the cost-benefit analysis of vaccinations and complications strongly argues in favor of vaccination.

  5. Interferon-alpha therapy for refractory kaposiform hemangioendothelioma: a single-center experience

    PubMed Central

    Wu, Hai Wei; Wang, Xuan; Zhang, Ling; Zhao, Hai Guang; Wang, Yan An; Su, Li Xin; Fan, Xin Dong; Zheng, Jia Wei

    2016-01-01

    Kaposiform hemangioendothelioma (KHE) is a relatively rare vascular tumor with an aggressive and infiltrating nature. Previous studies have revealed an exclusive relationship between KHE and Kasabach-Merritt Phenomenon (KMP), which is associated with high morbidity and mortality. No universally accepted treatment modality exists for refractory KHE with or without KMP. The aim of this study was to evaluate the safety and efficacy of interferon-alpha (IFN-α) therapy for treatment of refractory KHE. Twelve consecutive patients with KHE were treated with subcutaneous injections of IFN-α after other treatments had failed. Eleven patients exhibited a reduction in tumor size of more than 50%, and the platelet count for all five patients with KMP returned to normal level after IFN-α therapy. The duration of IFN-α treatment ranged from 3 months to 9 months (mean: 6.3 months). The response time for IFN-α treatment ranged from 10 days to 5 weeks (mean: 3.6 weeks). Additionally, no severe complications, such as neurological damage or spastic diplegia, were observed in these patients. In conclusion, our study suggested that IFN-α therapy is effective and safe for refractory KHE, and IFN-α may be used as an alternative after other treatments have failed. PMID:27796340

  6. Guillain-Barré Syndrome Presenting with Sinus Node Dysfunction and Refractory Shock

    PubMed Central

    Ha, Le Dung; Abbas, Farrukh; Rao, Mohan

    2017-01-01

    Patient: Male, 76 Final Diagnosis: Guillain-Barré syndrome Symptoms: Bradycardia • refractory hypotension Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy that is usually associated with preceding respiratory or gastrointestinal infection and has the hallmark manifestation of ascending flaccid paralysis. We report an atypical presentation of GBS. Case Report: A 76-year-old male presented with acute onset of diaphoresis and altered mental status. He subsequently developed severe bradycardia and refractory hypotension, which initially responded to dopamine infusion. A temporary pacemaker wire was placed to stabilize the heart rate but hypotension persisted. Acute autonomic dysfunction was suspected. Head and chest imaging was unrevealing. Lumbar puncture revealed albuminocytologic dissociation that was consistent with a diagnosis of GBS. Hospital course was complicated with acute kidney injury and metabolic acidosis. Plasmapharesis was initiated. The patient eventually died of multi-organ failure. Conclusions: Autonomic dysfunction is a known but rare presentation of GBS. In patients presenting with refractory bradycardia and hypotension, GBS should be considered in the differential diagnosis. PMID:28283677

  7. Dental hardware complicating diagnosis in refractory gelastic epilepsy secondary to hypothalamic hamartoma.

    PubMed

    Bateman, Lisa M; Latchaw, Richard; Seyal, Masud

    2010-07-01

    Hypothalamic hamartomas (HH) are developmental malformations of the hypothalamus associated with a potentially treatable epileptic encephalopathy, characterized by early onset gelastic seizures, the later development of multiple seizure types and progressive cognitive and behavioral decline. Surgical treatment of HH can lead to seizure control and improvement in the cognitive-behavioral syndrome. Video-EEG telemetry (VET) is often necessary to characterize the semiology of the seizures, but there are no specific interictal or ictal EEG pattems that will confirm the diagnosis. Magnetic resonance imaging (MRI) can identify HH and define their anatomy, but the imaging findings may be subtle and susceptible to artifactual contamination. We present a patient with intractable gelastic epilepsy in whom the diagnosis of HH was initially missed due to failure to recognize the clinical syndrome and contamination of the MRI images with dental hardware artifact. VET confirmed the clinical diagnosis and the HH was identified on MRI after the dental hardware was removed. VET should be performed to confirm seizure semiology in patients with suspected gelastic epilepsy. Establishing this diagnosis can subsequently direct the appropriate neuroradiological evaluation for HH and surgical treatment of these lesions.

  8. Idiopathic inflammatory myopathies: definition and management of refractory disease.

    PubMed

    Brandão, Mariana; Marinho, António

    2011-09-01

    Adult idiopathic inflammatory myopathies, commonly referred to as myositis, are a heterogeneous group of diseases with an autoimmune etiology. In this review, the authors are going to focus on myositis excluding inclusion body myositis. They will review the prognostic factors (for mortality and response to steroids), define refractory disease, introduce a new concept (presumed refractory disease), analyze definitions of active disease, damage and improvement criteria, and summarize therapeutic alternatives for refractory patients, based on different disease phenotypes.

  9. Tocilizumab for steroid refractory acute graft-versus-host disease.

    PubMed

    Roddy, Julianna V F; Haverkos, Bradley M; McBride, Ali; Leininger, Kathryn M; Jaglowski, Samantha; Penza, Sam; Klisovic, Rebecca; Blum, William; Vasu, Sumithira; Hofmeister, Craig C; Benson, Don M; Andritsos, Leslie A; Devine, Steven M; Efebera, Yvonne A

    2016-01-01

    Acute graft-versus-host-disease (aGVHD) is a frequent and often lethal complication of allogeneic hematopoietic stem cell transplant despite prophylaxis. Tocilizumab is a humanized anti-IL-6 receptor monoclonal antibody that has evidence of activity in patients with steroid refractory (SR) GVHD. We retrospectively report on nine patients with grade 3 or 4 SR aGVHD who received tocilizumab. Eight mg/kg of tocilizumab was administered intravenously every 3-4 weeks. aGVHD grading and responses were based on consensus criteria. Median age at transplant was 48 years. Five patients had alternate donor sources. Median time from aGVHD onset to tocilizumab administration was 44 days. Two patients had complete responses and two had partial responses. Median survival from start of tocilizumab was 26 days (range 13-1054). Our limited experience demonstrated an overall response rate of 44% (CR + PR); however, this response was not durable. Further studies are needed to determine the optimal time for tocilizumab initiation.

  10. Tocilizumab for steroid refractory acute graft-versus-host disease

    PubMed Central

    Roddy, Julianna V. F.; Haverkos, Bradley M.; McBride, Ali; Leininger, Kathryn M.; Jaglowski, Samantha; Penza, Sam; Klisovic, Rebecca; Blum, William; Vasu, Sumithira; Hofmeister, Craig C.; Benson, Don M.; Andritsos, Leslie A.; Devine, Steven M.; Efebera, Yvonne A.

    2015-01-01

    Acute graft-versus-host-disease (aGVHD) is a frequent and often lethal complication of allogeneic hematopoietic stem cell transplant despite prophylaxis. Tocilizumab is a humanized anti-IL-6 receptor monoclonal antibody that has evidence of activity in patients with steroid refractory (SR) GVHD. We retrospectively report on nine patients with grade 3 or 4 SR aGVHD who received tocilizumab. Eight mg/kg of tocilizumab was administered intravenously every 3–4 weeks. aGVHD grading and responses were based on consensus criteria. Median age at transplant was 48 years. Five patients had alternate donor sources. Median time from aGVHD onset to tocilizumab administration was 44 days. Two patients had complete responses and two had partial responses. Median survival from start of tocilizumab was 26 days (range 13–1054). Our limited experience demonstrated an overall response rate of 44% (CR + PR); however, this response was not durable. Further studies are needed to determine the optimal time for tocilizumab initiation. PMID:26140610

  11. ECMO Used in a Refractory Ventricular Tachycardia and Ventricular Fibrillation Patient

    PubMed Central

    Chen, Chih-Yu; Tsai, Ju; Hsu, Tai-Yi; Lai, Wan-Yu; Chen, Wei-Kung; Muo, Chih-Hsin; Kao, Chia-Hung

    2016-01-01

    Abstract Refractory cardiac arrhythmia, which has a poor response to defibrillation and antiarrhythmia medication, is a complicated problem for clinical physicians during resuscitation. Extracorporeal membrane oxygenation (ECMO) may be used to sustain life in this situation. ECMO is useful for cardiopulmonary resuscitation among patients suffering from cardiac arrest; the use of ECMO in this context is called E-cardiopulmonary resuscitation. However, a large-scale and nationwide survey of ECMO usage in cases involving refractory cardiac arrhythmia during resuscitation is lacking. We aimed to clarify the characteristics and efficacy of the application of ECMO in cases involving refractory cardiac arrhythmia during resuscitation by conducting a nationwide study. Using national insurance data from 1996 to 2011, 2702 patients who received defibrillation and amiodarone injections were selected. We excluded trauma patients (n = 316) and those aged<20 years (n = 24). A total of 2362 patients were included, 376 of whom had ECMO support, and 1986 of whom had no ECMO support. After propensity score matching, 320 patients had ECMO support and 640 patients without ECMO support. Conditional logistic regression was used to estimate the risk of death in ECMO users compared to non-EMCO users. ECMO used in refractory cardiac arrhythmia with high propensity score patients had lower risk of death (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.36–0.98). However, prolonged ECMO used >1 day was higher risk of death (OR = 2.88, 95% CI = 1.27–6.53). In our retrospective case control study in refractory cardiac arrhythmia patients, ECMO supportive in high propensity score patients showed improving the overall survival rate but ECMO support for >1 day would be harmful. The evidence derived from this retrospective study using data from the national insurance system is generally of lower methodological evidence than that from randomized controlled trials

  12. Detection of ascitic feline coronavirus RNA from cats with clinically suspected feline infectious peritonitis.

    PubMed

    Soma, Takehisa; Wada, Makoto; Taharaguchi, Satoshi; Tajima, Tomoko

    2013-10-01

    Ascitic feline coronavirus (FCoV) RNA was examined in 854 cats with suspected feline infectious peritonitis (FIP) by RT-PCR. The positivity was significantly higher in purebreds (62.2%) than in crossbreds (34.8%) (P<0.0001). Among purebreds, the positivities in the Norwegian forest cat (92.3%) and Scottish fold (77.6%) were significantly higher than the average of purebreds (P=0.0274 and 0.0251, respectively). The positivity was significantly higher in males (51.5%) than in females (35.7%) (P<0.0001), whereas no gender difference has generally been noted in FCoV antibody prevalence, indicating that FIP more frequently develops in males among FCoV-infected cats. Genotyping was performed for 377 gene-positive specimens. Type I (83.3%) was far more predominantly detected than type II (10.6%) (P<0.0001), similar to previous serological and genetic surveys.

  13. Antitumor Activity of Prosopis glandulosa Torr. on Ehrlich Ascites Carcinoma (EAC) Tumor Bearing Mice

    PubMed Central

    Senthil Kumar, Raju; Rajkapoor, Balasubramanian; Perumal, Perumal; Dhanasekaran, Thangavel; Alvin Jose, Manonmani; Jothimanivannan, Chennakesavalu

    2011-01-01

    The antitumor activity of ethanol extract of Prosopis glandulosa Torr. (EPG) was evaluated against Ehrlich ascites carcinoma (EAC) tumor model in Swiss albino mice on dose dependent manner. The activity was assessed using survival time, average increase in body weight, hematological parameters and solid tumor volume. Oral administration of EPG at the dose of 100, 200 and 400 mg/Kg, significantly (p < 0.001) increased the survival time and decreased the average body weight of the tumor bearing mice. After 14 days of inoculation, EPG was able to reverse the changes in the hematological parameters, protein and PCV consequent to tumor inoculation. Oral administration of EPG was effective in reducing solid tumor mass development induced by EAC cells. The results indicate that EPG possess significant antitumor activity on dose dependent manner. PMID:24250382

  14. A Study of the Mechanisms of Attachment of Allergised Lymphocytes to BP8 Ascites Tumour Cells

    PubMed Central

    Lee, P. J.; Cater, D. B.

    1969-01-01

    The attachment of allergised and non-allergised lymph-node cells from C57B1 mice to BP8 ascites tumour cells were compared in vitro in the presence of vaso-active agents and mediators of the inflammatory reaction. It was found that Priscol, noradrenaline, adrenaline, 5-HT and histamine caused some cell adherence, while bradykinin and lysolecithin caused a marked increase of adherence of the allergised lymph-node cells to the BP8 cells. Electrophoretic studies of BP8 cells in the presence of polyornithine showed an abolition of the anodic mobility. Theories of action of the various agents are discussed. ImagesFigs. 5-8Figs. 1-4 PMID:5364386

  15. Chronobiological characteristics of the action of thyroxine of reproduction of Ehrlich's Ascites Tumor cells

    SciTech Connect

    Stepanenko, V.A.; Romanov, Y.A.

    1985-05-01

    This paper studies the action of thyroxine on cell proliferation in a hyperdiploid strain of Ehrlich's Ascites Tumor (EAT) depending on clock time. Five albino mice were given an injection of tritium-thymidine in a dose of 0.5 u Ci/g body weight (specific radioactivity 4.1 Ci/mmole) one hour before sacrifice. On autoradiographs from each animal, during examination of 3000-5000 cells, the number of dividing and DNA-synthesizing cells was counted and mitotic index and radioactive index were calculated and expressed in promille. Parameters method and the results were subjected to statistical analysis by the Fisher-Student method. Differences were considered significant at the P less than 0.05 level.

  16. Properties of Refractory Concrete in Tension and Compression

    NASA Technical Reports Server (NTRS)

    Sampson, Jeffrey

    2009-01-01

    Refractory concrete on the LC-39A Flame Deflector has been damaged during multiple Space Shuttle launches (e.g. STS-124, STS-126, STS-119, and STS-125, STS-127). These events have prompted a better understanding of the system via an analytical model of the Flame Deflector assembly to include the Fondu Fyre refractory concrete. This model requires test data inputs of the refractory concrete's mechanical properties, which include stress versus strain curves in tension and compression, modulus of elasticity, and Poisson's ratio. Sections of Fondu Fyre refractory concrete removed from the LC-39A Flame Deflector were provided for this testing.

  17. Advances in nondestructive evaluation methods for inspection of refractory concretes

    SciTech Connect

    Ellingson, W. A.

    1980-01-01

    Refractory concrete linings are essential to protect steel pressure boundaries from high-temperature agressive erosive/corrosive environments. Castable refractory concretes have been gaining more acceptance as information about their performance increases. Economic factors, however, have begun to impose high demands on the reliability of refractory materials. Advanced nondestructive evaluation methods are being developed to assist the refractory user. Radiographic techniques, thermography, acoustic-emission detection, and interferometry have been shown to yield information on the structural status of refractory concrete. Methods using /sup 60/Co radiation sources are capable of yielding measurements of refractory wear rate as well as images of cracks and/or voids in pre- and post-fired refractory linings up to 60 cm thick. Thermographic (infrared) images serve as a qualitative indicator of refractory spalling, but quantitative measurements are difficult to obtain from surface-temperature mapping. Acoustic emission has been shown to be a qualitative indicator of thermomechanical degradation of thick panels of 50 and 95% Al/sub 2/O/sub 3/ during initial heating and cooling at rates of 100 to 220/sup 0/C/h. Laser interferometry methods have been shown to be capable of complete mappings of refractory lining thicknesses. This paper will present results obtained from laboratory and field applications of these methods in petrochemical, steel, and coal-conversion plants.

  18. Treating Complicated Grief

    PubMed Central

    Simon, Naomi M.

    2015-01-01

    IMPORTANCE The death of a loved one is one of life’s greatest, universal stressors to which most bereaved individuals successfully adapt without clinical intervention. For a minority of bereaved individuals, grief is complicated by superimposed problems and healing does not occur. The resulting syndrome of complicated grief causes substantial distress and functional impairment even years after a loss, yet knowing when and how to intervene can be a challenge. OBJECTIVE To discuss the differential diagnosis, risk factors for and management of complicated grief based on available evidence and clinical observations. EVIDENCE REVIEW MEDLINE was searched from January 1990 to October 2012. Additional citations were procured from references of select research and review articles. Available treatment studies targeting complicated grief were included. RESULTS A strong research literature led to inclusion of complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (termed persistent complex bereavement disorder as a subtype of other specified trauma and stressor-related disorders), although it is a condition for which more research is formally recommended, and there is still ongoing discussion about the optimal name and diagnostic criteria for the disorder. Reliable screening instruments are available, and the estimated prevalence rate is 7% of bereaved people. Randomized controlled data support the efficacy of a targeted psychotherapy including elements that foster resolution of complicating problems and facilitate the natural healing process. Preliminary studies suggest antidepressant medications may be helpful. CONCLUSION AND RELEVANCE Individuals with complicated grief have greater risk of adverse health outcomes, should be diagnosed and assessed for suicide risk and comorbid conditions such as depression and posttraumatic stress disorder, and should be considered for treatment. PMID:23917292

  19. Postoperative visual loss following dorsal root entry zone rhizotomy: A dreaded complication after a benign procedure

    PubMed Central

    Mishra, RK; Mahajan, C; Bindra, A; Goyal, K

    2016-01-01

    Postoperative visual loss (POVL) is a rare but grave postoperative complication. It has been mainly reported in patients undergoing cardiac and spinal surgeries. Dorsal root entry zone (DREZ) is pain relieving procedure performed in patients with refractory neuropathic pain with minimal complication rate. We present a case of unilateral POVL following DREZ rhizotomy in prone position in a patient having brachial plexus neuropathy. Exact etiology of vision loss was though not clear; hypotension, use of vasopressors and hemodilution may have led to vision loss in this patient. This case report highlights the associated risk factors for development of this hazardous complication. PMID:27833493

  20. [Fibrin glue injection therapy with diluted thrombin for complicated postoperative fistulas following digestive surgery].

    PubMed

    Tono, Takeshi; Murakami, Masahiro; Ohtsuru, Minoru; Monden, Takushi

    2014-11-01

    Fibrin glue injection is used for treating postoperative digestive fistulas; however, this method is not always successful, especially in cases of complicated fistulas. Generally, the fibrin glue coagulates immediately after application before it reaches the end of the fistulas. Based on the results of an in vitro study of tensile strength and coagulation time, we utilized fibrin glue injection therapy with diluted thrombin solution (× 30) for treating refractory postoperative complicated fistulas in 23 cancer patients. In 20 of these patients, the fistulas were successfully closed after an average of 2.0 treatment cycles. This simple method of fibrin glue injection with diluted thrombin is useful for treating complicated postoperative digestive fistulas.

  1. Segregation analysis of blood oxygen saturation in broilers suggests a major gene influence on ascites.

    PubMed

    Navarro, P; Visscher, P M; Chatziplis, D; Koerhuis, A N M; Haley, C S

    2006-12-01

    1. Blood oxygen saturation (SaO) is a potential indicator trait for resistance to ascites in chickens. 2. The objective of the study was to investigate the genetic architecture of SaO in a meat-type chicken line reared in commercial conditions. 3. Data were collected over 15 generations of selection and were divided into two data sets on the basis of a change in recording age from 6 to 5 weeks of age, approximately halfway through the period. The resulting pedigrees comprised in excess of 90,000 birds each and, on average, 12% of these birds had SaO records. 4. Segregation analyses of SaO were carried out assuming a mixed inheritance model that included a major locus segregating in a polygenic background. 5. The analyses suggest that a major gene is involved in the genetic control of SaO in this line. The putative gene acts in a dominant fashion and has an additive effect of around 0.90 sigma(p), equivalent to a predicted difference in SaO between the two homozygous classes of more than 10%. The frequency of the allele that increases SaO changed from 0.53 to 0.65 from the first to the second set of data, consistent with selection on SaO scores. 6. Using estimated genotype probabilities at the putative major locus, we inferred that it acts in an overdominant fashion on body weight and fleshing score. If the low SaO allele leads to susceptibility to ascites, its combined effects are consistent with it being maintained in the population by a balance of natural selection on fitness nad artificial selection on growth and carcase traits. 7. Even with selection on both SaO and growth traits, the combined genotypic effects would make it difficult to remove the unfavourable low-SaO allele by means of traditional selection without the use of genetic markers.

  2. Gracilaria edulis extract induces apoptosis and inhibits tumor in Ehrlich Ascites tumor cells in vivo

    PubMed Central

    2013-01-01

    Background Marine environment is inestimable for their chemical and biological diversity and therefore is an extraordinary resource for the discovery of new anticancer drugs. Recent development in elucidation of the mechanism and therapeutic action of natural products helped to evaluate for their potential activity. Methods We evaluated Gracilaria edulis J. Ag (Brown algae), for its antitumor potential against the Ehrlich ascites tumor (EAT) in vivo and in vitro. Cytotoxicity evaluation of Ethanol Extract of Gracilaria edulis (EEGE) using EAT cells showed significant activity. In vitro studies indicated that EEGE cytotoxicity to EAT cells is mediated through its ability to produce reactive oxygen species (ROS) and therefore decreasing intracellular glutathione (GSH) levels may be attributed to oxidative stress. Results Apoptotic parameters including Annexin-V positive cells, increased levels of DNA fragmentation and increased caspase-2, caspase-3 and caspase-9 activities indicated the mechanism might be by inducing apoptosis. Intraperitoneally administration of EEGE to EAT-bearing mice helped to increase the lifespan of the animals significantly inhibited tumor growth and increased survival of mice. Extensive hematology, biochemistry and histopathological analysis of liver and kidney indicated that daily doses of EEGE up to 300 mg/kg for 35 days are well tolerated and did not cause hematotoxicity nor renal or hepatotoxicity. Conclusion Comprehensive antitumor analysis in animal model and in Ehrlich Ascites Tumor cells was done including biochemical, and pathological evaluations indicate antitumor activity of the extract and non toxic in vivo. It was evident that the mechanism explains the apoptotic activity of the algae extract. PMID:24274337

  3. Launch Pad Flame Trench Refractory Materials

    NASA Technical Reports Server (NTRS)

    Calle, Luz M.; Hintze, Paul E.; Parlier, Christopher R.; Bucherl, Cori; Sampson, Jeffrey W.; Curran, Jerome P.; Kolody, Mark; Perusich, Steve; Whitten, Mary

    2010-01-01

    The launch complexes at NASA's John F. Kennedy Space Center (KSC) are critical support facilities for the successful launch of space-based vehicles. These facilities include a flame trench that bisects the pad at ground level. This trench includes a flame deflector system that consists of an inverted, V-shaped steel structure covered with a high temperature concrete material five inches thick that extends across the center of the flame trench. One side of the "V11 receives and deflects the flames from the orbiter main engines; the opposite side deflects the flames from the solid rocket boosters. There are also two movable deflectors at the top of the trench to provide additional protection to shuttle hardware from the solid rocket booster flames. These facilities are over 40 years old and are experiencing constant deterioration from launch heat/blast effects and environmental exposure. The refractory material currently used in launch pad flame deflectors has become susceptible to failure, resulting in large sections of the material breaking away from the steel base structure and creating high-speed projectiles during launch. These projectiles jeopardize the safety of the launch complex, crew, and vehicle. Post launch inspections have revealed that the number and frequency of repairs, as well as the area and size of the damage, is increasing with the number of launches. The Space Shuttle Program has accepted the extensive ground processing costs for post launch repair of damaged areas and investigations of future launch related failures for the remainder of the program. There currently are no long term solutions available for Constellation Program ground operations to address the poor performance and subsequent failures of the refractory materials. Over the last three years, significant liberation of refractory material in the flame trench and fire bricks along the adjacent trench walls following Space Shuttle launches have resulted in extensive investigations of

  4. Bulk Vitrification Castable Refractory Block Protection Study

    SciTech Connect

    Hrma, Pavel R.; Bagaasen, Larry M.; Beck, Andrew E.; Brouns, Thomas M.; Caldwell, Dustin D.; Elliott, Michael L.; Matyas, Josef; Minister, Kevin BC; Schweiger, Michael J.; Strachan, Denis M.; Tinsley, Bronnie P.; Hollenberg, Glenn W.

    2005-05-01

    Bulk vitrification (BV) was selected for a pilot-scale test and demonstration facility for supplemental treatment to accelerate the cleanup of low-activity waste (LAW) at the Hanford U.S. DOE Site. During engineering-scale (ES) tests, a small fraction of radioactive Tc (and Re, its nonradioactive surrogate) were transferred out of the LAW glass feed and molten LAW glass, and deposited on the surface and within the pores of the castable refractory block (CRB). Laboratory experiments were undertaken to understand the mechanisms of the transport Tc/Re into the CRB during vitrification and to evaluate various means of CRB protection against the deposition of leachable Tc/Re. The tests used Re as a chemical surrogate for Tc. The tests with the baseline CRB showed that the molten LAW penetrates into CRB pores before it converts to glass, leaving deposits of sulfates and chlorides when the nitrate components decompose. Na2O from the LAW reacts with the CRB to create a durable glass phase that may contain Tc/Re. Limited data from a single CRB sample taken from an ES experiment indicate that, while a fraction of Tc/Re is present in the CRB in a readily leachable form, most of the Tc/Re deposited in the refractory is retained in the form of a durable glass phase. In addition, the molten salts from the LAW, mainly sulfates, chlorides, and nitrates, begin to evaporate from BV feeds at temperatures below 800 C and condense on solid surfaces at temperatures below 530 C. Three approaches aimed at reducing or preventing the deposition of soluble Tc/Re within the CRB were proposed: metal lining, sealing the CRB surface with a glaze, and lining the CRB with ceramic tiles. Metal liners were deemed unsuitable because evaluations showed that they can cause unacceptable distortions of the electric field in the BV system. Sodium silicate and a low-alkali borosilicate glaze were selected for testing. The glazes slowed down molten salt condensate penetration, but did little to reduce the

  5. Metabolomics in diabetic complications.

    PubMed

    Filla, Laura A; Edwards, James L

    2016-04-01

    With a global prevalence of 9%, diabetes is the direct cause of millions of deaths each year and is quickly becoming a health crisis. Major long-term complications of diabetes arise from persistent oxidative stress and dysfunction in multiple metabolic pathways. The most serious complications involve vascular damage and include cardiovascular disease as well as microvascular disorders such as nephropathy, neuropathy, and retinopathy. Current clinical analyses like glycated hemoglobin and plasma glucose measurements hold some value as prognostic indicators of the severity of complications, but investigations into the underlying pathophysiology are still lacking. Advancements in biotechnology hold the key to uncovering new pathways and establishing therapeutic targets. Metabolomics, the study of small endogenous molecules, is a powerful toolset for studying pathophysiological processes and has been used to elucidate metabolic signatures of diabetes in various biological systems. Current challenges in the field involve correlating these biomarkers to specific complications to provide a better prediction of future risk and disease progression. This review will highlight the progress that has been made in the field of metabolomics including technological advancements, the identification of potential biomarkers, and metabolic pathways relevant to macro- and microvascular diabetic complications.

  6. Celiac disease: how complicated can it get?

    PubMed

    Tjon, Jennifer May-Ling; van Bergen, Jeroen; Koning, Frits

    2010-10-01

    In the small intestine of celiac disease patients, dietary wheat gluten and similar proteins in barley and rye trigger an inflammatory response. While strict adherence to a gluten-free diet induces full recovery in most patients, a small percentage of patients fail to recover. In a subset of these refractory celiac disease patients, an (aberrant) oligoclonal intraepithelial lymphocyte population develops into overt lymphoma. Celiac disease is strongly associated with HLA-DQ2 and/or HLA-DQ8, as both genotypes predispose for disease development. This association can be explained by the fact that gluten peptides can be presented in HLA-DQ2 and HLA-DQ8 molecules on antigen presenting cells. Gluten-specific CD4(+) T cells in the lamina propria respond to these peptides, and this likely enhances cytotoxicity of intraepithelial lymphocytes against the intestinal epithelium. We propose a threshold model for the development of celiac disease, in which the efficiency of gluten presentation to CD4(+) T cells determines the likelihood of developing celiac disease and its complications. Key factors that influence the efficiency of gluten presentation include: (1) the level of gluten intake, (2) the enzyme tissue transglutaminase 2 which modifies gluten into high affinity binding peptides for HLA-DQ2 and HLA-DQ8, (3) the HLA-DQ type, as HLA-DQ2 binds a wider range of gluten peptides than HLA-DQ8, (4) the gene dose of HLA-DQ2 and HLA-DQ8, and finally,(5) additional genetic polymorphisms that may influence T cell reactivity. This threshold model might also help to understand the development of refractory celiac disease and lymphoma.

  7. Phosphates in some missouri refractory clays

    USGS Publications Warehouse

    Hall, R.B.; Foord, E.E.; Keller, D.J.; Keller, W.D.

    1997-01-01

    This paper describes in detail phosphate minerals occurring in refractory clays of Missouri and their effect on the refractory degree of the clays. The minerals identified include carbonate-fluorapatite (francolite), crandallite, goyazite, wavellite, variscite and strengite. It is emphasized that these phosphates occur only in local isolated concentrations, and not generally in Missouri refractory clays. The Missouri fireclay region comprises 2 districts, northern and southern, separated by the Missouri River In this region, clay constitutes a major part of the Lower Pennsylvanian Cheltenham Formation. The original Cheltenham mud was an argillic residue derived from leaching and dissolution of pre-Pennsylvanian carbonates. The mud accumulated on a karstic erosion surface truncating the pre-Cheltenham rocks. Fireclays of the northern district consist mainly of poorly ordered kaolinite, with variable but minor amounts of illite, chlorite and fine-grained detrital quartz. Clays of the southern district were subjected to extreme leaching that produced well-ordered kaolinite flint clays. Local desilication formed pockets of diaspora, or more commonly, kaolinite, with oolite-like nubs or burls of diaspore ("burley" clay). The phosphate-bearing materials have been studied by X-ray diffraction (XRD), scanning electron microscopy-energy dispersive spectral analysis (SEM-EDS) and chemical analysis. Calcian goyazite was identified in a sample of diaspore, and francolite in a sample of flint clay. A veinlet of wavellite occurs in flint clay at one locality, and a veinlet of variscite-strengite at another locality. The Missouri flint-clay-hosted francolite could not have formed in the same manner as marine francolite The evidence suggests that the Cheltenham francolite precipitated from ion complexes in pore water nearly simultaneously with crystallization of kaolinite flint clay from an alumina-silica gel. Calcian goyazite is an early diagenetic addition to its diaspore host

  8. Iron-refractory iron deficiency anemia (IRIDA).

    PubMed

    Heeney, Matthew M; Finberg, Karin E

    2014-08-01

    Iron deficiency anemia is a common global problem whose etiology is typically attributed to acquired inadequate dietary intake and/or chronic blood loss. However, in several kindreds multiple family members are affected with iron deficiency anemia that is unresponsive to oral iron supplementation and only partially responsive to parenteral iron therapy. The discovery that many of these cases harbor mutations in the TMPRSS6 gene led to the recognition that they represent a single clinical entity: iron-refractory iron deficiency anemia (IRIDA). This article reviews clinical features of IRIDA, recent genetic studies, and insights this disorder provides into the regulation of systemic iron homeostasis.

  9. [Treatment of refractory medication overuse headache].

    PubMed

    Hamada, Junichi

    2011-11-01

    Medication overuse headache (MOH) is refractory headache with continuous and large amount use of drugs (analgesics, non-steroidal anti-inflammatory drugs, and triptans etc.) For treatment of MOH, overused drugs must be stopped as soon as possible. And preventive medication should be started at the same time. Also, the history of the patient's headache and social condition must be clarified. In some cases, replacement therapy with another medication must be considered. But, even in recent years, scientific research in high-evidence level cannot be achieved. We should make more clear animal models of MOH and the investigations with more basic study must be scheduled.

  10. SNAP-8 refractory boiler development program

    NASA Technical Reports Server (NTRS)

    Fuller, R. A.

    1974-01-01

    Performance and endurance tests of the SNAP-8, SN-1 refractory metal boiler are described. The tests were successful and indicated that the boiler heat transfer area could be reduced significantly primarily because of the wetting characteristics of mercury on tantalum in a contaminant-free environment. A continuous endurance test of more than 10,000 hours was conducted without noticeable change in the thermal performance of the boiler. A conclusion of the metallographic examination of the boiler following the endurance test was that expected boiler life would be of the order of 40,000 hours at observed corrosion rates.

  11. REFRACTORY ARTICLE AND PROCESS OF MANUFACTURING SAME

    DOEpatents

    Hamilton, N.E.

    1957-12-10

    A method is described for fabricating improved uranium oxide crucibles. In the past, such crucibles have lacked mechanical strength due to the poor cohesion of the uranium oxide particles. This difficulty has now been overcome by admixing with the uranium oxide a quantity of a refractory oxide binder, and dry pressing and sintering the resulting mixture into the desired shape. Suitable as binders are BeO, CaO, Al/sub 2/C/sub 3/, and ThO/sub 2/ among others.

  12. Refractory overactive bladder: Beyond oral anticholinergic therapy

    PubMed Central

    Glinski, Ronald W.; Siegel, Steven

    2007-01-01

    Objectives: In this review, we discuss the treatment of refractory overactive bladder (OAB) that has not adequately responded to medication therapy and we propose an appropriate care pathway to the treatment of OAB. We also attempt to address the cost of OAB treatments. Materials and Methods: A selective expert review of the current literature on the subject of refractory OAB using MEDLINE was performed and the data is summarized. We also review our experience in treating refractory OAB. The role and outcomes of various treatment options for refractory OAB are discussed and combined therapy with oral anticholinergics is explored. Emerging remedies including intravesical botulinum toxin injection and pudendal neuromodulation are also reviewed, along with conventional surgical options. Results: In general behavioral therapy, pelvic floor electrical stimulation, magnetic therapy and posterior tibial nerve stimulation (PTNS), have shown symptom decreases in 50-80% of patients with OAB. Depending on the study, combination therapy with oral anticholinergics seems to improve efficacy of behavioral therapy and PTNS in approximately 10-30%. In multicenter, long-term randomized controlled trials, sacral neuromodulation has been shown to improve symptoms of OAB and OAB incontinence in up to 80% of the patients treated. Studies involving emerging therapies such as pudendal serve stimulation suggest that there may be a 15-20% increase in efficacy over sacral neuromodulation, but long-term studies are not yet available. Another emerging therapy, botulinum toxin, is also showing similar success in reducing OAB symptoms in 80-90% of patients. Surgical approaches, such as bladder augmentation, are a last resort in the treatment of OAB and are rarely used at this point unless upper tract damage is a concern and all other treatment options have been exhausted. Conclusion: The vast majority of OAB patients can be managed successfully by behavioral options with or without

  13. Treatment algorithms in refractory partial epilepsy.

    PubMed

    Jobst, Barbara C

    2009-09-01

    An algorithm is a "step-by-step procedure for solving a problem or accomplishing some end....in a finite number of steps." (Merriam-Webster, 2009). Medical algorithms are decision trees to help with diagnostic and therapeutic decisions. For the treatment of epilepsy there is no generally accepted treatment algorithm, as individual epilepsy centers follow different diagnostic and therapeutic guidelines. This article presents two algorithms to guide decisions in the treatment of refractory partial epilepsy. The treatment algorithm describes a stepwise diagnostic and therapeutic approach to intractable medial temporal and neocortical epilepsy. The surgical algorithm guides decisions in the surgical treatment of neocortical epilepsy.

  14. [Complications of tubal sterilization].

    PubMed

    Schreiner, W E

    1986-05-01

    In Europe and the US, tubal sterilization by laparoscopy has become the most widely used technique for female sterilization. The overall rate of intra- and postoperative complications differs between 0.145% and 0.85% in the numerous studies which have been done. This means 1 severe complication in 120-700 laparoscopic sterilizations. The lethality of tubal sterilization by laparoscopy lies between 3-10 deaths/100,000 interventions. The so-called "post-tubal ligation syndrome" is a rare complication. The overall pregnancy rate after tubal sterilization is 3-10/1000 women. The rate of ectopic pregnancy is very high and varies between 13.6% and 90%. Only 5% of the sterilized women show dissatisfaction. Several factors are relevant with regard to psychological sequelae and must be considered before tubal sterilization can be performed. 1 of the most important is the individual comprehensive counselling of the female or the couple prior to the sterilization.

  15. Osteoarticular complications of brucellosis.

    PubMed Central

    Colmenero, J D; Reguera, J M; Fernández-Nebro, A; Cabrera-Franquelo, F

    1991-01-01

    Two hundred and sixty three patients with a diagnosis of brucellosis between January 1984 and December 1987 were studied prospectively. Sixty five patients (25%) developed osteoarticular complications. These patients had a more prolonged course than those with no complications. Spondylitis in 38 (58%) and sacroiliitis in 29 (45%) were the most prevalent. There were no significant laboratory, serological, or bacteriological differences between patients with and without osteoarticular complications. At diagnosis 47 patients (72%) showed radiographic abnormalities, commonly in axial sites but rarely in peripheral sites. Radionuclide bone scan was positive with no radiographic abnormalities in 17 (26%) of cases. Fifty seven patients received medical treatment alone, 51 (89%) being cured with a single course of treatment. Treatment failed or there was a relapse in six patients (11%), of whom five had spondylitis. Eight of the 65 patients (12%), all of whom had spondylitis and paravertebral or epidural abscesses, also required surgical treatment. Images PMID:1994863

  16. [Orbital complications of sinusitis].

    PubMed

    Šuchaň, M; Horňák, M; Kaliarik, L; Krempaská, S; Koštialová, T; Kovaľ, J

    2014-12-01

    Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal

  17. Chronic unilateral occlusion of an extrapulmonary primary bronchus induces pulmonary hypertension syndrome (ascites) in male and female broilers.

    PubMed

    Wideman, R F; Kirby, Y K; Owen, R L; French, H

    1997-02-01

    Previously, it was demonstrated that acute (4 min) and chronic (12 d) occlusion of an extrapulmonary primary bronchus triggers pulmonary hypertension but not pulmonary hypertension syndrome (PHS, ascites) in broilers. The present study was conducted to determine whether a more prolonged period of bronchus occlusion causes PHS similar to that induced by clamping one pulmonary artery. Male and female broiler chicks, 14 to 18 d old, were anesthetized, the thoracic inlet was opened, and a silver clip was positioned to fully obstruct the left extrapulmonary primary bronchus (BRONCHUS CLAMP group) or the left pulmonary artery (PA-CLAMP group). Sham-operated chicks were anesthetized and the thoracic inlet was opened; however, neither the pulmonary artery nor the bronchus was clamped (SHAM group). An electrocardiogram (ECG) was obtained whenever clinical ascites became apparent in individual broilers, or prior to the final necropsy for broilers surviving to the end (Day 36) of the experiment. The right:total ventricular weight ratio (RV:TV) was evaluated as an index of pulmonary arterial pressure. Early post-surgical mortality (up to 21 d of age) was higher in the PA-CLAMP group (27% for males and females combined) than in the BRONCHUS CLAMP (10%) and SHAM (2%) groups. Cumulative ascites mortality (Days 22 to 36) also was higher in the PA-CLAMP group (86% for males, 77% for females) than in the BRONCHUS CLAMP (69% for males, 41% for females) and SHAM (23% for males, 0% for females) groups. Ascitic birds in all treatment groups had higher RV:TV ratios and more negative ECG Lead II S-wave amplitudes than nonascitic birds, reflecting the right ventricular hypertrophy and generalized ventricular dilation typically associated with PHS. These results demonstrate that unilateral bronchus occlusion is an effective experimental model for triggering ascites at a lower incidence than that obtained by occluding one pulmonary artery. Following the onset of pulmonary hypertension, the

  18. The effects of feed restriction and ambient temperature on growth and ascites mortality of broilers reared at high altitude.

    PubMed

    Ozkan, S; Takma, C; Yahav, S; Sögüt, B; Türkmut, L; Erturun, H; Cahaner, A

    2010-05-01

    The development of ascites was investigated in broilers at low versus high altitudes, cold versus normal ambient temperatures (AT), and 3 feeding regimens. One-day-old chicks obtained at sea level were reared at high altitude (highA; 1,720 m; n = 576) with 2 AT treatments, low AT from 3 wk onward at highA (highA/cold) and normal AT from 3 wk onward at highA (highA/norm), or at sea level (normal AT from 3 wk onward at low altitude, lowA/norm; n = 540). Under highA/cold, AT ranged between 16 to 17 degrees C in the fourth week, 17 to 19 degrees C in the fifth week, and 19 to 21 degrees C thereafter. Under highA/norm and lowA/norm, AT was 24 degrees C in the fourth week and ranged between 22 to 24 degrees C thereafter. Broilers in each condition were divided into 3 groups: feed restriction (FR) from 7 to 14 d, FR from 7 to 21 d, and ad libitum (AL). Ascites mortality and related parameters were recorded. Low mortality (0.4%) occurred under lowA/norm conditions. Under highA/norm, mortality was lower in females (8.6%) than in males (13.8%) and was not affected by the feeding regimen. The highA/cold treatment resulted in higher mortality but only in males; it was 44.2% among highA/cold AL-fed males and only about 26% under the FR regimens, suggesting that FR helped some males to better acclimatize to the highA/cold environment and avoid ascites. However, mortality was only 13.3% in AL-fed males at highA/norm and FR did not further reduce the incidence of ascites under these conditions. Thus, avoiding low AT in the poultry house by slight heating was more effective than FR in reducing ascites mortality at highA. Compared with FR from 7 to 14 d, FR from 7 to 21 d did not further reduce mortality and reduced growth. At 47 d, the majority of surviving broilers at highA had high levels of hematocrit and right ventricle:total ventricle weight ratio (>0.29), but they were healthy and reached approximately the same BW as their counterparts at low altitude. This finding may

  19. [Arteriovenous fistula of the spleen revealed by ascites and profuse diarrhea. A case report including ultrasonography and arteriography findings (author's transl)].

    PubMed

    Wenger, J J; Matter, D; Dupeyron, J P; Kretz, J G; Challan-Belval, P; Warter, P

    1981-05-01

    Abdominal pain, ascites and diarrhea revealed acute portal hypertension in a young woman. Ultrasonography and angiography demonstrated the causative congenital arterio-venous fistula of the splenic vessels. Surgery was successfully performed.

  20. Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

    PubMed Central

    Kheirkhah, A; Zavareh, M K; Farzbod, F; Mahbod, M; Behrouz, M J

    2011-01-01

    Purpose To evaluate the efficacy and safety of topical 0.005% tacrolimus eye drop for treatment of refractory vernal keratoconjunctivitis (VKC). Methods This prospective study included 20 eyes of 10 patients with refractory VKC, who had active symptomatic disease despite conventional medications including topical steroids. After discontinuing all other medications, patients were treated with topical 0.005% tacrolimus eye drop four times a day. Changes in subjective symptoms and objective signs after treatment were evaluated, and development of possible complications was assessed. Results Mean age of patients was 21.3±7.4 years and mean duration of VKC was 12.1±5.8 years. After starting tacrolimus eye drop, patients were followed for a mean duration of 10.7±3.7 months (range, 6–15 months). All symptoms including itching, redness, photosensitivity, foreign body sensation, and mucus discharge improved after the treatment; itching was the first symptom to show dramatic relief. In addition, there was improvement in objective signs including conjunctival hyperaemia, conjunctival papillary hypertrophy, giant papillae, limbal hypertrophy, corneal punctate epithelial erosions, and corneal pannus; conjunctival hyperaemia was the first sign to show improvement. No patient required addition of other medications including steroids for further relief. Any attempt to discontinue tacrolimus eye drop was associated with recurrence of patients' symptoms and signs, necessitating continued use of the medication during the entire follow-up time. No ocular complication related to tacrolimus was noted. Conclusion Topical 0.005% tacrolimus eye drop seemed to be a safe and effective treatment for steroid-resistant refractory VKC; however, long-term use was needed to control the disease. PMID:21475312

  1. Ziconotide: a new option for refractory pain.

    PubMed

    Prommer, Eric

    2006-06-01

    Ziconotide has been introduced as a new nonopioid treatment for chronic pain. Structurally, it is a peptide, the synthetic analog of the omega-conotoxin, derived from the marine snail, Conus magus. N-type voltage-sensitive calcium channels play a role in the transmission of nociceptive stimuli and also are involved in the release of neurotransmitters important in pain transmission. Ziconotide's therapeutic benefit derives from its potent and selective blockade of neuronal-type voltage-sensitive calcium channels. Blockade of the channels results in suppression of abnormal ectopic discharges from the injury site or the dorsal root ganglia, possibly resulting in decreased neuroplasticity, and decreased synaptic transmission that leads to the generation of chronic pain syndromes. The advantage of ziconotide is that tolerance does not occur, while disadvantages associated with ziconotide are the need for intrathecal administration and significant neurotoxicites associated with its use. When tested in clinical trials, ziconotide has been shown to have synergistic or additive value to the effect of morphine. Ziconotide, formerly known also as SNX- 111, represents a new class of agents, the N-type calcium channel blockers. These may represent another option for patients with refractory pain and refractory pain syndromes.

  2. Liposteroid therapy for refractory seizures in children.

    PubMed

    Yoshikawa, H; Yamazaki, S; Abe, T; Oda, Y

    2000-10-01

    Liposteroid is dexamethasone palmitate incorporated into liposomes and was developed as an anti-inflammatory drug for targeting therapy mainly for rheumatoid arthritis. Recently, it was reported that liposteroid might be effective for the treatment of West syndrome, with fewer side effects than those of corticotropin therapy. We describe three patients, a 2-month-old boy with early infantile epileptic encephalopathy, a 4-month-old girl with symptomatic West syndrome, and a 2-year-old girl with symptomatic localization-related epilepsy, whose refractory seizures were treated with liposteroid according to the original method reported by Yamamoto and colleagues in 1998. Uncontrollable seizures ceased completely in two patients and the seizure frequency decreased markedly in the other patient. Electroencephalograms revealed marked improvement in all patients. They showed no relapse of the seizures, and all showed no adverse effects except for mild brain shrinkage in one patient. Our experience with these three patients suggests that liposteroid therapy might be a new option for the treatment of refractory seizures in children, as well as for West syndrome.

  3. Dynamic Abnormal Grain Growth in Refractory Metals

    NASA Astrophysics Data System (ADS)

    Noell, Philip J.; Taleff, Eric M.

    2015-11-01

    High-temperature plastic deformation of the body-centered cubic (BCC) refractory metals Mo and Ta can initiate and propagate abnormal grains at significantly lower temperatures and faster rates than is possible by static annealing alone. This discovery reveals a new and potentially important aspect of abnormal grain growth (AGG) phenomena. The process of AGG during plastic deformation at elevated temperatures, termed dynamic abnormal grain growth (DAGG), was observed at homologous temperatures between 0.52 and 0.72 in both Mo and Ta sheet materials; these temperatures are much lower than those for previous observations of AGG in these materials during static annealing. DAGG was used to repeatedly grow single crystals several centimeters in length. Investigations to date have produced a basic understanding of the conditions that lead to DAGG and how DAGG is affected by microstructure in BCC refractory metals. The current state of understanding for DAGG is reviewed in this paper. Attention is given to the roles of temperature, plastic strain, boundary mobility and preexisting microstructure. DAGG is considered for its potential useful applications in solid-state crystal growth and its possibly detrimental role in creating undesired abnormal grains during thermomechanical processing.

  4. Refractory Materials for Flame Deflector Protection

    NASA Technical Reports Server (NTRS)

    Calle, Luz M.; Hintze, Paul E.; Parlier, Christopher R.; Sampson, Jeffrey W.; Curran, Jerome P.; Kolody, Mark R.; Peruisich, Stephen A.

    2010-01-01

    Fondu Fyre (FF) is currently the only refractory material qualified for use in the flame trench at KSC's Shuttle Launch Pads 39A and 3913. However, the material is not used as it was qualified and has undergone increasingly frequent and severe degradation due to the launch blasts. This degradation is costly as well as dangerous for launch infrastructure, crew and vehicle. The launch environment at KSC is unique. The refractory material is subject to the normal seacoast environment, is completely saturated with water before launch, and is subjected to vibrations and aggressive heat/blast conditions during launch. This report presents results comparing two alternate materials, Ultra-Tek FS gun mix and Kruzite GR Plus, with Fondu Fyre. The materials were subjected to bulk density, porosity, compression strength, modulus of rupture and thermal shock tests. In addition, test specimens were exposed to conditions meant to simulate the launch environment at KSC to help better understand how the materials will perform once installed.

  5. Evaluation of olivine refractories for TES

    NASA Astrophysics Data System (ADS)

    Gay, B. M.; Cochrane, R. L.; Palmour, H., III; Paisley, M. J.

    1982-02-01

    The principal objectives of this program are to (1) experimentally determine the degree of improvement in thermal and mechanical performance that can be obtained with an olivine thermal storage brick made of domestic materials using advanced processing techniques compared with state-of-the-art as represented by commercial European bricks, (2) conduct an assessment of existing German ceramic process technology and determine its adaptability to domestic raw materials and manufacturing practices, and (3) investigate, on a limited basis, method for further improvement of domestic-olivine brick. To date, accomplishments include (1) installation of improved, computer-based instrumentation, (2) the use of this system to determine performance characteristics of a set of heat storage refractories under cyclic use conditions, (3) acquisition of the services of a knowledgeable European consultant, (4) continued lab-scale process/property optimization studies, and (5) comparative testing of olivine-based and magnesite-based heat storage refractories in the calorimetric test facility at Purdue University.

  6. Extracorporeal Membrane Oxygenation for Refractory Cardiac Arrest

    PubMed Central

    Conrad, Steven A; Rycus, Peter T

    2017-01-01

    Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30–60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists). Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management. PMID:28074817

  7. Extracorporeal membrane oxygenation for refractory cardiac arrest.

    PubMed

    Conrad, Steven A; Rycus, Peter T

    2017-01-01

    Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists). Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  8. [Lenvatinib in radioiodine refractory thyroid carcinomas].

    PubMed

    de la Fouchardiere, Christelle

    2016-11-01

    Differentiated thyroid cancers are usually cured by an appropriate surgery and a radioiodine remnant ablation. If metastases occur, successive radioiodine administrations and/or local treatments can be provided. Nevertheless, some patients will be, or become refractory to radioiodine. In case of significant and rapid progression of metastatic lesions, they will be candidate to kinase inhibitor treatments. Two agents are now approved in this situation: sorafenib and lenvatinib. Lenvatinib (Lenvima(®)) is a tyrosine kinase inhibitor (TKI) targeting the VEGFR1-3, FGFR 1-4, PDGFR-α, RET and c-kit. It received an FDA and EMA approval in February and March 2015 for the treatment of radioiodine refractory thyroid cancers following the SELECT study's results. In this study, patients treated with lenvatinib had a significant increase in progression-free survival (18.3 months vs. 3.6 months; HR=0.21; CI=0.14-0.31, P < 0.001) and response rate (64.8% vs. 1.5% with placebo). The median overall survival was not reached in both groups at the time of data cutoff. In France, lenvatinib was first available within a compassionate use program (ATU) and is now dispended by hospitals because not yet marketed.

  9. Extracorporeal photopheresis performed on the CELLEX® compared with the UVAR-XTS® instrument is more efficient and better tolerated in children with steroid-refractory graft-versus-host disease.

    PubMed

    Kapadia, Ekta; Wong, Edward; Perez-Albuerne, Evelio; Jacobsohn, David

    2015-08-01

    Extracorporeal photopheresis (ECP) is an effective therapy in children with refractory graft-versus-host disease (GVHD). The two most frequently used instruments are UVAR-XTS® and CELLEX®. We performed a retrospective chart review of ten patients who underwent ECP with both UVAR-XTS® and CELLEX® instruments for steroid-refractory acute or chronic GVHD to compare instrument run times, percentages of cells treated, and complication rates. We found that compared to the UVAR-XTS® instrument, use of the CELLEX® instrument resulted in shorter run times, increased percentage of mononuclear cells treated, reduced incidence of line occlusions requiring TPA treatment, and decreased incidence of patient-related complications.

  10. Myocardial expression of transforming growth factor beta family and endothelin-1 in the progression from heart failure to ascites in broilers with cold-induced pulmonary hypertension.

    PubMed

    Ruiz-Castañeda, Gabriel; Dominguez-Avila, Norma; González-Ramírez, Javier; Fernandez-Jaramillo, Nora; Escoto-Herrera, Jorge; Sánchez-Muñoz, Fausto; Amezcua-Guerra, Luis Manuel; Marquez-Velasco, Ricardo; Bojalil, Rafael; Espinosa-Cervantes, Roman; Sánchez, Fausto

    2015-11-13

    We determined mRNA expression of genes of endothelin-1 (ET-1), and of the transforming growth factor beta ligands (TGFβ1, TGFβ2 and TGFβ3), their receptors (TβRI and TβRII) and their pseudoreceptor BAMBI in the heart of broilers raised under cold temperature conditions and affected by pulmonary hypertension. Gene expression was determined by RT-qPCR in right myocardial ventricle samples from 4-week-old chickens (n = 48) raised either under normal (control) or cold temperature conditions (22 °C versus 14 °C). We do not find differences among healthy birds, birds with cardiac failure and ascitic birds in the mRNA levels of TGFβ2, TGFβ3 and BAMBI. In the control group, ET-1 mRNA level was increased in the ascitic birds as compared with healthy birds and birds with cardiac failure (p < 0.05) whereas in the cold treated group, no increase was observed (p > 0.05); yet, ascitic birds in the cold group showed lower mean than ascitic birds in the control group (p < 0.05). TβRII mRNA expression was higher in ascitic than in healthy birds (p < 0.05) in both control and cold treated groups; however, in the ascitic birds of the cold treated group TβRII expression was lower than in ascitic birds from the control group (p < 0.05). Thus, the higher ET-1 and TβRII levels observed in ascitic birds seem to be attenuated by cold.

  11. [Septic complications of gonorrhea].

    PubMed

    Ebner, H; Gebhart, W

    1976-09-01

    Septic gonococcal complications consist in intermittent fever, arthralgia and skin lesions. In recent years predominantly females suffering from this disease were observed. This diagnosis is made by the demonstration of gonococcal infection combined with the above mentioned clinical symptoms. A further confirmation is possible by blood culture and the demonstration of gonococci in skin lesions or joint fluid.

  12. Cardiovascular Complications of Pregnancy

    PubMed Central

    Gongora, Maria Carolina; Wenger, Nanette K.

    2015-01-01

    Pregnancy causes significant metabolic and hemodynamic changes in a woman’s physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up. PMID:26473833

  13. Cardiovascular Complications of Pregnancy.

    PubMed

    Gongora, Maria Carolina; Wenger, Nanette K

    2015-10-09

    Pregnancy causes significant metabolic and hemodynamic changes in a woman's physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.

  14. Complicating Visual Culture

    ERIC Educational Resources Information Center

    Daiello, Vicki; Hathaway, Kevin; Rhoades, Mindi; Walker, Sydney

    2006-01-01

    Arguing for complicating the study of visual culture, as advocated by James Elkins, this article explicates and explores Lacanian psychoanalytic theory and pedagogy in view of its implications for art education practice. Subjectivity, a concept of import for addressing student identity and the visual, steers the discussion informed by pedagogical…

  15. Hypoglycemia: The neglected complication

    PubMed Central

    Kalra, Sanjay; Mukherjee, Jagat Jyoti; Venkataraman, Subramanium; Bantwal, Ganapathi; Shaikh, Shehla; Saboo, Banshi; Das, Ashok Kumar; Ramachandran, Ambady

    2013-01-01

    Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications. PMID:24083163

  16. Fibers of newly developed refractory ceramics produced by improved process

    NASA Technical Reports Server (NTRS)

    1966-01-01

    Rods of refractory ceramic material and glasses having relatively high fusion temperatures and tensile strengths are converted to fiber by subjecting these rods to alternate fusion and gas-jet bursts. The refractory, high tensile strength fibers produced are combined with suitable binder to produce heat-resistant fabrics and rigid structures.

  17. Method of coating graphite tubes with refractory metal carbides

    DOEpatents

    Wohlberg, C.

    1973-12-11

    A method of coating graphite tubes with a refractory metal carbide is described. An alkali halide is reacted with a metallic oxide, the metallic portion being selected from the IVth or Vth group of the Periodic Table, the resulting salt reacting in turn with the carbon to give the desired refractory metal carbide coating. (Official Gazette)

  18. Bortezomib for refractory antibody-mediated cardiac allograft rejection.

    PubMed

    Eckman, Peter M; Thorsgard, Marit; Maurer, David; Kim, Youngki; Alloway, Rita R; Woodle, E Steve

    2009-01-01

    This experience demonstrates that a bortezomib-based regimen provided effective therapy for late, refractory AMR in an adult heart transplant recipient and was well tolerated. This remarkably positive experience despite the refractory nature of the AMR episode argues strongly for continued evaluation of bortezomib use in this patient population.

  19. Refractory alloy technology for space nuclear power applications

    SciTech Connect

    Cooper, R.H. Jr.; Hoffman, E.E.

    1984-01-01

    Purpose of this symposium is twofold: (1) to review and document the status of refractory alloy technology for structural and fuel-cladding applications in space nuclear power systems, and (2) to identify and document the refractory alloy research and development needs for the SP-100 Program in both the short and the long term. In this symposium, an effort was made to recapture the space reactor refractory alloy technology that was cut off in midstream around 1973 when the national space nuclear reactor program began in the early 1960s, was terminated. The six technical areas covered in the program are compatibility, processing and production, welding and component fabrication, mechanical and physical properties, effects of irradiation, and machinability. The refractory alloys considered are niobium, molybdenum, tantalum, and tungsten. Thirteen of the 14 pages have been abstracted separately. The remaining paper summarizes key needs for further R and D on refractory alloys. (DLC)

  20. PENETRATION OF COAL SLAGS INTO HIGH-CHROMIA REFRACTORIES

    SciTech Connect

    Longanbach, Sara C.; Matyas, Josef; Sundaram, S. K.

    2009-10-05

    Slagging coal gasifiers are used for the production of electricity and synthetic gases, as well as chemicals. High temperatures in the reaction chamber, typically between 1250ºC and 1600ºC, high pressure, generally greater than 400 psi, and corrosive slag place severe demands on the refractory materials. Slag produced during the combustion of coal flows over the refractory surface and penetrates the porous material. Slag penetration is typically followed by spalling of a brick that significantly decreases the service life of gasifier refractories. Laboratory tests were conducted to determine the penetration depth of slags into high-chromia refractories as a function of time and temperature for various refractory-slag combinations.