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1.
Curr Med Sci ; 39(5): 719-726, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612388

RESUMO

Hepatitis E virus (HEV) infection is a major cause of morbidity in endemic areas. Its consequences among chronic hepatitis B (CHB) patients have been under-reported. The aim of this study was to assess the impact of superinfective HEV infection (acute and past) on virological and clinical features of patients with CHB infection. Clinical, biochemical, virological and immunological data of 153 CHB patients including 98 with hepatitis B virus (HBV) monoinfection and 55 with HBV-HEV superinfection with both HEV and HBV infection was retrospectively investigated and analyzed in this study conducted in Wuhan, China. An overall anti-HEV IgG seroprevalence was found to be 35.9% in CHB patients. HBV-HEV superinfection patients showed significantly higher rate of complications (ascites, hepato-renal syndrome & encephalopathy) (all with P=0.04), cirrhosis (P<0.001) and acute-on-chronic liver failure (P<0.001) than HBV monoinfection patients. They also displayed elevated ALTs (P<0.001) and total serum bilirubin (P<0.001) with diminished albumin (P<0.001) and HBV viral load (P<0.001). Cytokines assay revealed increased expression of IL-6 (P=0.02), IL-10 (P=0.009) and TNF-α (P=0.003) in HBV-HEV superinfection patients compared to HBV monoinfection patients. Our study demonstrated that HEV superinfection in CHB patients was associated with progressive clinical manifestation, which is likely due to the enhanced expression of cytokines related with hepatocytes necrosis. HEV was also associated with repressed HBV replication, but the underlying mechanism requires further investigation.


Assuntos
Insuficiência Hepática Crônica Agudizada/virologia , Ascite/virologia , Encefalopatia Hepática/virologia , Hepatite B Crônica/virologia , Hepatite E/virologia , Síndrome Hepatorrenal/virologia , Cirrose Hepática/virologia , Superinfecção/virologia , Insuficiência Hepática Crônica Agudizada/complicações , Insuficiência Hepática Crônica Agudizada/imunologia , Insuficiência Hepática Crônica Agudizada/patologia , Adulto , Idoso , Alanina Transaminase/sangue , Alanina Transaminase/imunologia , Ascite/complicações , Ascite/imunologia , Ascite/patologia , Bilirrubina/sangue , Bilirrubina/imunologia , China , Feminino , Encefalopatia Hepática/complicações , Encefalopatia Hepática/imunologia , Encefalopatia Hepática/patologia , Anticorpos Anti-Hepatite/sangue , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/complicações , Hepatite B Crônica/imunologia , Hepatite B Crônica/patologia , Hepatite E/complicações , Hepatite E/imunologia , Hepatite E/patologia , Vírus da Hepatite E/imunologia , Vírus da Hepatite E/patogenicidade , Hepatócitos/imunologia , Hepatócitos/patologia , Hepatócitos/virologia , Síndrome Hepatorrenal/complicações , Síndrome Hepatorrenal/imunologia , Síndrome Hepatorrenal/patologia , Humanos , Imunoglobulina G/sangue , Interleucina-10/sangue , Interleucina-10/imunologia , Interleucina-6/sangue , Interleucina-6/imunologia , Fígado/imunologia , Fígado/patologia , Fígado/virologia , Cirrose Hepática/complicações , Cirrose Hepática/imunologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Superinfecção/complicações
2.
Am J Case Rep ; 20: 1446-1448, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570687

RESUMO

BACKGROUND Spontaneous bacterial peritonitis is frequently described in cirrhotic patients who develop infected ascitic fluid. However, ascites can be cardiac in origin. The phenomenon of spontaneous bacterial peritonitis in cardiac ascites is an extremely rare but deadly occurrence. CASE REPORT Here we present a unique case of a patient who was admitted for advanced cardiorenal syndrome in the setting of a viral colitis that likely promoted a bacterial translocation resulting in spontaneous bacterial peritonitis. CONCLUSIONS This case tends to shed light on a few quintessential points for clinicians to be aware of, including the potential intersection between the microbiota and metabolic effects of congestive heart failure and the necessity to lower the diagnostic threshold for spontaneous bacterial peritonitis cardiac ascites in patient's presenting for a congestive heart failure exacerbation.


Assuntos
Ascite/complicações , Translocação Bacteriana , Peritonite/microbiologia , Idoso de 80 Anos ou mais , Colite/virologia , Evolução Fatal , Microbioma Gastrointestinal , Insuficiência Cardíaca/complicações , Humanos , Masculino
3.
Medicine (Baltimore) ; 98(43): e17078, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651835

RESUMO

To investigate the feasibility, efficacy, and safety of laparoscopic totally extraperitoneal (TEP) repair in patients with inguinal hernia accompanied by liver cirrhosis.Between October 2015 and May 2018, 17 patients with liver cirrhosis who underwent TEP repair were included in this study. The baseline characteristics, perioperative data, and recurrence were retrospectively reviewed.Seventeen patients with a mean duration of 18.23 ± 16.80 months were enrolled. All TEP repairs were successful without conversion to trans-abdominal pre-peritoneal (TAPP) surgery or open repair, but 4 patients had peritoneum rupture during dissection. The mean operation time was 54.23 ±â€Š10.51 minutes for unilateral hernia and 101.25 ±â€Š13.77 minutes for bilateral hernias. We found 2 cases with contralateral inguinal hernia and 2 cases with obturator hernia during surgery. The rate of complication was 17.65% (3/17), 2 of 3 cases were Child-Turcotte-Pugh C with large ascites. During a follow-up of 19.29 ±â€Š9.01 months, no patients had recurrence and chronic pain, but 2 patients died because of the progression of underlying liver disease.Early and elective inguinal hernia repair is feasible and effective for patients with liver cirrhosis. TEP is a feasible and safe repair option for cirrhotic patients in experienced hands.


Assuntos
Ascite/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Cirrose Hepática/cirurgia , Abdome/cirurgia , Adulto , Idoso , Ascite/complicações , Conversão para Cirurgia Aberta/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hérnia Inguinal/etiologia , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Peritônio/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
4.
Am J Case Rep ; 20: 1526-1529, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31619662

RESUMO

BACKGROUND Spontaneous fungal peritonitis (SFP) is a life-threatening infection which occurs more commonly in patients with liver failure. SFP is not as common as spontaneous bacterial peritonitis (SBP) and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. Spontaneous fungal peritonitis is extremely uncommon in patients with cardiac ascites due to a high protein content, which predisposes to a low risk of infections. CASE REPORT This report presents a rare case of spontaneous fungal peritonitis in a patient with cardiogenic ascites. To the best of our knowledge, this is the second known case of SFP occurring in a patient with cardiac cirrhosis. The patient did not respond to initiation of SBP treatment and after ascitic fluid grew Candida glabrata, the diagnosis of SFP was made. The patient's clinical status improved after initiation of intravenous caspofungin. CONCLUSIONS SFP should be a differential diagnosis in patients who have cardiac or liver cirrhosis, who are not improving with empirical antibiotic therapy for spontaneous bacterial peritonitis.


Assuntos
Ascite/complicações , Fibrose/complicações , Micoses/diagnóstico , Micoses/etiologia , Miocárdio/patologia , Peritonite/diagnóstico , Peritonite/etiologia , Antifúngicos/uso terapêutico , Candida glabrata/efeitos dos fármacos , Caspofungina/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Peritonite/tratamento farmacológico , Fatores de Tempo
5.
Transplant Proc ; 51(8): 2740-2744, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31563243

RESUMO

BACKGROUND: Refractory ascites is one of the major complications of liver transplant (LT) and is associated with increased morbidity and mortality. The aim of this study was to analyze the efficacy and safety of novel cell-free and concentrated ascites reinfusion therapy (KM-CART) for the treatment of refractory ascites during preoperative living donor liver transplant. METHODS: Forty KM-CART procedures were performed on 8 liver transplant candidates. We investigated the safety and efficacy of KM-CART in terms of the processed ascites, adverse events, laboratory data, and patient condition. RESULTS: By using KM-CART, an average of 12.5 L (range, 2.6-26.1 L) of ascites was filtered and concentrated to 0.5 L (range, 0.1-1.6 L) in 62 minutes (range, 8-187 minutes). Final products contained 21.5 g (range, 2.5-65.6 g) of albumin and 13.5 g (range, 1.5-61.8 g) of globulin. No endotoxin contamination was detected in the ascites. Although the incidence of adverse events was 35.0% (including fever, hypotension, bleeding, leg cramps, and nausea), all of these could be treated conservatively. Body weight and oral intake were significantly improved after KM-CART. Furthermore, the use of fresh frozen plasma for the LT recipients with KM-CART was significantly lower than that for patients without KM-CART. In addition, no patients lost their opportunity for LT because of adverse events due to KM-CART. CONCLUSIONS: Our findings show that KM-CART could be a promising option for the treatment of refractory ascites during the preoperative period of LT. This study provides the foundation for further large-scale prospective studies.


Assuntos
Ascite/complicações , Ascite/cirurgia , Cirrose Hepática/complicações , Transplante de Fígado , Paracentese/métodos , Adulto , Idoso , Feminino , Humanos , Cirrose Hepática/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Medicine (Baltimore) ; 98(26): e16016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261505

RESUMO

Spontaneous bacterial peritonitis (SBP) is one of the most frequent and severe complications in patients with decompensated cirrhosis. Early antibiotic therapy is extremely important for successful treatment and reducing mortality. Prostaglandin E2 (PGE2) is a regulator of the immune response and infection. This study aimed to explore whether ascitic PGE2 could be used as a marker for diagnosing SBP and predicting in-hospital mortality.Patients with cirrhosis and ascites undergoing abdominal paracentesis were enrolled in our study. Demographic, clinical, and laboratory parameters were recorded at the time of paracentesis and ascitic PGE2 levels were determined by ELISA. The correlation between ascitic PGE2 level and SBP as well as in-hospital mortality were analyzed.There were 224 patients enrolled, 29 (13%) patients diagnosed as SBP based on the current guideline criteria. The ascitic PGE2 level of patients with SBP [32.77 (26.5-39.68) pg/mL] was significantly lower than that of patients without SBP [49.72 (37.35-54.72) pg/mL]. In ROC analysis, the AUC of ascitic PGE2 for the diagnosis of SBP was 0.75, and the AUC of ascitic PGE2 combined with WBC and ascitic PGE2 combined with neutrophils were 0.90 and 0.90, respectively, which were significantly higher than that of ascitic PGE2. In multivariate analysis, ascites PGE2≤32.88 pg/mL (OR: 9.39; 95% CI: 1.41-67.44, P = .026), hepatic encephalopathy (OR: 18.39; 95% CI: 3.00-113.13, P = .002) and a higher MELD score (OR: 1.25; 95% CI: 1.05-1.40, P = .009) remained independent predictors of in-hospital mortality.Ascitic PGE2 level is likely to be a valuable marker in prediction of in-hospital mortality in patients with decompensated cirrhosis, and its value in diagnosis of SBP was not superior to other inflammatory indicators.


Assuntos
Líquido Ascítico/metabolismo , Infecções Bacterianas/metabolismo , Dinoprostona/metabolismo , Mortalidade Hospitalar , Cirrose Hepática/complicações , Peritonite/metabolismo , Área Sob a Curva , Ascite/complicações , Ascite/metabolismo , Ascite/mortalidade , Infecções Bacterianas/complicações , Infecções Bacterianas/mortalidade , Biomarcadores/metabolismo , Feminino , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/mortalidade , Prognóstico , Estudos Prospectivos , Curva ROC
7.
Ann Ital Chir ; 90: 252-257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31354143

RESUMO

BACKGROUND: Inguinal hernioplasty in patients with LC and ascites has been long discouraged for the incidence of postoperative complications. The aim is to evaluate the appropriateness of this elective surgical procedure in patients with LC and ascites. METHODS: Thirty consecutive LC patients with ascites and affected by inguinal hernia (LC group), who underwent elective open inguinal hernioplasty with mesh placement, have been matched with the same number of patients non-LC (non-LC group) who underwent the same surgical procedure in the same period of time. All patients in LC group received a careful hepatological assessment and were classified according to the etiology of LC and to the Child's class. Patients of both groups received an antibiotic prophylaxis and were operated under local anesthesia. RESULTS: No significant complications were observed in any patients during surgery. The hospital stay was significantly longer in LC group. During the postoperative time, 4 inguinoscrotal hematoma appeared in LC group, of which 3 in class C (LC VS non-LC p>0.05; non-LC VS Child's class C p<0.023). Ascites leakage or wound infection were not observed. CONCLUSION: Inguinal hernioplasty can be safely performed for LC patients in Child's class A and B; for patients in class C, careful attention must be paid to the hemorrhagic events. KEY WORDS: Ascites, Cirrhosis, Hernioplasty.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Ascite/complicações , Estudos de Casos e Controles , Hérnia Inguinal/complicações , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
10.
Medicine (Baltimore) ; 98(19): e15477, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083181

RESUMO

RATIONALE: Recurrent massive hemorrhagic ascites secondary to endometriosis is extremely rare in the medical literature. PATIENT CONCERNS: We report the case of a 24-year-old nulliparous woman presenting with severe abdominal distention, massive ascites, moderate anemia, menstrual pain, and an elevated CA-125 level. DIAGNOSIS: We found a thickened peritoneum in the left lower abdomen by ultrasound during the follow-up period, and endometriosis was subsequently diagnosed by performing core needle biopsy (CNB). INTERVENTIONS AND OUTCOMES: The patient received medical treatment for endometriosis and had a good response to the treatment. LESSONS: This is the first case in which endometriosis ectopic to peritoneum was diagnosed by CNB. Endometriosis should be considered a differential diagnosis when recurrent massive hemorrhagic ascites occur. CNB should be valued as a method for diagnosing endometriosis.


Assuntos
Ascite/diagnóstico , Endometriose/diagnóstico , Hemorragia/diagnóstico , Ascite/complicações , Ascite/tratamento farmacológico , Ascite/patologia , Biópsia com Agulha de Grande Calibre , Tratamento Conservador , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/tratamento farmacológico , Endometriose/patologia , Feminino , Hemorragia/complicações , Hemorragia/tratamento farmacológico , Hemorragia/patologia , Humanos , Peritônio/diagnóstico por imagem , Peritônio/patologia , Recidiva , Adulto Jovem
12.
Am J Med Sci ; 357(6): 512-516, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30975430

RESUMO

An anuric woman with ascites rapidly developed extreme hyperglycemia and seizures after hemodialysis. During development of hyperglycemia, the decrease in serum sodium concentration (Δ[Na]) was nearly twice the value predicted by a formula accounting for the degree of hyperglycemia and the intracellular-to-extracellular volume ratio. The prediction assumed that ascitic fluid is part of the extracellular volume. Potential contributors to the development of seizures include the rapid development of severe hypertonicity, a remote history of seizure disorder and development of dialysis disequilibrium syndrome. Observations in peritoneal dialysis suggest that fluid with sodium concentration lower than in the ascitic fluid is transferred from the abdominal cavity into the blood during rapid development of hyperglycemia. In this case, Δ[Na], which determines the tonicity level expected after correction of hyperglycemia, resulted from exit of both intracellular and ascitic fluid into the extracellular compartment and, therefore, ascitic fluid functions as an extension of the intracellular fluid.


Assuntos
Ascite/complicações , Hiperglicemia/etiologia , Diálise Renal/efeitos adversos , Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/terapia , Feminino , Humanos , Adulto Jovem
13.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(3): 277-281, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-30907354

RESUMO

A 13-year-old boy was admitted due to intermittent abdominal pain for one year with massive ascites. The purified protein derivative (PPD) test after admission yielded positive results (3+), and ascites examination revealed a yellow color. There were 634×109 nucleated cells/L in the ascites, among which 82.2% were mononuclear cells and 17.8% were multinuclear cells. The Rivalta test yielded a positive result and revealed that the ascites was exudate, suggesting the possibility of tuberculosis infection. The symptoms were not relieved after isoniazid-rifampicin anti-tuberculosis therapy and symptomatic/supportive treatment. Plain CT scan of the abdomen and contrast-enhanced CT showed that the lesion was located at the left wall of the transverse colon, with uneven thickening of the peritoneum and heterogeneous enhancement. Colonoscopic biopsy found signet ring cells in the mucosa and immunohistochemical examination revealed Syn (-), CgA (-), CD56 (-), CK(pan) (+), CDX-2 (+), CK20 (+), Muc-1 (+) and Ki-67 (+, about 80%). PET-CT scan showed an abnormal increase in fluorodeoxyglucose metabolism, which was shown as a mass near the splenic flexure of the transverse colon, with a maximum standard uptake value of 9.9, indicating a highly active lesion; this was consistent with the metabolic changes of malignant tumors. Surgical operation was performed and intraoperative exploration revealed massive ascites, a hard mass located at the hepatic flexure of the colon, involvement of the serous coat and surrounding tissues, stenosis of the bowel, lymph node enlargement around the superior mesenteric vessels and the gastrocolic ligament, and multiple metastatic nodules in the greater omentum, the abdominal wall and the pelvic cavity. The results of postoperative pathology were consistent with those of colonoscopic biopsy, i.e., poorly differentiated mucinous adenocarcinoma of the transverse colon and partly signet-ring cell carcinoma. Therefore, the boy was diagnosed with colon signet-ring cell carcinoma with peritoneal metastasis and tuberculosis infection. When a child is suffering from intractable abdominal pain, unexplained intestinal obstruction and massive intractable ascites, the possibility of malignancy should be considered. Abdominal plain CT scan as well as contrast-enhanced CT scan should be performed as early as possible, and enteroscopy should be performed when necessary.


Assuntos
Dor Abdominal , Ascite , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Abdome , Dor Abdominal/etiologia , Adolescente , Ascite/complicações , Fadiga/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
14.
J Pharmacol Sci ; 139(4): 373-376, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30857764

RESUMO

To investigate the relationship between the exposure and efficacy of tolvaptan, we measured pharmacokinetics of total drug at 7 days after repeated doses of 3.75 mg/day tolvaptan in 16 patients with hepatic edema. Nine patients (56.3%) were responders, which were defined as those with body weight reduction of >1.5 kg/week. Serum albumin levels were significantly lower in responders than in non-responders (P = 0.031). However, the pharmacokinetics varied greatly among individuals and was not relevant to the clinical response.


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/farmacocinética , Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Ascite/tratamento farmacológico , Ascite/metabolismo , Edema/tratamento farmacológico , Edema/metabolismo , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/metabolismo , Hepatopatias/tratamento farmacológico , Hepatopatias/metabolismo , Tolvaptan/farmacocinética , Tolvaptan/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas dos Receptores de Hormônios Antidiuréticos/sangue , Ascite/complicações , Edema/complicações , Feminino , Humanos , Cirrose Hepática/complicações , Hepatopatias/complicações , Masculino , Pessoa de Meia-Idade , Albumina Sérica/metabolismo , Tolvaptan/sangue , Resultado do Tratamento
15.
Trop Doct ; 49(3): 189-192, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30786830

RESUMO

Cirrhotic patients with ascites are at high risk of developing spontaneous bacterial peritonitis (SBP). After exclusion of patients with acute kidney injury (AKI) or other infections, urinary neutrophil gelatinase-associated lipocalin (NGAL) levels were compared between two matched groups of Egyptian cirrhotic patients with ascites, mostly secondary to hepatitis C infection (98%). Group 1 had SBP (n = 41) and group 2 did not (n = 45). By univariate analysis, urinary-NGAL, high total bilirubin, serum creatinine, international normalised ratio and the Model of End-Stage Liver Disease (MELD) score and low platelet count were all significantly correlated with the presence of SBP, but only urinary-NGAL could independently predict development of SBP (P = 0.001). Urinary-NGAL at a cut-off value of 1225 pg/mL, showed a sensitivity of 95% and a specificity of 76%, and is therefore a most useful tool.


Assuntos
Ascite/complicações , Infecções Bacterianas/urina , Lipocalina-2/urina , Cirrose Hepática/complicações , Peritonite/urina , Adulto , Ascite/urina , Infecções Bacterianas/complicações , Biomarcadores/urina , Feminino , Humanos , Cirrose Hepática/urina , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Sensibilidade e Especificidade
16.
Clin Lab ; 65(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30775892

RESUMO

BACKGROUND: Cirrhotic patients with hemorrhagic ascites have significant morbidity and mortality. This study aims to determine the relationship between D-dimer values and hemorrhagic ascites in cirrhotic patients and analyze its predictive value. METHODS: This retrospective study screened 572 consecutive cirrhotic patients with ascites and hemorrhagic ascites (defined as red blood cells (RBC) in ascitic fluid ≥ 10,000/µL) during a 72-month period. The overall patient survival rate was measured by Kaplan-Meier analysis method. The relationship between D-dimer and hemorrhagic ascites was also examined. A multivariate Cox proportional hazard analysis was performed to assess the indepen-dent risk factors related to mortality. RESULTS: Both control group and hemorrhagic ascites patients had obvious hepatic dysfunction as determined by Model for End-Stage Liver Disease (MELD) scores of 6.37 ± 1.05 and 11.82 ± 2.86, respectively (p < 0.001). There was a higher prevalence of patients with significant ascites in those with spontaneous hemorrhagic ascites than in the control group (p = 0.003). There were significant differences in D-dimer levels between both groups (9.44 ± 5.11 vs. 26.83 ± 5.35, p < 0.001). Hemorrhagic ascites was significantly and positively correlated with D-dimer levels (r = 0.692, p < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.9838. Using Cox proportional hazard model for multivariate prognostic analysis, MELD, D-dimer and presence of spontaneous hemorrhagic ascites were independent predictors of 3-year mortality. CONCLUSIONS: Patients with hemorrhagic ascites had a significantly higher MELD score, D-dimer, and mortality than patients with ascites alone. D-dimer was associated with the appearance of hemorrhagic ascites and was found to be a marker of advanced liver disease and poor outcomes.


Assuntos
Ascite/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Cirrose Hepática/sangue , Adulto , Idoso , Ascite/complicações , Líquido Ascítico , Feminino , Hemorragia/sangue , Hemorragia/complicações , Humanos , Estimativa de Kaplan-Meier , Fígado/patologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
17.
Pancreas ; 48(3): 343-349, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789387

RESUMO

OBJECTIVES: This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with pancreatic ascites (PAs). METHODS: Severe acute pancreatitis patients with PAs were randomly assigned within 3 days of onset of symptoms to receive either PL or PCD. The primary end point was a composite of mortality or major complications during hospitalization and within 1 month of discharge. Per-protocol analyses were performed. RESULTS: Between September 2011 and June 2014, 86 patients were randomly assigned to intervention with PL or PCD. Ultimately, 41 patients in the PCD group and 39 patients in the PL group completed the study. The primary end point occurred in 15 (36.6%) of 41 patients in the PCD group and in 17 (43.6%) of 39 patients in the PL group (risk ratio, 0.84; 95% confidence interval, 0.49-1.44; P = 0.27). Mortality or major complications did not differ between the groups. Percutaneous drainage reduced intra-abdominal hypertension; however, PL reduced the incidence of deep venous thrombosis and pancreatic encephalopathy and was associated with a reduced need for intervention. CONCLUSIONS: In our study, the PCD was not superior to the PL in reducing mortality or major complications in severe acute pancreatitis patients with PAs.


Assuntos
Ascite/terapia , Drenagem/métodos , Pancreatopatias/terapia , Pancreatite/terapia , Lavagem Peritoneal/métodos , Doença Aguda , Adulto , Ascite/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatite/complicações , Pancreatite/patologia , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
18.
Med Ultrason ; 21(1): 30-36, 2019 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-30779828

RESUMO

AIMS: To evaluate ultrasound findings in order to determine potential predictors of prognosis in pediatric patients with portal venous gas (PVG) detected by ultrasound. MATERIALS AND METHODS: Thirty-nine children were included and divided into two groups: benign PVG (n=24) and life-threatening PVG (n=15; 6 surgical interventions and 9 deaths). Possible predictors, i.e., the location of PVG in the liver, the distribution of intestinal pneumatosis, ascites and free air were compared between the two groups. RESULTS: A significant difference was noted between the two groups in terms of the distribution of intestinal pneumatosis (limited to the large bowel, benign vs life-threatening = 60.9% (14/23):21.4% (3/14), p=0.040), the absence of ascites (benign vs life-threatening = 79.1% (19/24):40.0% (6/15), p=0.019) and patient age (benign vs life-threatening = 52.5±65.3 months vs 19.7±44.0 months, p=0.019). No significant difference was observed in the location of PVG in the liver, the presence of free air, and sex between the two groups. CONCLUSIONS: In pediatric patients with PVG, including various ages and underlying diseases, intestinal pneumatosis limited to the large bowel and absence of ascites were predictors of a benign prognosis. However, despite the presence of these predictors, some patients with PVG required surgical intervention, therebysuggesting that the cause of PVG, such as necrotizing enterocolitis, volvulus, or pancreatitis, must be also carefully evaluated.


Assuntos
Enteropatias/complicações , Enteropatias/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Ultrassonografia , Adolescente , Ascite/complicações , Ascite/diagnóstico por imagem , Ascite/patologia , Criança , Pré-Escolar , Feminino , Gases , Humanos , Lactente , Recém-Nascido , Enteropatias/patologia , Intestinos/diagnóstico por imagem , Intestinos/patologia , Intestinos/cirurgia , Masculino , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/patologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
BMJ Case Rep ; 12(1)2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30635302

RESUMO

The clinical scenario of a female patient with a pelvic mass, elevated CA125 tumour marker, pleural effusion and ascites is often associated with malignancy. However, not all cases are malignant. Non-malignant diseases, such as Meigs syndrome and pseudo-Meigs syndrome, must be part of your differential. We present a 56-year-old woman with dyspnoea secondary to a right pleural effusion. After further investigations, a serum cancer antigen-125 was found to be elevated at 437.3 U/mL. CT of her abdomen and pelvis showed a large heterogeneous mass in the pelvis measuring 13.2×9.7×15.1 cm with mild ascites. She was initially thought to have ovarian carcinoma and underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with omental biopsy. Pathology from the surgical specimen revealed a hydropic leiomyoma and after removal of pelvic mass her pleural effusion and ascites completely resolved. She was ultimately diagnosed with the rare pseudo-Meigs syndrome.


Assuntos
Leiomioma/patologia , Síndrome de Meigs/patologia , Neoplasias Ovarianas/patologia , Ascite/complicações , Ascite/diagnóstico , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Humanos , Histerectomia/métodos , Leiomioma/diagnóstico , Síndrome de Meigs/diagnóstico por imagem , Síndrome de Meigs/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Derrame Pleural/complicações , Derrame Pleural/diagnóstico , Doenças Raras , Salpingo-Ooforectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Dig Dis ; 37(3): 239-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625470

RESUMO

AIMS: Ascites is one of the major complications in advanced cirrhotic patients. Tolvaptan is a non-peptide orally available arginine vasopressin V2 receptor antagonist. We investigated and found that tolvaptan therapy improved the prognosis and predictive factor of cirrhotic patients with ascites. METHODS: Overall, 99 patients with newly diagnosed ascites with cirrhosis were enrolled. No patients had intrahepatic malignancy. The patients were divided into 2 groups based on tolvaptan therapy: 86 patients treated with tolvaptan (tolvaptan-group) and 13 patients treated without tolvaptan (non-tolvaptan-group). Tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan. RESULTS: Tolvaptan therapy was effective in 61.6% of cirrhotic patients. There was a significant difference in the overall survival (OS) between the tolvaptan-responder-group and the other groups (p < 0.001). Male (HR 5.05; p = 0.01), tolvaptan responder (HR 0.21; p = 0.02), and dosage of furosemide < 40 mg/day (HR 0.17; p = 0.01) were factors that were independently associated with the OS. The multivariate analysis revealed that C-reactive protein < 0.9 mg/dL (HR 0.07; p = 0.001), and furosemide dosage < 40 mg/day (HR 0.09; p = 0.003) were independently associated with the tolvaptan response. CONCLUSION: Therapeutic response to tolvaptan was associated with longer survival in cirrhosis patients complicated with ascites. These preliminary findings warrant validation and further exploration.


Assuntos
Ascite/complicações , Ascite/tratamento farmacológico , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Tolvaptan/uso terapêutico , Idoso , Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Feminino , Furosemida/uso terapêutico , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática/patologia , Masculino , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Resultado do Tratamento
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