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Refractory ascites

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https://www.readbyqxmd.com/read/29331339/cardiopulmonary-hemodynamics-and-c-reactive-protein-as-prognostic-indicators-in-compensated-and-decompensated-cirrhosis
#1
Laura Turco, Guadalupe Garcia-Tsao, Ilenia Magnani, Marcello Bianchini, Martina Costetti, Cristian Caporali, Stefano Colopi, Emilio Simonini, Nicola De Maria, Federico Banchelli, Rosario Rossi, Erica Villa, Filippo Schepis
BACKGROUND AND AIMS: The main stages of cirrhosis (compensated and decompensated) have been substaged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient, HVPG) features. Vasodilatation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage with inflammation being currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C reactive protein, CRP) among the different substages of cirrhosis and to investigate their interrelationship and prognostic relevance...
January 10, 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/29321413/remission-of-refractory-ascites-and-discontinuation-of-hemodialysis-after-additional-rituximab-to-long-term-glucocorticoid-therapy-in-a-patient-with-tafro-syndrome
#2
Hanako Tsurumi, Yoshihide Fujigaki, Tadashi Yamamoto, Risa Iino, Kei Taniguchi, Michito Nagura, Shigeyuki Arai, Yoshifuru Tamura, Tatsuru Ota, Shigeru Shibata, Fukuo Kondo, Nozomu Kurose, Yasufumi Masaki, Shunya Uchida
Thrombocytopenia, ascites, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a newly recognized but rare disease, and its treatment has not yet been established. We reported a 50-year-old woman with TAFRO syndrome diagnosed 2 years after the initial symptoms of a fever, fatigue, epigastric pain, edema, ascites, lymphadenopathy, thrombocytopenia and renal insufficiency. The patient showed refractory ascites and required hemodialysis under corticosteroid mono-therapy for suspected immune-mediated disease but was successfully treated with additive rituximab, resulting in improvement in her laboratory data, the withdrawal of hemodialysis and the disappearance of ascites...
January 11, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29318565/a-case-of-severe-stenosis-of-hepatic-veins-and-inferior-vena-cava-with-stomal-variceal-bleeding-induced-by-oxaliplatin-based-chemotherapy
#3
Hayato Yamaguchi, Yoshihiro Furuichi, Yoshitaka Kasai, Hirohito Takeuchi, Yuu Yoshimasu, Katsutoshi Sugimoto, Ikuo Nakamura, Takao Itoi
A 27-year-old woman with colon cancer and liver metastasis was referred to our hospital. Colectomy and colostomy were performed to improve her ileus. Following 13 sessions of oxaliplatin-based chemotherapy (OC) with mFOLFOX6 + bevacizumab, thrombocytopenia and frequent peristomal bleeding occurred. Computed tomography showed severe ascites, splenomegaly, significant collateral veins around the stoma, and severe stenosis of the hepatic veins (HV) and inferior vena cava (IVC). Ultrasound elastography showed high liver (and spleen) stiffness values...
January 9, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29316565/transjugular-intrahepatic-portosystemic-shunt-in-patients-with-portal-hypertension-patency-depends-on-coverage-and-interventionalist-s-experience
#4
Matthias Buechter, Paul Manka, Guido Gerken, Ali Canbay, Sandra Blomeyer, Axel Wetter, Jens Altenbernd, Alisan Kahraman, Jens M Theysohn
BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. PATIENTS AND METHODS: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included...
January 9, 2018: Digestive Diseases
https://www.readbyqxmd.com/read/29284759/portomesenteric-venous-stenting-for-palliation-of-ascites-and-variceal-bleeding-caused-by-prehepatic-portal-hypertension
#5
Rahul A Sheth, Sharjeel H Sabir, Philip Parmet, Roshon Amin, Joshua D Kuban, Steven Y Huang, Armeen Mahvash, David Fogelman, Milind Javle, Michael J Wallace
BACKGROUND: The purpose of this study was to evaluate percutaneous transhepatic portal vein stenting (PVS) for palliation of refractory ascites and/or variceal bleeding caused by extrahepatic portomesenteric venous stenosis in patients with pancreaticobiliary cancer. MATERIALS AND METHODS: A single-institution, retrospective review of patients who underwent PVS between January 2007 and July 2015 was performed. A total of 38 patients were identified, of whom 28 met the inclusion criterion of PVS performed primarily for refractory ascites or variceal bleeding...
December 28, 2017: Oncologist
https://www.readbyqxmd.com/read/29261352/incrementally-expandable-transjugular-intrahepatic-portosystemic-shunts-single-center-experience
#6
Jie Cui, Sara E Smolinski, Fengyong Liu, Dihua Xu, Kal Dulaimy, Zubin Irani
OBJECTIVE: The purpose of this study is to investigate the long-term safety and efficacy of a small-diameter expandable transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. MATERIALS AND METHODS: This single-center retrospective study included 28 patients (12 women and 16 men; mean age, 56.9 years) who underwent small-diameter expandable TIPS creation between 2008 and 2010 for refractory ascites (n = 15; mean [± SD] model for end-stage liver disease [MELD] score, 15...
December 20, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29250586/endoscopic-ultrasound-guided-placement-of-plastic-pigtail-stents-for-the-drainage-of-refractory-malignant-ascites
#7
Rafael Romero-Castro, Victoria Alejandra Jimenez-Garcia, Jaime Boceta-Osuna, Luis Castilla-Guerra, Francisco Pellicer-Bautista, Angel Caunedo-Alvarez, Juan Manuel Herrerias-Gutierrez, Manuel Romero-Gómez, Marc Giovannini
Endoscopic ultrasound (EUS)-guided drainage is now the treatment of choice in cases of pancreatic pseudocysts and walled-off necrosis, especially in the absence of luminal bulging and in patients with portal hypertension. Malignant refractory ascites usually heralds a poor prognosis and substantially impairs the quality of life of patients because of the symptoms experienced and the need for repeated paracentesis. EUS-guided placement of lumen-apposing, fully covered, self-expandable metal stents (FCSEMS) has been reported for the drainage of malignant ascites...
November 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/29250327/tolvaptan-is-effective-in-treating-patients-with-refractory-ascites-due-to-cirrhosis
#8
Toshiyuki Tahara, Kiyoto Mori, Mari Mochizuki, Ryoko Ishiyama, Marin Noda, Hitomi Hoshi, Alan Kawarai Lefor, Satoshi Shinozaki
The treatment of refractory ascites due to cirrhosis is a clinical challenge for hepatologists. Tolvaptan, a novel aquaporin modulator, was made available in Japan in 2013 for the treatment of patients with refractory ascites due to cirrhosis. Despite the potential of this drug, few reports are available regarding its clinical use. The aim of the present study was to clarify the efficacy of tolvaptan in patients with refractory ascites due to cirrhosis and to review the clinical outcomes of treatment. Medical records were retrospectively reviewed for 65 patients with refractory ascites due to cirrhosis who were treated daily with 7...
December 2017: Biomedical Reports
https://www.readbyqxmd.com/read/29245228/use-of-concomitant-variceal-embolization-and-prophylactic-antiplatelet-anticoagulative-in-transjugular-intrahepatic-portosystemic-shunting-a-retrospective-study-of-182-cirrhotic-portal-hypertension-patients
#9
Yingmei Tang, Sheng Zheng, Jinhui Yang, Weimin Bao, Lihong Yang, Yingchun Li, Ying Xu, Jing Yang, Yuyun Tong, Jinhang Gao, Chengwei Tang
Transjugular intrahepatic portosystemic shunting (TIPS) is an effective treatment modality for refractory variceal bleeding and ascites in patients with cirrhotic portal hypertension (CPH). Variceal rebleeding and shunt dysfunction are major post-TIPS morbidities. This study aimed to retrospectively evaluate the effectiveness and safety of use of concomitant variceal embolization and prophylactic antiplatelet/anticoagulative in patients with CPH undergoing TIPS. Between October 2006 and October 2011, 182 patients with CPH were retrospectively and consecutively hospitalized for elective TIPS with Fluency stenting...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29238869/lymphangiography-and-lymphatic-embolization-for-the-treatment-of-refractory-chylous-ascites
#10
Gregory J Nadolski, Nikunj R Chauhan, Maxim Itkin
PURPOSE: Assess the effectiveness of conventional lymphangiography, MR lymphangiography, and lymphatic embolization for the diagnosis and treatment of refractory chylous ascites. MATERIALS AND METHODS: A retrospective review of 31 patients (M/F:16/15, average age 52) who presented for the management of refractory chylous ascites was conducted to assess the diagnostic value of conventional and MR lymphangiography and outcome of lymphatic embolization. RESULTS: Of the total 31 patients, 25 presented with chylous ascites secondary to iatrogenic trauma and six patients with a non-traumatic etiology...
December 13, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/29226410/editorial-alfapump-an-alternative-to-large-volume-paracentesis-for-patients-with-refractory-ascites-authors-reply
#11
EDITORIAL
G Stirnimann, A De Gottardi
No abstract text is available yet for this article.
January 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29226396/editorial-alfapump-an-alternative-to-large-volume-paracentesis-for-patients-with-refractory-ascites
#12
EDITORIAL
S Macdonald, R Jalan
No abstract text is available yet for this article.
January 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29214793/mesocaval-shunt-creation-for-jejunal-variceal-bleeding-with-chronic-portal-vein-thrombosis
#13
Ja Kyung Yoon, Man Deuk Kim, Do Yun Lee, Seok Joo Han
The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion...
January 2018: Yonsei Medical Journal
https://www.readbyqxmd.com/read/29210304/current-management-of-refractory-ascites-in-patients-with-cirrhosis
#14
Ruihong Zhao, Juan Lu, Yu Shi, Hong Zhao, Kaijin Xu, Jifang Sheng
Liver cirrhosis is a health problem worldwide, and ascites is its principal symptom. Refractory ascites is intractable and occurs in 5%-10% of all patients with ascites due to cirrhosis. Refractory ascites leads to a poor quality of life and high mortality rate. Ascites develops as a result of portal hypertension, which leads to water-sodium retention and renal failure. Various therapeutic measures can be used for refractory ascites, including large-volume paracentesis, transjugular intrahepatic portosystemic shunt, vasoconstrictive drugs, and an automated low-flow ascites pump system...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/29201241/clinical-value-of-urinary-retinol-binding-protein-in-ascites-due-to-cirrhosis
#15
Yujing Xia, Jingjing Li, Sainan Li, Tong Liu, Yuqing Zhou, Qin Yin, Jianrong Wang, Wenxia Lu, Rong Zhang, Yuanyuan Zheng, Fan Wang, Jie Lu, Kan Chen, Weiqi Dai, Yingqun Zhou, Chuanyong Guo
The aim of the present study was to explore the clinical value of urinary retinol-binding protein (RBP) level in the prognosis of cirrhotic ascites by assessment of the RBP levels prior to and following ascites treatment. The levels of urinary RBP, urinary microalbumin (mAlb), serum urea nitrogen (urea) and serum creatinine (Cr), and the estimated glomerular filtration rate (eGFR) were measured in 90 patients with cirrhosis and ascites hospitalized in a single institution between May 2011 and January 2012, and in 30 healthy controls...
November 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29188319/a-dedicated-paracentesis-clinic-decreases-healthcare-utilization-for-serial-paracenteses-in-decompensated-cirrhosis
#16
Yao-Wen Cheng, Kumar Sandrasegaran, Katherine Cheng, Angela Shah, Marwan Ghabril, William Berry, Craig Lammert, Naga Chalasani, Eric S Orman
PURPOSE: The purpose of the study is to describe the effect of a dedicated paracentesis clinic on healthcare utilization by patients with decompensated cirrhosis and refractory ascites. METHODS: This Institutional Review Board-approved retrospective study identified cirrhotic patients receiving paracenteses over a 6-month period before and after creating the paracentesis clinic. Patients were followed for 12 months to collect outcome data including characteristics of subsequent hospitalizations and paracenteses...
November 29, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29183533/predictive-factors-for-treatment-failure-after-peritoneovenous-shunt-for-hepatic-ascites
#17
Hiroya Iida, Tsukasa Aihara, Shinichi Ikuta, Naoki Yamanaka
Peritoneovenous shunt (PVS) is used to treat refractory ascites. Here, we identify predictive factors for inhospital death after PVS placement. Thirty-five patients with refractory ascites related to liver cirrhosis and/or hepatocellular carcinoma (HCC) who underwent PVS placement between February 2005 and February 2013 were included in the study. Group A comprised 13 patients for whom the PVS placement outcome was inhospital death. Group B comprised 22 patients who were discharged after PVS placement without complications...
November 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29171115/carboplatin-and-programmed-death-ligand-1-blockade-synergistically-produce-a-similar-antitumor-effect-to-carboplatin-alone-in-murine-id8-ovarian-cancer-model
#18
Xinxin Zhu, Jia Xu, Han Cai, Jinghe Lang
AIM: In advanced, platinum resistant or refractory ovarian cancer (OC), the therapeutic efficacy of carboplatin is controversial. Although anti-programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) pathway blockages show great potential in cancer treatment, the antitumor effect of single anti-PD-L1 pathway monoclonal antibody (mAb) is not obvious in advanced or some poorly immunogenic tumors, including OC. We compared the effects of single or combined carboplatin and anti-PD-L1 mAb treatments and explored the possible antitumor mechanisms in a murine ID8 OC model...
November 24, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29168037/efficacy-and-safety-of-reinfusion-of-concentrated-ascitic-fluid-for-malignant-ascites-a-concept-proof-study
#19
Rumi Hanada, Naosuke Yokomichi, Chihiro Kato, Kazumi Miki, Sachiko Oyama, Tatsuya Morita, Ryoko Kawahara
PURPOSE: Malignant ascites is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one treatment modality, but controlled trials are limited. The primary aim of this study was to explore the efficacy and safety of CART, as well as their predictors, to obtain data for planning a further controlled trial. METHODS: This was a single center retrospective cohort study in patients with refractory malignant ascites...
November 22, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29166137/primary-constrained-tips-for-treating-refractory-ascites-or-variceal-bleeding-secondary-to-hepatic-cirrhosis
#20
R Rabei, S Mathesovian, J Tasse, S Madassery, B Arslan, U Turba, O Ahmed
PURPOSE: To report an initial experience using a primary constrained TIPS technique for treating cirrhotic patients with refractory ascites or variceal bleeding. METHODS: All patients undergoing primary constrained (n=9) and conventional (n=18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Pre-procedure demographics, Child-Pugh (CP), MELD, and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision...
November 22, 2017: British Journal of Radiology
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