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Refractory ascites

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https://www.readbyqxmd.com/read/28079252/outcomes-of-surgical-shunts-and-transjugular-intrahepatic-portasystemic-stent-shunts-for-complicated-portal-hypertension
#1
I Hosokawa, R Adam, M-A Allard, G Pittau, E Vibert, D Cherqui, A Sa Cunha, H Bismuth, M Miyazaki, D Castaing
BACKGROUND: Transjugular intrahepatic portasystemic stent shunt (TIPSS), instead of surgical shunt, has become the standard treatment for patients with complicated portal hypertension. This study compared outcomes in patients who underwent TIPSS or surgical shunting for complicated portal hypertension. METHODS: This was a retrospective study of all consecutive patients who received portasystemic shunts from 1994 to 2014 at a single institution. Patients who underwent surgical shunting were compared with those who had a TIPSS procedure following one-to-one propensity score matching...
January 12, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28060125/massive-mesenteric-lymphadenopathy-causing-protein-losing-enteropathy-in-gaucher-disease
#2
Ewan A Simpson, Matthew R F Jaring, Savvas Andronikou
Protein-losing enteropathy due to massive mesenteric lymphadenopathy is a rare complication of Gaucher disease which is generally refractory to treatment with enzyme replacement and substrate reduction therapies. It is postulated that lymph nodes may act as a "sanctuary site" into which these treatments cannot penetrate. We present the case of a male child with Gaucher disease who developed massive mesenteric lymph nodes despite otherwise successful treatment with enzyme replacement therapy, and subsequently developed protein-losing enteropathy...
January 5, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28058594/an-algorithm-for-management-after-transjugular-intrahepatic-portosystemic-shunt-placement-according-to-clinical-manifestations
#3
REVIEW
Seung Kwon Kim, Bryan G Belikoff, Carlos J Guevara, Seong Jin Park
We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency...
January 5, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28057913/humoral-hypercalcemia-in-uterine-cancers-a-case-report-and-literature-review
#4
Vijeyaluxmy Motilal Nehru, Gwenalyn Garcia, Juan Ding, Fanyi Kong, Qun Dai
BACKGROUND Paraneoplastic hypercalcemia is a well-described complication associated with a variety of malignancies. However, its incidence in gynecological malignancies is low. CASE REPORT A 53-year-old woman presented with progressive abdominal distention and irregular vaginal bleeding of several weeks' duration. A contrast CT abdomen and pelvis was significant for a mass in the lower uterine/cervical region, multiple peritoneal and omental masses, enlarged pelvic and paraaortic lymph nodes, and large-volume ascites...
January 6, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28051803/%C3%A2-observational-cohort-study-of-hepatic-encephalopathy-after-transjugular-intrahepatic-portosystemic-shunt-tips
#5
Michaela Routhu, Vaclav Safka, Sunil Kumar Routhu, Tomas Fejfar, Vaclav Jirkovsky, Antonin Krajina, Eva Cermakova, Ladislav Hosak
:  Introduction and Aim: Hepatic encephalopathy (HE) is a common complication of transjugular intrahepatic portosystemic shunting (TIPS). It is associated with a reduced quality of life and poor prognosis. The aim of this study was to compare two groups of patients who did and did not develop overt HE after TIPS. We looked for differences between these groups before TIPS. MATERIALS AND METHODS: A study of 895 patients was conducted based on a retrospective analysis of clinical data...
January 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/28028255/-a-new-treatment-strategy-novel-cell-free-and-concentrated-ascites-reinfusion-system-km-cart-for-massive-malignant-ascites
#6
Keisuke Matsusaki
Massive ascites associated with cancerous peritonitis can result in severe respiratory discomfort and abdominal fullness. Additionally, it can significantly impair the activities of daily living of a patient, and relaxation is difficult to achieve, even with opioids. Frequent ascites drainage can cause rapid worsening of the patient's general condition, and a large amount of ascites can lead to discontinuation of anti-cancer treatment. Cell-free and concentrated ascites reinfusion therapy(CART)for refractory ascites was first covered by the insurance system in 1981...
December 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/27984174/emergency-tips-in-a-child-pugh-b-patient-when-does-the-window-of-opportunity-open-and-close
#7
REVIEW
Jonel Trebicka
Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using endoscopic and medical treatment in patients with compensated cirrhosis; in decompensated patients, however, TIPS improves survival. Therefore, an early TIPS (within 72h or if later, still early after bleeding) might improve the survival of patients by preventing an inflammatory response and bacterial translocation...
October 29, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27972300/cost-effectiveness-evaluation-of-tips-procedures-with-expanded-polytetrafluoroethylene-eptfe-covered-stent-grafts-compared-to-large-volume-paracentesis-in-patients-with-refractory-ascites-a-spanish-scenario
#8
A Pérez-Mitru, A Villacampa Lordan, F Scarpa
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/27941973/immune-inflammatory-and-metabolic-effects-of-high-dose-furosemide-plus-hypertonic-saline-solution-hss-treatment-in-cirrhotic-subjects-with-refractory-ascites
#9
Antonino Tuttolomondo, Domenico Di Raimondo, Chiara Bellia, Giuseppe Clemente, Rosaria Pecoraro, Carlo Maida, Irene Simonetta, Valerio Vassallo, Danilo Di Bona, Eliana Gulotta, Marcello Ciaccio, Antonio Pinto
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...
2016: PloS One
https://www.readbyqxmd.com/read/27938554/-current-status-of-treatment-of-refractory-ascites-in-patients-with-liver-cirrhosis
#10
J Shao, L Zhang, G H Han, D M Fan
Ascites is a common clinical manifestation of cirrhotic portal hypertension, and about 60%-80% of cirrhotic patients develop the symptom of ascites within 10 years. Once ascites occurs, the 5-year survival rate is reduced from 80% to 50%. With the progression of liver diseases, approximately 5%-10% of patients with ascites develop refractory ascites, and the median survival time is only 6-12 months. This article reviews the definition and diagnosis of refractory ascites, evaluation of prognostic factors, and treatment regimens, including large-volume paracentesis combined with protein supplementation, transjugular intrahepatic portosystemic shunt, and liver transplantation...
October 20, 2016: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/27917793/high-dose-oral-furosemide-with-salt-ingestion-in-the-treatment-of-refractory-ascites-of-liver-cirrhosis
#11
Tolga Yakar, Mehmet Demir, Ozlem Dogan, Alper Parlakgumus, Birol Ozer, Ender Serin
PURPOSE: We aimed to evaluate and compare the efficacy and safety of high-dose furosemide+salt orally by comparing HSS+ furosemide (i.v.) and repeated paracentesis in patients with RA. METHODS: This was a prospective study of 78 cirrhotic patients with RA, randomized into three groups: Group A (n= 25) i.v. furosemide (200-300 mg bid) and 3% hypotonic saline solution (HSS) (once or twice a day); Group B (n= 26) oral furosemide tablets (360-520 mg bid) and salt (2...
1, 2016: Clinical and Investigative Medicine. Médecine Clinique et Experimentale
https://www.readbyqxmd.com/read/27888621/intraperitoneal-ziv-aflibercept-effectively-manages-refractory-ascites-in-colorectal-cancer-patients
#12
Chieh-Sheng Lu, Jen-Kou Lin, Wei-Shone Chen, Tzu-Chen Lin, Jeng-Kai Jiang, Shung-Haur Yang, Huann-Sheng Wang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-Chi Lin, Hung-Hsin Lin, Hao-Wei Teng
Ascites related to metastatic colorectal cancer (mCRC) reduces patient survival and quality of life, and systemic chemotherapy is largely ineffective for managing ascites. Here, we examined the clinical efficacy of intraperitoneal (IP) ziv-aflibercept for managing refractory ascites in 15 mCRC patients who did not respond to standard chemotherapy. Fifty or 100 mg of ziv-aflibercept in 100 mL of saline solution were infused through a pigtail catheter and retained for 24 h. When the ascites drainage volumes were subsequently monitored, 73...
November 24, 2016: Oncotarget
https://www.readbyqxmd.com/read/27874969/idiopathic-myelofibrosis-accompanied-by-peritoneal-extramedullary-hematopoiesis-presenting-as-refractory-ascites-in-a-dog
#13
Yolandi Rautenbach, Amelia Goddard, Sarah J Clift
A 2.5-year-old spayed female American Pit Bull Terrier dog presented with a primary complaint of chronic refractory ascites. The dog's CBC displayed a moderate to severe macrocytic, hypochromic, nonregenerative anemia, and a moderate leukopenia as result of a moderate neutropenia and monocytopenia. Microscopic examination of the blood smear showed marked anisocytosis, mild polychromasia, mild acanthocytosis and ovalocytosis, moderate schistocytosis and poikilocytosis, and 4 metarubricytes/100 WBC. Abdominal ultrasonography revealed a homogenous, mild to moderately hyperechoic appearing liver as well as marked amounts of speckled anechoic to slightly hypoechoic peritoneal fluid...
November 22, 2016: Veterinary Clinical Pathology
https://www.readbyqxmd.com/read/27864004/beta-adrenergic-blockade-and-decompensated-cirrhosis
#14
REVIEW
Thomas Reiberger, Mattias Mandorfer
Non-selective betablockers (NSBBs) remain the cornerstone of medical treatment of portal hypertension. The evidence for their efficacy to prevent variceal bleeding is derived from prospective trials, which largely excluded patients with refractory ascites and renal failure. In parallel to the increasing knowledge on portal hypertension-induced changes in systemic hemodynamics, cardiac function, and renal perfusion, emerging studies have raised concerns about harmful effects of NSBBs. Clinicians are facing an ongoing controversy on the use of NSBBs in patients with advanced cirrhosis...
November 15, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27853493/implantability-complications-and-follow-up-after-transjugular-intrahepatic-portosystemic-stent-shunt-creation-with-the-6f-self-expanding-sinus-superflex-visual-stent
#15
Daniel Spira, Jakub Wiskirchen, Ulrich Lauer, Dominik Ketelsen, Konstantin Nikolaou, Benjamin Wiesinger
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...
July 2016: Iranian Journal of Radiology: a Quarterly Journal Published By the Iranian Radiological Society
https://www.readbyqxmd.com/read/27853068/cases-with-refractory-ascites-and-a-delayed-response-to-tolvaptan
#16
Satoru Hagiwara, Naoshi Nishida, Hirokazu Chishina, Hiroshi Ida, Toshiharu Sakurai, Yoriaki Komeda, Masayuki Kitano, Masatoshi Kudo
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...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27830342/refractory-ascites-in-systemic-lupus-erythematosus-further-biological-support-of-intraperitoneal-steroid-treatment-as-a-suitable-therapeutical-option
#17
Yemil Atisha-Fregoso, Diego F Hernández-Ramírez, Elizabeth Olivares-Martínez, Carlos A Núñez-Alvarez, Luis Llorente, Gabriela Hernández-Molina
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...
November 9, 2016: Clinical Rheumatology
https://www.readbyqxmd.com/read/27805025/transjugular-intrahepatic-portosystemic-shunt-for-budd-chiari-syndrome-with-diffuse-occlusion-of-hepatic-veins
#18
Fuliang He, Hongwei Zhao, Shan Dai, Yingfeng Wu, Lei Wang, Hongdong Huang, Zhendong Yue, Zhenhua Fan, Xiaoqun Dong, Fuquan Liu
Either acute or sub-acute Budd-Chiari syndrome (BCS) with diffuse occlusion of hepatic veins has a high mortality rate and remains challenging for clinical treatment. We aimed to evaluate the feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) as a treatment for BCS with diffuse occlusion of hepatic veins. From January 2007 to December 2010, 100 patients were randomly recruited onto this study and 91 patients were treated with TIPS. 14 patients were defined as acute BCS group and 86 patients as sub-acute group...
November 2, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27802853/large-volume-paracentesis-with-indwelling-peritoneal-catheter-and-albumin-infusion-a-community-hospital-study
#19
Daniel K Martin, Saqib Walayat, Ren Jinma, Zohair Ahmed, Karthik Ragunathan, Sonu Dhillon
BACKGROUND: The management of ascites can be problematic. This is especially true in patients with diuretic refractory ascites who develop a tense abdomen. This often results in hypotension and decreased venous return with resulting renal failure. In this paper, we further examine the risks and benefits of utilizing an indwelling peritoneal catheter to remove large-volume ascites over a 72-h period while maintaining intravascular volume and preventing renal failure. METHODS: We retrospectively reviewed charts and identified 36 consecutive patients undergoing continuous large-volume paracentesis with an indwelling peritoneal catheter...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27797679/long-term-outcome-and-analysis-of-dysfunction-of-transjugular-intrahepatic-portosystemic-shunt-placement-in-chronic-primary-budd-chiari-syndrome
#20
Georges Hayek, Maxime Ronot, Aurélie Plessier, Annie Sibert, Mohamed Abdel-Rehim, Magaly Zappa, Pierre-Emmanuel Rautou, Dominique Valla, Valérie Vilgrain
Purpose To evaluate the long-term safety, technical success, and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in a series of patients with Budd-Chiari syndrome (BCS), and to determine the predictors of shunt dysfunction. Materials and Methods From 2004 to 2013, all patients with primary BCS referred for TIPS placement were included in the study. The primary and secondary technical success rates and the number and types of early (ie, before day 7) complications were noted. Factors associated with dysfunction were analyzed with uni- and multivariate analyses...
October 31, 2016: Radiology
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