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1.
Int J Cancer ; 146(6): 1553-1567, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31503345

RESUMO

Detachment of cancer cells from the primary tumor and formation of spheroids in ascites is required for implantation metastasis in epithelial ovarian cancer (EOC), but the underlying mechanism of this process has not been thoroughly elucidated. To mimic this process, ovarian cancer cells were grown in 3D and 2D culture. Hey and OVCA433 spheroids exhibited decreased cell proliferation and enhanced adhesion and invasion. SMYD3 expression was elevated in ovarian carcinoma spheroids in association with increased H3K4 methylation. Depletion of SMYD3 by transient siRNA, stable shRNA knockdown and the SMYD3 inhibitor BCI-121 all decreased spheroid invasion and adhesion. Gene expression arrays revealed downregulation of integrin family members. Inhibition assays confirmed that invasion and adhesion of spheroids are mediated by ITGB6 and ITGAM. SMYD3-deficient cells regained the ability to invade and adhere after forced overexpression of SMYD3, ITGB6 and ITGAM. However, this biological ability was not restored by forced overexpression of SMYD3 in ITGB6- and/or ITGAM-deficient cancer cells. SMYD3 and H3K4me3 binding at the ITGB6 and ITGAM promoters was increased in spheroids compared to that in monolayer cells, and the binding was decreased when SMYD3 expression was inhibited, consistent with the expression changes in integrins. SMYD3 expression and integrin-mediated adhesion were also activated in an intraperitoneal xenograft model and in EOC patient spheroids. In vivo, SMYD3 knockdown inhibited tumor metastasis and reduced ascites volume in both the intraperitoneal xenograft model and a PDX model. Overall, our results suggest that the SMYD3-H3K4me3-integrin pathway plays a crucial role in ovarian cancer metastasis to the peritoneal surface.


Assuntos
Ascite/patologia , Carcinoma Epitelial do Ovário/secundário , Histona-Lisina N-Metiltransferase/metabolismo , Integrinas/genética , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/secundário , Adulto , Idoso , Ascite/etiologia , Carcinoma Epitelial do Ovário/genética , Adesão Celular/genética , Técnicas de Cultura de Células , Linhagem Celular Tumoral , Metilação de DNA , Regulação para Baixo , Feminino , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Técnicas de Silenciamento de Genes , Histona-Lisina N-Metiltransferase/genética , Histonas/metabolismo , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Neoplasias Peritoneais/genética , Regiões Promotoras Genéticas/genética , Esferoides Celulares , Ensaios Antitumorais Modelo de Xenoenxerto
2.
Rinsho Ketsueki ; 60(11): 1555-1559, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31839634

RESUMO

A 67-year-old male was referred to our hospital because of anemia, thrombocytopenia, and massive ascites. A diagnosis of systemic mastocytosis was made based on the observation of many mast cells in his bone marrow, elevated serum tryptase levels, and the presence of c-kit point mutation Asp816Val. Dasatinib and cladribine were ineffective, and a large volume of ascites was removed approximately every 3 days. Then, following an asthma attack, the patient was treated with pranlukast, a leukotriene receptor antagonist (LTRA). After LTRA treatment initiation, the frequency of ascites drainage decreased, and no puncture was necessary from the 10th day after the start of LTRA. Interferon α (IFN-α) was administered from the 15th day after the start of LTRA. Thereafter, his anemia and thrombocytopenia gradually improved, the ascites disappeared, the mast cells in his bone marrow were significantly reduced, and the Asp816Val mutation disappeared. Because persistent monocytosis was evident, he was suspected of chronic myelomonocytic leukemia but has not been diagnosed and is undergoing watchful waiting. This was considered to be a rare case of refractory ascites in which IFN-α was effective and LTRA might have been beneficial.


Assuntos
Ascite/etiologia , Interferon-alfa/uso terapêutico , Antagonistas de Leucotrienos/uso terapêutico , Mastocitose Sistêmica , Idoso , Humanos , Masculino , Mastócitos , Mastocitose Sistêmica/complicações , Mastocitose Sistêmica/tratamento farmacológico
3.
Anticancer Res ; 39(11): 5953-5962, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704820

RESUMO

BACKGROUND/AIM: The presence of ascites in ovarian cancer patients is considered a negative prognostic factor. The underlying mechanisms are not clearly understood. MATERIALS AND METHODS: The amount of ascites was evaluated, preferably, using diffusion-weighted MRI at primary diagnosis in a retrospective cohort of 214 women with ovarian cancer, in an ordinal manner (amount of ascites: none, limited, moderate, abundant). In a prospective cohort comprising 45 women with ovarian cancer, IL-10 (interleukin), VEGF (vascular endothelial growth factor), TGF-ß (transforming growth factor) and CCL-2 [chemokine (C-C) motif ligand 2] were measured at diagnosis (and at interval debulking, when available). RESULTS: Gradually increasing amounts of ascites were correlated significantly, even after correction for FIGO stage, with reduced survival (p<0.0001) and stronger immunosuppression (IL10 and VEGF). Neoadjuvant chemotherapy reduced immunosuppression, which was observed as a reduction in CCL-2, IL-10 and VEGF. CONCLUSION: The amount of ascites is an independent predictor of survival and correlates with increased immunosuppression.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ascite/mortalidade , Imunossupressão/mortalidade , Terapia Neoadjuvante/efeitos adversos , Neoplasias Ovarianas/mortalidade , Adenocarcinoma de Células Claras/tratamento farmacológico , Adenocarcinoma de Células Claras/imunologia , Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/imunologia , Adenocarcinoma Mucinoso/mortalidade , Adenocarcinoma Mucinoso/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Ascite/patologia , Cistadenocarcinoma Seroso/tratamento farmacológico , Cistadenocarcinoma Seroso/imunologia , Cistadenocarcinoma Seroso/mortalidade , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/imunologia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/patologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
5.
Curr Med Sci ; 39(5): 778-783, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612396

RESUMO

Laparoscopic hepatectomy (LH) is a newly developed technique associated with advantages as open surgery, but the study on outcome of liver function recovery was scarce. This preliminary report was aimed to comparatively assess the short-term outcomes between LH and open hepatectomy (OH) for primary hepatocellular carcinoma (PHC). This study retrospectively analyzed the demographic data and short-term outcomes of 81 patients who underwent LH or OH for the primary treatment of PHC between Oct. 2017 and May 2018 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (China). A total of 81 PHC patients who received major liver resection were enrolled. There were 38 (47%) patients in the LH group and 43 (53%) patients in the OH group. The operative time was significantly longer (373.53±173.38 vs. 225.43±55.08, P<0.01), and hospital stay (17.34±5.93 vs. 21.70±6.89, P=0.003), exhaust time (2.32±0.62 vs. 3.07±0.59, P<0.01) and defecation time (2.92±0.78 vs. 3.63±0.58, P<0.01) were significantly shorter in LH group than in OH group. The recovery of liver function was significantly faster in LH group, including higher serum albumin (P=0.002), higher ratio of albumin/globulin (P=0.029) and lower direct bilirubin (P=0.001) than in OH group. It is suggested that LH can serve as a fast recovery and cheap surgical procedure in the treatment of PHC, which is safe and feasible.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Ascite/diagnóstico , Ascite/etiologia , Ascite/patologia , Bilirrubina/sangue , Carcinoma Hepatocelular/patologia , Feminino , Hepatectomia/instrumentação , Humanos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Albumina Sérica/metabolismo , Soroglobulinas/metabolismo , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia , Fatores de Tempo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(39): e17079, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574807

RESUMO

Advancements in diagnostic modalities have improved the diagnosis of meconium peritonitis (MP) both in utero and ex utero. This study aimed to determine the efficacy of prompt prenatal and postnatal diagnoses of MP on the postnatal outcomes of these patients.We conducted a retrospective chart review of neonates with MP admitted to the Mackay Memorial Hospital Systems from 2005 to 2016. The prenatal diagnoses, postnatal presentations, surgical indications, operative methods, types of MP, operative findings, associated anomalies, morbidities, patient outcomes, and survival rates were analyzed. Morbidities included postoperative adhesion ileus, bacteremia, and short bowel syndrome. We also performed subgroup analyses of the morbidity and survival rates of prenatally versus postnatally diagnosed patients, as well as inborn versus outborn neonates.Thirty-seven neonates with MP were enrolled. Of this number, 24 (64.9%) were diagnosed prenatally. Twenty-two (59.5%) were born preterm. The most common prenatal sonographic findings included fetal ascites followed by dilated bowel loops. Abdominal distention was the most frequent postnatal symptom. Thirty-four (91.9%) neonates underwent surgery, whereas 3 were managed conservatively. Volvulus of the gastrointestinal tract was the most frequent anatomic anomaly. The total morbidity and survival rates were 37.8% and 91.9%, respectively. The morbidity and survival rates did not differ significantly between prenatally and postnatally diagnosed patients (37.5% vs 33.3%, P = 1.00; 91.7% vs 92.3%, P = 1.00, respectively). Inborn and outborn patients did not differ in terms of morbidity and survival rates (27.3% vs 53.3%, P = .17; 100% vs 80.0%, P = .06, respectively).Although not statistically significant, inborn MP neonates had higher survival rates when compared with outborn MP neonates. Prompt postnatal management at tertiary centers seemed crucial.


Assuntos
Mecônio , Peritonite/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ascite/etiologia , Dilatação Patológica/etiologia , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Volvo Intestinal/etiologia , Intestinos/patologia , Avaliação de Resultados da Assistência ao Paciente , Peritonite/complicações , Peritonite/mortalidade , Peritonite/terapia , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida , Tempo para o Tratamento
7.
Rev. clín. med. fam ; 12(3): 151-154, oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186806

RESUMO

El divertículo de Meckel constituye la anomalía congénita gastrointestinal más frecuente. Aunque la forma clínica de presentación más común es la hemorragia digestiva, también puede manifestarse como obstrucción intestinal o como proceso inflamatorio agudo. Su correcto diagnóstico y tratamiento requiere un elevado índice de sospecha clínica. Presentamos el caso de un varón de 19 años con un cuadro de dolor abdominal recurrente al que posteriormente fue extirpado un divertículo de Meckel


Meckel's diverticulum is the most frequent gastrointestinal congenital anomaly. Although its most common clinical presentation is gastrointestinal bleeding, it also manifests with bowel obstruction or acute inflammatory process. Correct diagnosis and treatment require a high degree of clinical suspicion. We present the case of a 19-year-old man with recurring abdominal pain, who eventually had a Meckel's diverticulum removed


Assuntos
Humanos , Masculino , Adulto Jovem , Divertículo Ileal/diagnóstico por imagem , Dor Abdominal/etiologia , Intussuscepção/diagnóstico por imagem , Recidiva , Brometo de Butilescopolamônio/uso terapêutico , Dispepsia/etiologia , Ascite/etiologia
8.
World J Gastroenterol ; 25(28): 3738-3752, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391769

RESUMO

This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: "liver cirrhosis," "portal hypertension," "ascites," "pathogenesis," "diagnostics," and "treatment." Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.


Assuntos
Ascite/terapia , Doença Hepática Terminal/terapia , Hipertensão Portal/terapia , Cirrose Hepática/terapia , Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Ascite/diagnóstico , Ascite/etiologia , Ascite/mortalidade , Ensaios Clínicos como Assunto , Diuréticos/uso terapêutico , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/mortalidade , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/etiologia , Hipertensão Portal/mortalidade , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Transplante de Fígado , Paracentese/instrumentação , Paracentese/métodos , Derivação Portossistêmica Transjugular Intra-Hepática , Prognóstico , Qualidade de Vida , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
9.
Pediatr Blood Cancer ; 66(11): e27932, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31385434

RESUMO

PURPOSE: The presence of pleural effusion or ascites at the time of diagnosis is generally considered a poor prognostic factor for children with rhabdomyosarcoma (RMS), and treatment is usually intensified despite the fact that there are no published studies to support this decision. We investigated the prognostic role of the presence of pleural effusion or ascites at diagnosis in patients with localized RMS consecutively enrolled in the Italian Soft Tissue Sarcoma Committee protocols over a 30-year period. METHODS: We reviewed the radiological reports at diagnosis of 150 children with supradiaphragmatic and infradiaphragmatic RMS, noting any presence of effusion and its extent (minimal, moderate, or massive). All patients received intensive chemotherapy, surgery, and standard or hyperfractionated radiotherapy. RESULTS: Effusion was identified in 32 children (21.3%), 14 with pleural effusion and 18 with ascites. As for its extent, 13 children presented with minimal, 12 with moderate, and 7 with massive effusion. The 5-year progression-free survival (PFS) rate was 49.8% (confidence interval [CI] 31.7-65.5) and 49.5% (CI 40-58.2) for patients with and without effusion, respectively (P = .5). When only patients with moderate or massive effusion were considered, however, their PFS was 36.8% (CI 16.5-57.5) versus 51.2% (CI 42.2-59.5) in patients with minimal or no effusion (P = .01). On the whole, patients with pleural effusion had a very poor outcome with a 5-year PFS of 35.7% (CI 13-59.4). CONCLUSIONS: The presence of moderate or massive effusion seems to be an unfavorable prognostic factor in children with RMS, and justifies their inclusion in experimental studies.


Assuntos
Ascite/etiologia , Derrame Pleural Maligno/etiologia , Rabdomiossarcoma/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Ensaios Clínicos como Assunto/estatística & dados numéricos , Terapia Combinada , Gerenciamento Clínico , Feminino , Humanos , Lactente , Itália/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Especificidade de Órgãos , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Rabdomiossarcoma/complicações , Rabdomiossarcoma/terapia , Resultado do Tratamento
10.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451473

RESUMO

Mycobacterium tuberculosisis highly endemic in the Philippines. The diagnosis is challenging with its non-specific presentation and the organism could extend to any of the organs. Interestingly, bacterial peritonitis arising spontaneously from gastrointestinal tuberculosis (TB) in an otherwise healthy, non-cirrhotic patient is quite unusual. In this paper, we discuss the case of a 27-year-old HIV-seronegative woman with massive intraperitoneal mixed bacterial and tuberculous abscess presenting 20 months after being diagnosed with bacteriologically confirmed gastrointestinal TB. Repeated large-volume paracentesis was done to drain out the infected ascites instead of inserting a percutaneously implanted catheter. Clinical improvement was noted and she was discharged after 12 days of intravenous antibiotics. She had completed 6 months of antituberculosis therapy and been well since then. The case has demonstrated that repeated paracentesis along with appropriate antibiotic regimen, may be a viable option for patients with TB and bacterial coinfected peritonitis. And possibly, peritoneal TB may increase the risk for (spontaneous) bacterial peritonitis.


Assuntos
Antituberculosos/administração & dosagem , Ascite , Íleo , Mycobacterium tuberculosis/isolamento & purificação , Paracentese/métodos , Peritonite Tuberculosa , Tuberculose Gastrointestinal , Adulto , Ascite/etiologia , Ascite/fisiopatologia , Ascite/terapia , Colonoscopia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Íleo/diagnóstico por imagem , Íleo/microbiologia , Íleo/patologia , Infecções Intra-Abdominais/diagnóstico , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/fisiopatologia , Peritonite Tuberculosa/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Gastrointestinal/fisiopatologia , Tuberculose Gastrointestinal/terapia
11.
Ethiop J Health Sci ; 29(3): 383-390, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447507

RESUMO

Background: The aim of this study was to assess the role of transabdominal ultrasonography in characterizing and determining the etiology of ascites in comparison with laboratory ascitic fluid analysis and other methods used to establish the final diagnosis. Methods: A prospective descriptive study was conducted on 61 patients with ascites attending outpatient department (OPD) or admitted to wards of Tikur Anbesa Specialized Hospital (TASH) and referred to radiology department for imaging from June 2017 to November 2017. Data were collected following the internationally recommended scanning technique in consecutive bases. The data were analyzed using SPSS version 20. The comparison of ultrasound and laboratory findings with final clinical diagnosis was analyzed using Chi-square test (X2). Results: Of 61 patients with ascites enrolled in this study, females were 35(57.4%) with age range of 16 to 75 and mean age of 43.2±14.11. The cause of ascites was established in 59 cases using a combination of clinical, pathological, imaging evidences and tumor markers. However there were two cases who had ascites with indeterminate cause. US suggested the diagnosis in 54(91.5%) patients. Excluding mixed and indeterminate cases, ultrasound characterized ascites correctly as exudate and transudate in 95% cases. Conclusion: Ultrasound has significant accuracy to distinguish transudate and exudate ascites and in suggesting the underlying cause. It can be a valuable method of investigation of ascites in places where CT and MRI are not available, and it is the best complement for laboratory investigations on ascites in suggesting the etiology based on ascitic fluid texture and ancillary findings.


Assuntos
Ascite/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Idoso , Ascite/diagnóstico , Ascite/etiologia , Líquido Ascítico/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
12.
Intern Med ; 58(21): 3069-3075, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292400

RESUMO

Objective Ascites becomes refractory to diuretics in cirrhotic patients, who then require repeated large-volume paracentesis or cell-free and concentrated ascites reinfusion therapy (CART). The objective of this study was to confirm the safety and efficacy of CART, evaluate the actual situations with respect to the prescription of diuretics and determine the role of diuretics after the introduction of CART. Patients and Methods We recruited 34 cirrhotic patients who received CART with concomitant diuretics using furosemide (76.2%), spironolactone (48.5%), thiazide (4.0%) and tolvaptan (53.5%) from a post-marketing surveillance of CART. Results CART improved the tested clinical indices, i.e., body weight, abdominal circumference, performance status, dietary intake, total protein and albumin. The intervals of CART sessions were significantly prolonged in patients who received tolvaptan (mean, 22.5 days) compared to those not receiving tolvaptan (mean, 10.8 days) (p<0.001). The drop-out rate was significantly decreased in patients receiving tolvaptan compared to those not receiving tolvaptan when drop-out was defined as paracentesis (p<0.05). Conclusion We confirmed that CART is an effective treatment for refractory ascites occurring in cirrhotic patients. The administration of tolvaptan in combination with CART leads to a significantly reduced rate of ascites accumulation.


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Ascite/terapia , Líquido Ascítico , Diuréticos/uso terapêutico , Hidratação/métodos , Cirrose Hepática/complicações , Tolvaptan/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ascite/sangue , Ascite/etiologia , Feminino , Furosemida/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados , Albumina Sérica , Espironolactona/uso terapêutico
13.
Zhongguo Zhen Jiu ; 39(7): 713-6, 2019 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-31286732

RESUMO

OBJECTIVE: To observe the clinical efficacy of umbilical needling therapy of I-Ching at 1 PM to 3 PM for cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention. METHODS: Forty-eight patients of cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention were randomly divided into an observation group and a control group, 24 cases in each one. Both groups were treated with routine treatment of western medicine combined with TCM decoction. In addition, the patients in the observation group were treated with umbilical needling therapy of I-Ching at locations of Kun, Kan, Gen and Dui. The treatment was given at 1 PM to 3 PM, once a day; 10-d treatment was a course of treatment, and a total of 20-d treatment was given. The abdominal circumference, urine volume, body mass, liver function and prothrombin time were observed before and after treatment in the two groups, and the clinical efficacy of the two groups was compared. RESULTS: The total effective rate was 91.7% (22/24) in the observation group, which was higher than 87.5% (21/24) in the control group (P<0.05). After treatment, the improvement of abdominal circumference, urine volume, body mass, liver function and prothrombin time between the two groups was significantly different (P<0.05), the observation group was better. CONCLUSION: Based on the western medicine treatment, the combination of TCM decoction and umbilical needling therapy of I-Ching shows significant efficacy for cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention.


Assuntos
Ascite , Cirrose Hepática , Ascite/etiologia , Ascite/terapia , Humanos , Cirrose Hepática/complicações , Agulhas , Baço , Síndrome , Umbigo
14.
Transplant Proc ; 51(6): 1779-1784, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31301855

RESUMO

After living donor liver transplantation, we encounter cases with massive ascites, which is difficult to manage. We analyzed the risk factors for massive ascites after living donor liver transplantation. The subjects were 100 adult recipients who underwent living donor liver transplantation at Kyoto University Hospital from 2013 to 2017. We retrospectively assessed patient, graft, operative factors, and percent fluid overload, which were defined as [(weight on the day - preoperative weight)/preoperative weight] × 100%. We defined the massive ascites group as having a14-day average ascites ≥ 2500 mL and the mild ascites group as having a 14-day average ascites < 2500 mL. Forty-seven patients were included in the massive group, and 53 patients were included in the mild group. There was no difference in short- and long-term survival. In multivariate analysis, the presence of preoperative ascites (P = .0008), 14-day average percent fluid overload ≥ 14.5% (P = .0095), graft-to-recipient weight ratio < 0.86 (P = .0253), and donors' age ≥ 47 years (P = .0466) were identified as independent risk factors for massive ascites after living donor liver transplantation. A liver graft with a small graft-to-recipient weight ratio or from an elderly donor, which may indicate poor graft quality, presence of preoperative ascites, and postoperative fluid overload were associated with massive ascites after living donor liver transplantation.


Assuntos
Ascite/etiologia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Adulto , Idoso , Feminino , Humanos , Fígado/patologia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Transplantes/patologia , Resultado do Tratamento
15.
Expert Rev Gastroenterol Hepatol ; 13(8): 751-759, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31304804

RESUMO

Introduction: Spontaneous bacterial peritonitis represents a frequent and severe complication in cirrhotic patients with ascites. In daily practice, the diagnosis of spontaneous bacterial peritonitis might be challenging in the absence of the typical signs and symptoms of infection such as fever or leukocytosis. Areas covered: Aim of this review is to revise the current state of the art on primary and secondary spontaneous bacterial peritonitis. Literature search in Medline/Pubmed was performed. Expert opinion: Historically, gram-negative bacteria were the most frequent etiologic agents of spontaneous bacterial peritonitis, with Escherichia coli and Klebsiella spp. being the most frequently isolated bacteria. However, major changes in this regard occurred over the last few decades with an increasing prevalence of gram-positive, quinolone-resistant, and multidrug-resistant bacteria. In particular, the increasing prevalence of quinolone-resistant bacteria challenged the prominent role of norfloxacin in spontaneous bacterial peritonitis prevention. Given the high mortality rate and the risk of developing the hepatorenal syndrome, prophylaxis of spontaneous bacterial peritonitis is indicated in three high-risk populations: patients with acute gastrointestinal hemorrhage, patients with low total protein content in ascitic fluid and advanced cirrhosis, and patients with a previous history of spontaneous bacterial peritonitis (secondary prophylaxis).


Assuntos
Infecções Bacterianas/prevenção & controle , Cirrose Hepática/complicações , Peritonite/prevenção & controle , Ascite/etiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/fisiopatologia , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/prevenção & controle , Humanos , Peritonite/etiologia , Peritonite/microbiologia , Peritonite/fisiopatologia , Prevenção Secundária
16.
Cancer Sci ; 110(9): 2933-2940, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278877

RESUMO

Chemotherapy has been the treatment of choice for unresectable peritoneal dissemination; however, it is difficult to eradicate such tumors because of poor drug delivery. To solve this issue, we developed FF-10832 as liposome-encapsulated gemcitabine to maintain a high concentration of gemcitabine in peritoneal tumors from the circulation and ascites. A syngeneic mouse model of peritoneal dissemination using murine Colon26 cell line was selected to compare the drug efficacy and pharmacokinetics of FF-10832 with those of gemcitabine. Despite the single intravenous administration, FF-10832 treatment enabled long-term survival of the lethal model mice as compared with those treated with gemcitabine. Pharmacokinetic analysis clarified that FF-10832 could achieve a more effective gemcitabine delivery to peritoneal tumors owing to better stability in the circulation and ascites. The novel liposome-encapsulated gemcitabine FF-10832 may be a curative therapeutic tool for cancer patients with unresectable peritoneal dissemination via the effective delivery of gemcitabine to target tumors.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Ascite/metabolismo , Desoxicitidina/análogos & derivados , Neoplasias Peritoneais/tratamento farmacológico , Peritônio/patologia , Animais , Antimetabólitos Antineoplásicos/farmacocinética , Ascite/etiologia , Linhagem Celular Tumoral/transplante , Desoxicitidina/administração & dosagem , Desoxicitidina/farmacocinética , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Estabilidade de Medicamentos , Feminino , Humanos , Injeções Intravenosas , Estimativa de Kaplan-Meier , Lipossomos , Camundongos , Camundongos Endogâmicos BALB C , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Distribuição Tecidual , Resultado do Tratamento
17.
BMC Surg ; 19(1): 73, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266494

RESUMO

BACKGROUND: Diagnosis and management of acute abdomen secondary to systematic lupus erythematosus (SLE) has always been a clinical challenge. CASE PRESENTATION: A 21-year-old lady, with BMI 17.7, presented to our department with acute abdomen. Laparoscopy was carried out to exclude surgical emergency when conservative regimen failed. The patient revealed a history of purpuric changes and lupus test was positive for SLE. CONCLUSION: Based on our experience, early laparoscopy to alleviate acute abdomen has shown to improve the prognosis of the patient.


Assuntos
Abdome Agudo/diagnóstico , Abdome Agudo/cirurgia , Ascite/etiologia , Lúpus Eritematoso Sistêmico/complicações , Mesentério/irrigação sanguínea , Vasculite/cirurgia , Abdome Agudo/tratamento farmacológico , Abdome Agudo/etiologia , Administração Intravenosa , Administração Oral , Antirreumáticos/administração & dosagem , Ascite/diagnóstico por imagem , Ascite/tratamento farmacológico , Ascite/cirurgia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hidroxicloroquina/administração & dosagem , Laparoscopia , Mesentério/diagnóstico por imagem , Metilprednisolona/administração & dosagem , Prognóstico , Vasculite/diagnóstico por imagem , Vasculite/tratamento farmacológico , Vasculite/etiologia , Adulto Jovem
18.
Pan Afr Med J ; 33: 11, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303956

RESUMO

Pseudo-Meigs syndrome combines a benign (all histological types are included) or malignant (primitive ovarian tumor or ovarian metastasis from another primitive tumor) ovarian tumor or a pelvic tumor (not necessarily ovarian or uterine, for example) with ascites and pleurisy (non-metastatic in the case of malignant tumor). These effusions disappear after tumor resection. A 37-year old female patient was admitted to our Department with dyspnoea and left intercostal pain. Radiological examinations showed left pleurisy of average abundance, ascites of low abundance and a pelvic mass. Surgical exploration showed ovarian tumor. After ablation, pleurisy solved spontaneously. Of particular interest, with regard to pneumology, is that this syndrome has occurred in a woman with pleurisy whose etiological assessment was negative and that abdominopelvic ultrasound allows diagnostic orientation.


Assuntos
Cistadenoma Seroso/diagnóstico , Síndrome de Meigs/etiologia , Neoplasias Ovarianas/diagnóstico , Adulto , Ascite/etiologia , Cistadenoma Seroso/complicações , Cistadenoma Seroso/patologia , Dispneia/etiologia , Feminino , Humanos , Síndrome de Meigs/patologia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Dor/etiologia , Pleurisia/etiologia
19.
Arab J Gastroenterol ; 20(2): 81-85, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31182343

RESUMO

BACKGROUND/AIMS: Functional impairment is common among cirrhotic patients with refractory ascites, and improvement in functional impairment is an expected issue after paracentesis. The six-minute walk test (6MWT) is considered an objective test for functional activity. No published data have evaluated the 6MWT among cirrhotic patients with refractory ascites before and after large-volume paracentesis. The research aim was to assess the feasibility of performing the 6MWT among cirrhotic patients who had refractory ascites before and after large-volume paracentesis. MATERIALS AND METHODS: Thirty-one cirrhotic inpatients with refractory ascites were subjected to pulmonary function tests (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], FEV1/FVC) and diffusion lung capacity for carbon monoxide (DLCO) before and 48 h after therapeutic large-volume paracentesis. Dyspnoea as assessed by the Borg scale and functional capacity as assessed by the 6MWT were also evaluated. RESULTS: Prior to paracentesis, the mean values of FVC and FEV1 were lower than the predicted values, and a significant increase was observed after paracentesis. There was improvement in the mean DLCO values after paracentesis (P < 0.05). Regarding the 6MWT, significant increases in the walked distance (6MWD) (310.7 ±â€¯73 vs. 348.7 ±â€¯72.3 m) and oxygen saturation after paracentesis (P = 0.001) were observed. Significant improvement in the dyspnoea scale also occurred after paracentesis (P = 0.001). A significant positive correlation between the 6MWD before paracentesis and serum albumin levels was demonstrated (r = 0.373, P = 0.039). CONCLUSION: We found a decrease in pulmonary function and the 6MWD in patients who had refractory ascites, which improved significantly following large-volume paracentesis. The 6MWT is useful in detecting impaired functional capacity among cirrhotic patients.


Assuntos
Ascite/fisiopatologia , Ascite/cirurgia , Tolerância ao Exercício , Paracentese , Ascite/etiologia , Dispneia/etiologia , Feminino , Volume Expiratório Forçado , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Projetos Piloto , Estudos Prospectivos , Capacidade de Difusão Pulmonar , Albumina Sérica/metabolismo , Capacidade Vital , Teste de Caminhada
20.
Transplant Proc ; 51(5): 1516-1519, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155185

RESUMO

OBJECTIVES: Refractory ascites after liver transplant commonly occurs in living donor liver transplant (LDLT). Refractory ascites is associated with postoperative complications and poor prognosis. This study sought to determine the risk factors of refractory ascites and discuss their perioperative management. METHODS: A retrospective study of 122 living donor liver transplant recipients between 2008 and 2017 was performed to analyze the risk factors, incidence, and characteristics of refractory ascites. Refractory ascites post LDLT was defined as the production of ascites fluid >1000 mL/d on postoperative day 14 or required repeated drainage. RESULTS: A total of 24 patients (19.6%) developed refractory ascites. The 1-year survival rate was significantly worse in the refractory ascites group compared with the nonrefractory ascites group (P < .001). In a univariate analysis, patients with refractory ascites had a higher Model for End-Stage Liver Disease (MELD) score, donor age, presence of left lobe graft, ascites at laparotomy, portal venous pressure just after surgery, cold ischemia time, and absence of hepatocellular carcinoma compared with patients without refractory ascites. Multivariate proportional regression analyses revealed that MELD score ≥20, left lobe graft, donor age 50 years or older, and ascites at laparotomy ≥350 mL were independently associated with refractory ascites. Postoperative complications, such as bleeding (P < .001), sepsis (P < .001), and bloodstream infection within 30 days after LDLT (P < .00), were significantly higher in the refractory ascites group. CONCLUSION: Refractory ascites is associated with reduced 1-year survival and increased postoperative complications. Four factors including MELD score ≥20, donor age 50 years or older, presence of left graft, and ascites at laparotomy ≥350 mL were independent predictors for refractory ascites.


Assuntos
Ascite/etiologia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Ascite/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Transplante de Fígado/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
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