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Refractory ascites

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https://www.readbyqxmd.com/read/28805258/impact-of-beta-blockers-on-cardiopulmonary-exercise-testing-in-patients-with-advanced-liver-disease
#1
M P Wallen, A Hall, K A Dias, J S Ramos, S E Keating, A J Woodward, T L Skinner, G A Macdonald, R Arena, J S Coombes
BACKGROUND: Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. Beta-blockers reduce portal pressure and minimise haemorrhage risk. These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing. AIM: To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease...
August 14, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28792999/clinical-features-of-refractory-ascites-in-outpatients
#2
Wanda Regina Caly, Rodrigo Martins Abreu, Bernardo Bitelman, Flair José Carrilho, Suzane Kioko Ono
OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month...
July 2017: Clinics
https://www.readbyqxmd.com/read/28765699/effect-of-initial-stent-position-on-patency-of-transjugular-intrahepatic-portosystemic-shunt
#3
Shi-Hua Luo, Jian-Guo Chu, He Huang, Ke-Chun Yao
AIM: To evaluate the effect of initial stent position on transjugular intrahepatic portosystemic shunt (TIPS). METHODS: We studied 425 patients from January 2004 to January 2015 with refractory ascites or variceal bleeding who required TIPS placement. Patients were randomly divided into group A (stent in hepatic vein, n = 57), group B (stent extended to junction of hepatic vein and inferior vena cava, n = 136), group C (stent in left branch of portal vein, n = 83) and group D (stent in main portal vein, n = 149)...
July 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28762169/successful-surgical-treatment-of-intractable-chylous-ascites-using-the-lymphatic-cable-flap-a-retrospective-review-study
#4
Shih-Heng Chen, Li-Fan Yeh, Pedro Ciudad, Hung-Chi Chen
OBJECTIVE: For evaluation of a novel surgical procedure for the treatment of chylous ascites. Chylous ascites is a debilitating condition associated with high morbidity and mortality rates. At least one-third of patients are refractory to medical therapy and may warrant further treatment. Traditional methods involving ligation of lymphatic fistulas or small bowel resection do not address the basic pathophysiologic mechanism of the underlying obstruction, and identification of chyloperitoneal fistulas may be challenging...
July 31, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28751810/effectiveness-of-tolvaptan-monotherapy-and-low-dose-furosemide-tolvaptan-combination-therapy-for-hepatoprotection-and-diuresis-in-a-rat-cirrhotic-model
#5
Norikazu Tanabe, Taro Takami, Koichi Fujisawa, Toshihiko Matsumoto, Naoki Yamamoto, Isao Sakaida
Spironolactone and furosemide, which are used to treat ascites associated with decompensated cirrhosis, are ineffective in treating refractory ascites. Hence, combination therapy with tolvaptan, a vasopressin V2 receptor antagonist, has been approved in Japan. Tolvaptan monotherapy and combination therapy with furosemide inhibit fibrosis in cardiac remodeling; hence, we examined these therapies in a rat cirrhotic model, including their usefulness in inhibiting hepatic fibrosis. In the present study, we used a model of hepatic fibrosis induced by a choline-deficient l-amino-acid-defined diet + diethylnitrosamine...
July 2017: Journal of Clinical Biochemistry and Nutrition
https://www.readbyqxmd.com/read/28737869/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-1-pathophysiology-diagnostic-evaluation-hospitalization-criteria-treatment-nutritional-management
#6
REVIEW
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamsch, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Álvarez
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 pediatric patients 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 its diagnostic and therapeutic aspects, and preventive care...
August 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28730292/efficacy-and-safety-of-taxane-monotherapy-in-advanced-gastric-cancer-refractory-to-triplet-chemotherapy-with-docetaxel-cisplatin-and-s-1-a-multicenter-retrospective-study
#7
Sakura Iizumi, Atsuo Takashima, Yukiya Narita, Masahiro Tajika, Kei Muro, Sadayuki Kawai, Hirofumi Yasui, Tomohiro Matsushima, Daisuke Takahari, Kengo Nagashima, Narikazu Boku
PURPOSE: Taxane monotherapy is widely used for advanced gastric cancer (AGC) after failure of standard first-line chemotherapy with fluoropyrimidine and cisplatin. Triplet chemotherapy with docetaxel, cisplatin, and S-1 (DCS) is a promising regimen for first-line chemotherapy of AGC. The aim of this study was to evaluate the efficacy of taxane monotherapy in patients refractory to DCS. METHODS: We retrospectively evaluated the efficacy and safety of taxane monotherapy in patients with AGC refractory to first-line therapy with DCS between January 2010 and April 2015...
July 20, 2017: Cancer Chemotherapy and Pharmacology
https://www.readbyqxmd.com/read/28693208/efficacy-and-safety-of-sox-chemotherapy-with-or-without-surgery-in-afp-producing-advanced-gastric-cancer
#8
Zhu Li, Xu Hou, Juan Chen, Huidong Sun, Yuetang Mi, Yongling Sui, Yuhong Li, Jiaping Xie, Yingli Qiao, Xiaofeng Lei, Xiaoshuang Che, Jun Liu
The present study investigated the clinical efficacy of S-1 plus oxaliplatin (SOX) regimen, with or without surgery in α-fetoprotein-producing gastric cancer (APGC) with liver metastasis. A total of 24 patients with APGC treated at the Liaocheng People's Hospital between January 2011 and December 2013 were retrospectively reviewed. Clinical efficacy and patient safety were compared between the two groups. The median progression-free survival (PFS) and overall survival (OS) in the SOX group were 6.5 [95% confidence interval (CI), 4...
July 2017: Oncology Letters
https://www.readbyqxmd.com/read/28688177/renal-vein-dilation-predicts-the-poor-outcome-in-patients-with-refractory-cirrhotic-ascites
#9
Naoki Matsumoto, Masahiro Ogawa, Mariko Kumagawa, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Shunichi Matsuoka, Mitsuhiko Moriyama, Hirotoshi Fujikawa
BACKGROUND & AIMS: Renal venous hypertension is known to be associated with worsening of renal function in patients with decompensated heart failure. Intra-abdominal hypertension including cirrhotic ascites also leads to renal venous hypertension. We aimed to clarify the effect of renal venous hypertension on cirrhotic ascites. METHODS: Two hepatologists measured the left renal vein diameter in 142 consecutive patients with refractory cirrhotic ascites using non-contrast computed tomography...
July 8, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28681347/new-concepts-on-the-clinical-course-and-stratification-of-compensated-and-decompensated-cirrhosis
#10
REVIEW
Gennaro D'Amico, Alberto Morabito, Mario D'Amico, Linda Pasta, Giuseppe Malizia, Paola Rebora, Maria Grazia Valsecchi
The clinical course of cirrhosis has been typically described by a compensated and a decompensated state based on the absence or, respectively, the presence of any of bleeding, ascites, encephalopathy or jaundice. More recently, it has been recognized that increasing portal hypertension and several major clinical events are followed by a marked worsening in prognosis, and disease states have been proposed accordingly in a multistate model. The development of multistate models implies the assessment of the probabilities of more than one possible outcome from each disease state...
July 5, 2017: Hepatology International
https://www.readbyqxmd.com/read/28676515/peritoneal-dialysis-catheters-to-treat-refractory-non-malignant-ascites
#11
Jay Hingwala, Reid Whitlock, Sara Dunsmore, Sean Armstrong, Navdeep Tangri, Paul Komenda
Refractory non-malignant ascites is associated with significant morbidity. Serial, large-volume paracentesis is a common treatment. Tunneled peritoneal dialysis (PD) catheters are an effective treatment for refractory malignant ascites, but there are limited data on complications and effectiveness for non-malignant ascites. We reviewed all 13 PD catheter insertions between 2010 - 2015 for this indication at our center. The median catheter survival time was 146 days. No complications occurred during catheter insertion, and no mechanical complications occurred after catheter insertion...
July 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28661095/protein-concentration-of-refractory-ascites-in-cancer-patients-is-reflected-by-the-presence-and-severity-of-peritoneal-and-liver-metastasis
#12
Yosuke Yamada, Akinori Yamaguchi, Makoto Harada, Yukifumi Kurasawa, Yuuta Hara, Daiki Yamazaki, Satoshi Fujita, Kosuke Sonoda, Tomoe Masuda, Aiko Yamada, Yohei Ogawa, Koji Hashimoto, Yuji Kamijo
Ascites total protein concentration (A-TP) affects the performance of cell-free and concentrated ascites reinfusion therapy (CART). As the factors determining A-TP remain unclear, we examined peritoneal and liver metastasis. Among 98 patients who received CART, 68 with cancer, ascites from no other apparent cause, and complete CT and A-TP data were recruited. Sixty-six patients (97%) with peritoneal and/or liver metastasis on CT were divided into the peritoneal metastasis group (PM group), peritoneal and liver metastasis group (PM + LM group), and liver metastasis group (LM group)...
June 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28661089/immunological-analysis-and-generation-of-dendritic-cells-from-lavage-fluid-obtained-by-cell-free-and-concentrated-ascites-reinfusion-therapy
#13
Masahiro Ogasawara, Mamiko Miyashita, Michio Iida, Takashi Fukuhara
Cell-free and concentrated ascites reinfusion therapy (CART) is an effective treatment for patients with refractory ascites. Cellular components such as cancer cells and blood cells are removed and discarded. The aim of this study was to investigate the alteration of immune cells in lavage fluid and the generation of dendritic cells (DCs) from lavage fluid obtained by CART. Flow cytometry analysis showed a trend toward immunosuppression and impairment in innate immunity in lavage fluid. Immature DCs with downregulation of CD14 and increased antigen-uptake were generated by culturing monocytes obtained from lavage fluid with GM-CSF and IL4...
June 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28645737/alfapump%C3%A2-system-vs-large-volume-paracentesis-for-refractory-ascites-a-multicenter-randomized-controlled-study
#14
Christophe Bureau, Danielle Adebayo, Mael Chalret de Rieu, Laure Elkrief, Dominique Valla, Markus Peck-Radosavljevic, Anne McCune, Victor Vargas, Macarena Simon-Talero, Juan Cordoba, Paolo Angeli, Silvia Rosi, Stewart MacDonald, Massimo Malago, Maria Stepanova, Zobair M Younossi, Claudia Trepte, Randall Watson, Oleg Borisenko, Sun Sun, Neil Inhaber, Rajiv Jalan
BACKGROUND AND AIMS: Patients with refractory ascites (RA) require repeated large volume paracenteses (LVP), which involves frequent hospital visits and is associated with a poor quality-of-life. This study assessed safety and efficacy of an automated, low-flow pump (alfapump® [AP]) compared with LVP standard of care [SoC]. METHODS: A randomized controlled trial, in seven centers, with six month patient observation was conducted. Primary outcome was time to first LVP...
June 21, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28625694/the-incidence-of-chylous-ascites-after-liver-transplantation-and-the-proposal-of-a-diagnostic-and-management-protocol
#15
Toshiharu Matsuura, Yusuke Yanagi, Makoto Hayashida, Yoshiaki Takahashi, Koichiro Yoshimaru, Tomoaki Taguchi
BACKGROUND: No protocol has been established for the diagnosis and management of chylous ascites after liver transplantation (LT). In this study, we retrospectively reviewed our cases of posttransplant chylous ascites (PTCA) and aimed to propose a diagnostic and management protocol. PATIENTS AND METHODS: We retrospectively reviewed the clinical records of 96 LT recipients who underwent LT at our department. The incidence of PTCA and the associated risk factors were analyzed and our protocol for chylous ascites was evaluated...
June 11, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28623993/management-of-refractory-chylous-ascites-with-peritoneovenous-shunts
#16
Ying Huang, Peter Gloviczki, Audra A Duncan, Mark D Fleming, David J Driscoll, Manju Kalra, Gustavo S Oderich, Thomas C Bower
OBJECTIVE: The purpose of this study was to define outcome of treatments of refractory chylous ascites using peritoneovenous shunts (PVSs). METHODS: Clinical data of patients with refractory chylous ascites treated with PVSs between 1992 and 2015 were retrospectively reviewed. The primary end point was clinical benefit, defined as cured, improved, or poor results; secondary end points were complications and reinterventions. RESULTS: Seventeen patients (eight female [47%]; median age, 47 years [range, 19-78 years]) with refractory chylous ascites were studied...
July 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28611269/the-role-of-tips-in-patients-with-refractory-ascites-and-portal-vein-thrombosis
#17
Paulina Chinchilla-López, Nashla Hamdan-Pérez, Jorge Guerrero-Ixtlahuac, Beatriz Barranco-Fragoso, Nahum Méndez-Sánchez
Nowadays the contraindication for Transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal vein thrombosis (PVT) had been modify. The experience and technology have reduce the complications for this procedure. We report a case of refractory ascites and portal vein thrombosis to emphasize the role of TIPS in the treatment for this condition.
August 1, 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/28602971/new-developments-in-hepatorenal-syndrome
#18
Ayse L Mindikoglu, Stephen C Pappas
Hepatorenal Syndrome (HRS) continues to be one of the major complications of decompensated cirrhosis leading to death in the absence of liver transplantation. Challenges in precisely evaluating renal function in the patient with cirrhosis remain due to the limitations of serum creatinine (Cr) alone in estimating glomerular filtration rate (GFR); current GFR estimating models appear to underestimate renal function. Newer models incorporating renal biomarkers, such as the Cr-Cystatin C GFR Equation for Cirrhosis appear to more accurately estimate true GFR...
June 7, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28590564/beta-blockers-in-patients-with-advanced-liver-disease-has-the-dust-settled
#19
REVIEW
Carlos Moctezuma-Velazquez, Sylvia Kalainy, Juan G Abraldes
Nonselective beta-blockers (NSBBs) have been the backbone for the treatment of portal hypertension in cirrhosis for the last 3 decades. A publication in 2010 of a prospective observational study suggested that NSBBs could increase mortality in patients with refractory ascites. This opened a controversy about the safety and efficacy of NSBBs in patients with advanced liver disease and led to the publication of a large corpus of observational data assessing the safety of NSBBs in patients with advanced cirrhosis...
August 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28589706/technical-performance-and-clinical-effectiveness-of-drop-type-with-adjustable-concentrator-cell-free-and-concentrated-ascites-reinfusion-therapy
#20
Yosuke Yamada, Makoto Harada, Akinori Yamaguchi, Yasuko Kobayashi, Takashi Chino, Takashi Minowa, Takashi Kosuge, Wataru Tsukada, Koji Hashimoto, Yuji Kamijo
Cell-free and concentrated ascites reinfusion therapy (CART) is a very useful treatment method for refractory ascites but is difficult for many hospitals to employ due to its need for specialized equipment. We have therefore developed drop-type with adjustable concentrator CART (DC-CART) that uses a drop-type filtration mechanism and requires only a simple pump and pressure monitor for its concentration process. Easy adjustment of ascites concentration is possible through a recirculation loop, and filter membrane washing is aided by DC-CART's external pressure-type filtration to enable the processing of any quality or quantity of ascites...
June 7, 2017: Artificial Organs
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