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Refractory ascites

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https://www.readbyqxmd.com/read/27917793/high-dose-oral-furosemide-with-salt-ingestion-in-the-treatment-of-refractory-ascites-of-liver-cirrhosis
#1
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...
December 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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/27795511/proposed-diagnostic-criteria-disease-severity-classification-and-treatment-strategy-for-a-novel-disorder-tafro-syndrome
#11
Yasufumi Masaki, Hiroshi Kawabata, Kazue Takai, Norifumi Tsukamoto, Shino Fujimoto, Yasuhito Ishigaki, Nozomu Kurose, Masaru Kojima, Shigeo Nakamura, Tomohiro Kinoshita, Sadao Aoki
TAFRO syndrome is a systemic inflammatory disorder manifesting as thrombocytopenia; anasarca including pleural effusion and ascites; fever; renal insufficiency; and organomegaly including hepatosplenomegaly and lymphadenopathy. Its onset may be acute or sub-acute, but its etiology remains unknown. Although several clinical and pathological characteristics of TAFRO syndrome resemble those of Castleman's disease, other specific features can differentiate between the two. Some patients have been successfully treated with glucocorticoids and/or immunosuppressants including cyclosporin A, tocilizumab and rituximab, whereas others are refractory to treatment, eventually succumbing to the disease...
2016: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
https://www.readbyqxmd.com/read/27756837/malignant-pleural-effusion-and-ascites-induce-epithelial-mesenchymal-transition-and-cancer-stem-like-cell-properties-via-vegf-pi3k-akt-mtor-pathway
#12
Tao Yin, Guoping Wang, Sisi He, Guobo Shen, Chao Su, Yan Zhang, Xiawei Wei, Tinghong Ye, Ling Li, Shengyong Yang, Dan Li, Fuchun Guo, Zemin Mo, Yang Wan, Ping Ai, Xiaojuan Zhou, Yantong Liu, Yongsheng Wang, Yuquan Wei
Malignant pleural effusion (PE) and ascites, common clinical manifestations in advanced cancer patients, are associated with poor prognosis. However, the biological characteristics of malignant PE and ascites are not clarified. Here, we report that malignant PE and ascites can induce frequent epithelial-mesenchymal transition (EMT) program and endow tumor cells with stem cell properties with high efficiency, which promote tumor growth, chemoresistance and immune evasion. We determine that this EMT process is mainly dependent on VEGF, one initiator of PI3K/Akt/mTOR pathway...
October 18, 2016: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/27756320/a-case-of-peritoneal-metastasis-during-treatment-for-hypopharyngeal-squamous-cell-carcinoma
#13
Takahiro Wakasaki, Hirofumi Omori, Shintaro Sueyoshi, Fumihide Rikimaru, Satoshi Toh, Kenichi Taguchi, Yuichiro Higaki, Masaru Morita, Muneyuki Masuda
BACKGROUND: Advanced head and neck squamous cell carcinomas frequently develop distant metastases to limited organs, including the lungs, bone, mediastinal lymph nodes, brain, and liver. Peritoneal carcinomatosis as an initial distant metastasis from hypopharyngeal squamous cell carcinoma is quite rare. CASE PRESENTATION: A 75-year-old man diagnosed with hypopharyngeal squamous cell carcinoma and his clinical stage was determined as T2N2cM0. Notably, the right retropharyngeal lymph node surrounded more than half of the right internal carotid artery...
October 18, 2016: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27750234/clinical-factors-predicting-the-effect-of-tolvaptan-for-refractory-ascites-in-patients-with-decompensated-liver-cirrhosis
#14
Hirokazu Chishina, Satoru Hagiwara, Naoshi Nishida, Kazuomi Ueshima, Toshiharu Sakurai, Hiroshi Ida, Yasunori Minami, Masahiro Takita, Masashi Kono, Tomohiro Minami, Mina Iwanishi, Yasuko Umehara, Tomohiro Watanabe, Yoriaki Komeda, Tadaaki Arizumi, Masotoshi Kudo
OBJECTIVE: Refractory ascites reduces the quality of life of liver cirrhosis patients. Albumin preparation and diuretics, such as furosemide, have been used to treat refractory ascites, but the effect was poor in many patients. In this study, we analyzed patients treated with tolvaptan (TLV) at our hospital and investigated predictors of the effect. METHODS: The subjects were 70 patients for whom TLV was introduced to treat refractory ascites who could be analyzed between November 2013 and March 2015 at our hospital...
2016: Digestive Diseases
https://www.readbyqxmd.com/read/27746424/tolvaptan-for-the-treatment-of-refractory-ascites
#15
Masayuki Kurosaki, Namiki Izumi
No abstract text is available yet for this article.
2016: Internal Medicine
https://www.readbyqxmd.com/read/27740526/%C3%A2-percutaneous-shunt-reduction-for-the-management-of-tips-induced-acute-liver-decompensation-a-follow-up-study
#16
Bart De Keyzer, Frederik Nevens, Annouschka Laenen, Sam Heye, Wim Laleman, Chris Verslype, Schalk van der Merwe, Geert Maleux
:  Background and rationale for the study. The purpose of this study was to assess the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) reduction for the management of TIPS-induced acute liver decompensation. Between August 2000 and November 2013, 347 patients underwent a TIPS procedure in the authors' institution; 21/347 (6%) developed post-TIPS acute liver decompensation which was managed using a percutaneous shunt reduction technique. Patient demographics, laboratory tests before and after initial TIPS and TIPS reduction, procedural data and clinical follow-up data were analysed...
November 2016: Annals of Hepatology
https://www.readbyqxmd.com/read/27729954/management-of-refractory-ascites-in-cirrhosis-are-we-out-of-date
#17
Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen
Cirrhosis is a major cause of morbidity and mortality worldwide with liver transplantations as it only possible cure. In the face of a significant organ shortage many patients die waiting. A major complication of cirrhosis is the development of portal hypertension and ascites. The management of ascites has barely evolved over the last hundred years and includes only a few milestones in our treatment approach, but has overall significantly improved patient morbidity and survival. Our mainstay to ascites management includes changes in diet, diuretics, shunt procedures, and large volume paracentesis...
October 8, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27717792/beta-blockers-and-cirrhosis-2016
#18
Mattias Mandorfer, Thomas Reiberger
To date, non-selective beta blockers (NSBBs) are a cornerstone in the treatment of portal hypertension. During the last years, our understanding of the potential benefits of early initiation of NSBB treatment, their effects beyond the prevention of variceal bleeding (i.e., their non-hemodyamic effects), as well as potential detrimental effects in patients with advanced disease has continuously evolved. In addition, we have learned that not all NSBBs are equal. Due to its additional anti-α1-adrenergic activity, carvedilol has been shown to be more potent in decreasing portal pressure, but might lead to more pronounced decreases in systemic arterial pressure, when compared to conventional NSBBs...
September 27, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27707955/palliative-long-term-abdominal-drains-in-refractory-ascites-due-to-end-stage-liver-disease-a-case-series
#19
Lucia Macken, Deepak Joshi, Jenny Messenger, Mark Austin, Jeremy Tibble, Louise Mason, Sumita Verma
BACKGROUND: Ascites, the commonest complication of cirrhosis, leads to frequent hospitalisations. Refractory ascites confers a median survival of 6 months without liver transplantation. In many, the management remains palliative (large-volume paracentesis). Despite calls for improvement, palliative and end-of-life care is not yet integrated into end-stage liver disease. Long-term abdominal drains are a palliative strategy in malignant ascites, but not end-stage liver disease. CASE PRESENTATION: A retrospective, single centre, case series review was performed of patients undergoing long-term abdominal drain placement for refractory ascites secondary to end-stage liver disease at a large teaching hospital between August 2011 and March 2013...
October 5, 2016: Palliative Medicine
https://www.readbyqxmd.com/read/27706896/the-soluble-mannose-receptor-is-released-from-the-liver-in-cirrhotic-patients-but-is-not-associated-with-bacterial-translocation
#20
Tea L Laursen, Sidsel Rødgaard-Hansen, Holger J Møller, Christian Mortensen, Stine Karlsen, Dennis T Nielsen, Susanne Frevert, Jens O Clemmesen, Søren Møller, Jørgen S Jensen, Flemming Bendtsen, Henning Grønbaek
BACKGROUND & AIMS: Intestinal bacterial translocation is involved in activation of liver macrophages in cirrhotic patients. Macrophages play a key role in liver inflammation and are involved in the pathogenesis of cirrhosis and complications. Bacterial translocation may be determined by presence of bacterial DNA and macrophage activation, by the soluble mannose receptor. We hypothesize that the soluble mannose receptor is released from hepatic macrophages in cirrhosis and associated with bacterial DNA, portal pressure and complications...
October 5, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
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