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Refractory ascites

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https://www.readbyqxmd.com/read/29142184/efficacy-of-cell-free-and-concentrated-ascites-reinfusion-therapy-for-palliative-care-in-a-patient-with-malignant-pleural-mesothelioma-a-case-report
#1
Kakeru Hisakane, Hironobu Ohmatsu, Shigeki Umemura, Keisuke Kirita, Shingo Matsumoto, Kiyotaka Yoh, Seiji Niho, Koichi Goto
Cell-free and concentrated ascites reinfusion therapy (CART) is recognized as a useful treatment to improve the symptoms caused by refractory ascites. Recently, a few clinical studies have reported the effects of CART for malignant ascites, especially in gynecological and gastrointestinal cancers. We report the case of malignant ascites in a patient with malignant pleural mesothelioma (MPM) whose symptoms were relieved by CART. A 59-year-old Japanese male with MPM who had undergone pleural decortication had pleural and peritoneal recurrence...
2017: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
https://www.readbyqxmd.com/read/29121427/long-term-survival-with-bevacizumab-in-heavily-pretreated-and-platinum-resistant-mucinous-ovarian-cancer-a-case-report
#2
Yosuke Tarumi, Taisuke Mori, Hiroshi Matsushima, Tetsuya Kokabu, Hiroshi Tsuchiya, Jo Kitawaki
The prognosis of patients with recurrent and platinum-resistant ovarian cancer is quite poor. Randomized trials have shown that bevacizumab (BEV) can be effective, even in platinum-resistant ovarian cancer, but only a few such cases of long-term survival with BEV have been reported. Furthermore, there is no consensus on how many cycles of BEV should be administered. Herein, we report a case of refractory mucinous ovarian cancer showing long-term survival after six cycles of weekly paclitaxel with BEV followed by 26 cycles of BEV maintenance...
November 9, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29113006/transjugular-portal-vein-recanalization-with-creation-of-intrahepatic-portosystemic-shunt-pvr-tips-in-patients-with-chronic-non-cirrhotic-non-malignant-portal-vein-thrombosis
#3
Christoph Klinger, Bettina Riecken, Arthur Schmidt, Andrea De Gottardi, Benjamin Meier, Jaime Bosch, Karel Caca
Purpose To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT). Methods This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1)...
November 7, 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/29108520/a-proposed-classification-system-and-therapeutic-strategy-for-chyle-leak-after-laparoscopic-living-donor-nephrectomy-a-single-center-experience-and-review-of-the-literature
#4
Zi Qin Ng, Bulang He
OBJECTIVES: Chyle leak or chylous ascites remains a rare complication after laparoscopic living-donor nephrectomy. Its cause and management have not been well elucidated in the literature. Thus, the aim of this study was to review the incidence of chyle leak/chylous ascites after laparoscopic living-donor nephrectomy in our institute and in the literature to propose a classification system with its associated treatment strategy. MATERILAS AND METHODS: In this retrospective review of laparoscopic living-donor nephrectomy patients from January 2005 to April 2016, we identified patients with chyle leak/chylous ascites along with the care performed...
October 31, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29091351/eptfe-tips-versus-repetitive-lvp-plus-albumin-for-the-treatment-of-refractory-ascites-in-patients-with-cirrhosis
#5
Theresa Bucsics, Sophie Hoffman, Johanna Grünberger, Maria Schoder, Wolfgang Matzek, Alexander Stadlmann, Mattias Mandorfer, Philipp Schwabl, Arnulf Ferlitsch, Markus Peck-Radosavljevic, Michael Trauner, Josef Karner, Franz Karnel, Thomas Reiberger
INTRODUCTION: Reduction of portal pressure by self-expandable polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts (TIPS) is a treatment option for refractory ascites. Data on clinical outcomes after ePTFE-TIPS versus repetitive large-volume paracentesis (LVP) plus albumin (A) administration for the treatment of patients with refractory ascites are limited. METHODS: Retrospective comparison of ePTFE-TIPS versus LVP+A in terms of (i) control of ascites, (ii) occurrence of overt hepatic encephalopathy (HE) and (iii) transplant-free survival in cirrhotic patients with refractory ascites...
November 1, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29064029/the-portal-hypertension-syndrome-etiology-classification-relevance-and-animal-models
#6
REVIEW
Jaime Bosch, Yasuko Iwakiri
BACKGROUND: Portal hypertension is a key complication of portal hypertension, which is responsible for the development of varices, ascites, bleeding, and hepatic encephalopathy, which, in turn, cause a high mortality and requirement for liver transplantation. AIM: This review deals with the present day state-of-the-art preventative treatments of portal hypertension in cirrhosis according to disease stage. Two main disease stages are considered, compensated and decompensated cirrhosis, the first having good prognosis and being mostly asymptomatic, and the second being heralded by the appearance of bleeding or non-bleeding complications of portal hypertension...
October 24, 2017: Hepatology International
https://www.readbyqxmd.com/read/29049216/fondaparinux-is-effective-for-acute-portal-vein-thrombosis-in-decompensated-cirrhotic-patients
#7
REVIEW
Zhi-Hao Zhang, Jing-Wen Zhang, Ping He, Yan Zhou, Chang-Yu Sun
Portal vein thrombosis (PVT) is a rare but serious complication in the decompensated stage of cirrhosis, and recurrent upper gastrointestinal bleeding and refractory ascites can occur in such patients. In decompensated cirrhotic patients, the application of conventional anticoagulant therapy is limited due to severe coagulation disorders, thrombocytopenia, and history of gastrointestinal bleeding.In this study, we sought to investigate the effect of fondaparinux on acute PVT in decompensated cirrhotic patients...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29046075/portal-hypertension-and-chylous-ascites-complicating-acute-pancreatitis-the-therapeutic-value-of-portal-vein-stenting
#8
S Poo, T D Pencavel, J Jackson, L R Jiao
Chylous ascites as a consequence of acute pancreatitis is very rare. We present an unusual case of a 73-year-old man who developed refractory chylous ascites one month after an acute severe episode of gallstone pancreatitis, associated with portal hypertension. He was successfully treated with portal vein stenting, which has remained patent to date.
October 19, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29024842/peritoneal-carcinomatosis-like-implants-of-extramedullary-hematopoiesis-an-insolite-occurrence-during-splenectomy-for-myelofibrosis
#9
Marco Casaccia, Rosario Fornaro, Marco Frascio, Denise Palombo, Cesare Stabilini, Emma Firpo, Ezio Gianetta
INTRODUCTION: Primary myelofibrosis (MF) is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib. CASE PRESENTATION: We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT)...
October 5, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29021448/additional-octreotide-therapy-to-sirolimus-achieved-a-decrease-in-sirolimus-refractory-chylous-effusion-complicated-with-lymphangioleiomyomatosis
#10
Masashi Namba, Takeshi Masuda, Takashi Nakamura, Yasushi Horimasu, Shintaro Miyamoto, Taku Nakashima, Hiroshi Iwamoto, Kazunori Fujitaka, Hironobu Hamada, Noboru Hattori
Recently, sirolimus, an inhibitor of mammalian target of rapamycin, was reported to decrease chylous effusion in patients with lymphangioleimyomatosis (LAM). We herein report a case of a 34-year-old woman with LAM who developed refractory chylothorax and chylous ascites during sirolimus therapy. In this case, to reduce chylous effusion, we administered octreotide, which is often used to control postoperative chylous effusion, in addition to the sirolimus therapy. This combination therapy reduced the chylothorax and chylous ascites...
October 11, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28994887/hepatic-hydrothorax-about-a-hospital-serie-of-63-cases
#11
Leila Mouelhi, Oussama Daboussi, Nadia Cheffi, Kaouther El Jery, Yosra Said, Sana Khedher, Mohamed Salem, Radhouane Dabbèche, Fatma Houissa, Taoufik Najjar
BACKGROUND: Hepatic hydrothorax is a less common complication of cirrhosis with an estimated prevalence of 10- 15%. In the vast majority of cases, ascites are also present but significant pleural effusion may develop in patients without ascites. Hepatic hydrothorax is associated with cirrhosis whatever its etiology. The prognosis of hepatic hydrothorax remains unclear and is closely related to available therapeutic options. The aim of our study is to determine the prevalence of hydrothorax in cirrhotic patients, detail its clinical and therapeutic characteristics, and study the evolutive profile of cirrhotic patients with hydrothorax by comparing it to those without hydrothorax...
December 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/28994122/beta-blockers-in-hospitalised-patients-with-cirrhosis-and-ascites-mortality-and-factors-determining-discontinuation-and-reinitiation
#12
A Q Bhutta, G Garcia-Tsao, K R Reddy, P Tandon, F Wong, J G O'Leary, C Acharya, D Banerjee, J G Abraldes, T M Jones, J Shaw, Y Deng, M Ciarleglio, J S Bajaj
BACKGROUND: It has been suggested that beta-blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta-blockers discontinuation or reinitiation has not been examined. AIMS: To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta-blockers discontinuation and reinitiation. METHODS: Sub-analysis of NACSELD (North American consortium for the study of end-stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites...
October 9, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28940225/treatment-of-refractory-ascites-with-an-automated-low-flow-ascites-pump-in-patients-with-cirrhosis
#13
G Stirnimann, T Berg, L Spahr, S Zeuzem, S McPherson, F Lammert, F Storni, V Banz, J Babatz, V Vargas, A Geier, A Stallmach, C Engelmann, C Trepte, J Capel, A De Gottardi
BACKGROUND: Refractory ascites (RA) is a frequent complication of cirrhosis, requiring large volume paracentesis or placement of a transjugular intrahepatic portosystemic shunt (TIPSS). The automated low-flow ascites pump (alfapump, Sequana Medical AG, Zurich, Switzerland) is an innovative treatment option for patients with RA. AIM: To assess safety and efficacy of this treatment in patients with a contraindication to TIPSS. METHODS: Fifty-six patients (43 males; mean age 62 years) from centres in Germany, Switzerland, UK and Spain were included and followed for up to 24 months...
November 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28928860/the-impact-of-cetuximab-plus-akt-or-mtor-inhibitor-in-a-patient-derived-colon-cancer-cell-model-with-wild-type-ras-and-pik3ca-mutation
#14
Ju Sun Kim, Jung Eun Kim, Kyung Kim, Jeeyun Lee, Joon Oh Park, Ho Yeong Lim, Young Suk Park, Won Ki Kang, Seung Tae Kim
Background: Anti-EGFR therapies have been recommended for advanced colorectal cancer (CRC) with wild-type RAS and PIK3CA mutation. However, PIK3CA mutations are a poor prognostic marker and a negative predictor of response to anti-EGFR therapies in RAS wild-type CRC. Therefore, new and advanced treatment strategies are needed for personalized medical treatment of patients with wild-type RAS and PIK3CA mutation. Methods: Patient-derived tumor cells were collected from the ascites of a refractory colon cancer patient with wild-type RAS and PIK3CA mutation...
2017: Journal of Cancer
https://www.readbyqxmd.com/read/28925475/percutaneous-implant-of-denver-peritoneo-venous-shunt-for-treatment-of-refractory-ascites-a-single-center-retrospective-study
#15
M Piccirillo, L Rinaldi, M Leongito, A Amore, A Crispo, V Granata, P Aprea, F Izzo
OBJECTIVE: Refractory ascites is defined as a lack of response to high doses of diuretics or the development of diuretic related side effects, which compel the patient to discontinue the diuretic treatment. Current therapeutic strategies include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunts (TIPS). Peritoneovenous shunt (Denver shunt) should be considered for patients with refractory ascites who are not candidates for paracentesis or TIPS. This study presents our case series in the implant of Denver peritoneovenous shunt...
August 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28916623/efficacy-of-radioembolization-with-holmium-166-microspheres-in-salvage-patients-with-liver-metastases-a-phase-2-study
#16
Jip F Prince, Maurice A A J van den Bosch, J F W Nijsen, Maarten L J Smits, Andor F van den Hoven, Stavros Nikolakopoulos, Frank J Wessels, Rutger C G Bruijnen, Manon Braat, Bernard A Zonnenberg, Marnix Lam
Rationale: Radioembolization of liver malignancies with holmium-166 (166Ho) microspheres has been shown safe in a phase 1 dose-escalation study. The purpose of this study was to investigate the efficacy of 166Ho radioembolization. Methods: In this prospective single-arm study, 56 patients were enrolled, all with liver metastases refractory to systemic therapy and ineligible for surgical resection. Radioembolization was performed with a projected average absorbed dose of 60 Gy to the liver (equal to 3.8 GBq/kg liver tissue)...
September 15, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/28916401/cart-cell-free-and-concentrated-ascites-reinfusion-therapy-against-malignancy-related-ascites
#17
REVIEW
Tetsuya Ito, Norio Hanafusa
A standard strategy against ascites, a common symptom observed in cirrhotic and cancer patients, includes restriction of sodium intake and use of a diuretic. Paracentesis is a widely applied method against refractory ascites that do not react to such treatment. However, emerging fatigue and hemodynamic instability are possibly attributable to a loss of protein included in ascites. Cell-free and Concentrated Ascites Reinfusion Therapy (CART) is also applied against refractory ascites. CART comprises three processes...
August 30, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28895701/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-2-electrolyte-disturbances-nonelectrolyte-disturbances-therapeutic-options
#18
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamscha, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Alvarez
Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of a pediatric patient with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to diagnostic and therapeutic aspects, and preventive care...
October 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28873293/the-role-of-midodrine-for-hypotension-outside-of-the-intensive-care-unit
#19
Lawrence B Gutman, Ben J Wilson
Midodrine is an oral, peripherally acting alpha-adrenergic agonist. After gaining Food and Drug Administration (FDA) approval in 1996 for orthostatic hypotension, its use has evolved to target vasoplegic conditions such as intradialytic hypotension in the end-stage renal disease population, refractory ascites in cirrhotic patients to support diuresis, and in hepatorenal syndrome. Upon oral ingestion, the drug undergoes enzymatic hydrolysis to an active metabolite, desglymidodrine. Its use has been well tolerated at 2...
August 23, 2017: Journal of Population Therapeutics and Clinical Pharmacology
https://www.readbyqxmd.com/read/28853729/predictors-of-early-readmission-in-patients-with-cirrhosis-after-the-resolution-of-bacterial-infections
#20
Salvatore Piano, Filippo Morando, Giovanni Carretta, Marta Tonon, Elia Vettore, Silvia Rosi, Marialuisa Stanco, Chiara Pilutti, Antonietta Romano, Alessandra Brocca, Antonietta Sticca, Daniele Donato, Paolo Angeli
OBJECTIVES: In patients with cirrhosis, infections represent a frequent trigger for complications, increasing frequency of hospitalizations and mortality rate. This study aimed to identify predictors of early readmission (30 days) and of mid-term mortality (6 months) in patients with liver cirrhosis discharged after a hospitalization for bacterial and/or fungal infection. METHODS: A total of 199 patients with cirrhosis discharged after an admission for a bacterial and/or fungal infection were included in the study and followed up for a least 6 months...
October 2017: American Journal of Gastroenterology
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