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Ascites approach

Manuel Guerrero-Hernandez, Carlos A Hinojosa, Javier E Anaya-Ayala, Erika Elenes, Aldo Torre
Portal vein (PV) thrombosis (PVT) in the absence of liver disease or thrombophilia is rare. We report a 57-year-old male with a history of stage 3 chronic kidney disease who presented at the emergency department 18 months after abdominal surgery with progressive abdominal pain and distention. Computed tomography revealed PVT with multiple collaterals and moderate ascites. He had undergone partial gastrectomy and gastrojejunal anastomosis at an outside facility for gastrointestinal stromal tumors that caused an iatrogenic stenotic lesion in the PV...
October 20, 2016: Vascular and Endovascular Surgery
R C Oey, H R van Buuren, R A de Man
Accumulation of fluid in the peritoneal cavity - ascites - is commonly encountered in clinical practice. Ascites can originate from hepatic, malignant, cardiac, renal, and infectious diseases. This review discusses the current recommended diagnostic approach towards the patient with ascites and summarises future diagnostic targets.
October 2016: Netherlands Journal of Medicine
Ricardo U Macías-Rodríguez, Astrid Ruiz-Margáin, Jose L Rodriguez-Garcia, Sergio Zepeda-Gómez, Aldo Torre
OBJECTIVE: Endoscopic retrograde cholangio-pancreatography (ERCP) is useful for the management of biliary tract diseases; in patients with cirrhosis, portal hypertension may increase the risk for complications from ERCP. We evaluated the outcome and risk factors related to ERCP in patients with cirrhosis and portal hypertension. PATIENTS AND METHODS: In this case-control study, 37 patients (71 procedures) with cirrhosis and portal hypertension (group 1) and 37 controls (group 2) undergoing ERCP were included...
October 14, 2016: European Journal of Gastroenterology & Hepatology
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame...
December 2016: Current Gastroenterology Reports
Yi-Chan Chen, Ting-Shuo Huang, Yu-Chao Wang, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jun Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee, Ruey-Shyang Soong
Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009...
2016: BioMed Research International
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
Marc G Besselink, L Bengt van Rijssen, Claudio Bassi, Christos Dervenis, Marco Montorsi, Mustapha Adham, Horacio J Asbun, Maximillian Bockhorn, Oliver Strobel, Markus W Büchler, Olivier R Busch, Richard M Charnley, Kevin C Conlon, Laureano Fernández-Cruz, Abe Fingerhut, Helmut Friess, Jakob R Izbicki, Keith D Lillemoe, John P Neoptolemos, Michael G Sarr, Shailesh V Shrikhande, Robert Sitarz, Charles M Vollmer, Charles J Yeo, Werner Hartwig, Christopher L Wolfgang, Dirk J Gouma
BACKGROUND: Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. METHODS: The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation...
September 28, 2016: Surgery
Jiaywei Tsauo, Moon-Won Yoo, Jung-Hoon Park, Ho-Young Song, Eun Jung Jun, Young Chul Cho, Guk Bae Kim
BACKGROUND: Self-expandable metallic stent (SEMS) placement is a well-established palliative treatment approach for malignant gastroduodenal obstruction. In patients with a long (>10 cm) stricture, multiple stents placed in an overlapping fashion are often required. PURPOSE: To investigate the outcomes of overlapping SEMS placement for the palliative treatment of malignant gastroduodenal obstruction in patients with a long (>10 cm) stricture. MATERIAL AND METHODS: The medical records of 40 patients who underwent fluoroscopic overlapping SEMS placement for malignant gastroduodenal obstruction due to a long (>10 cm) stricture were reviewed...
September 28, 2016: Acta Radiologica
Luigina Graziosi, Elisabetta Marino, Verena De Angelis, Alberto Rebonato, Annibale Donini
: Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal cancer dissemination. This clinical condition could represent the terminal evolution of a lethal disease and could influence the prognosis, severely impairing the patients' quality of life. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk; diuretics, paracentesis, peritoneo-venous shunts and intraperitoneal biologic agents like anti-VEGF molecules, metalloproteinase inhibitors and immunomodulators are included...
2016: Annali Italiani di Chirurgia
Yudai Fukui, Junichi Shindoh, Shuichiro Matoba, Kenji Tomizawa, Yutaka Hanaoka, Shigeo Toda, Jin Moriyama, Hiroya Kuroyanagi
A 53-year-old man was readmitted with abdominal distention 2 weeks after undergoing laparoscopic low anterior resection with para-aortic lymphadenectomy for advanced rectal cancer (T4aN1M0, Stage IIIb). Ultrasound revealed massive ascites, and paracentesis revealed chylous fluid with a markedly elevated triglyceride level (1762 mg/dL). Despite conservative management, the fistula remained on postoperative day 120. On percutaneous lymphangiography, the chylous leakage point was clearly visualized at the para-aortic site, and surgical intervention was planned...
September 26, 2016: Asian Journal of Endoscopic Surgery
Kanako K Kumamaru, Sachin S Saboo, Ayaz Aghayev, Phoebe Cai, Carlos Gonzalez Quesada, Elizabeth George, Zoha Hussain, Tianrun Cai, Frank J Rybicki
BACKGROUND: The purpose is to develop a comprehensive risk-scoring system based on CT findings for predicting 30-day mortality after acute pulmonary embolism (PE), and to compare it with PE Severity Index (PESI). MATERIALS AND METHODS: The study included consecutive 1698 CT pulmonary angiograms (CTPA) positive for acute PE performed at a single institution (2003-2010). Two radiologists independently assessed each study regarding clinically relevant findings and then performed adjudication...
August 24, 2016: Journal of Cardiovascular Computed Tomography
Hideo Koh, Mizuki Aimoto, Akio Matsuhisa, Shin-Ichi Inoue, Takako Katayama, Hiroshi Okamura, Takuro Yoshimura, Shiro Koh, Satoru Nanno, Mitsutaka Nishimoto, Yasuhiro Nakashima, Asao Hirose, Mika Nakamae, Takahiko Nakane, Masayuki Hino, Hirohisa Nakamae
BACKGROUND: A new 23S ribosomal RNA genes-targeted in situ hybridization (ISH) probe to detect global bacterial genomic DNA (59 species from 35 genera; referred to as the GB probe) phagocytized in leukocytes was recently developed. This method provided early and direct evidence of bacterial infection with high sensitivity and specificity in spontaneous bacterial peritonitis ascites. However, the utility of this method in febrile neutropenia (FN) is unknown. METHODS: We prospectively evaluated the utility of the ISH approach using the GB probe and previously reported probes in patients with neutropenia and fever undergoing chemotherapy at our institution between June 2011 and July 2013...
October 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Francesca Roggiani, Delia Mezzanzanica, Katia Rea, Antonella Tomassetti
Epithelial ovarian cancer (EOC) is the deadliest tumor among gynecological cancer in the industrialized countries. The EOC incidence and mortality have remained unchanged over the last 30 years, despite the progress in diagnosis and treatment. In order to develop novel and more effective therapeutic approaches, the molecular mechanisms involved in EOC progression have been thoroughly investigated in the last few decades. At the late stage, peritoneal metastases originate from the attachment of small clusters of cancer cells that shed from the primary site and carried by the ascites adhere to the abdominal peritoneum or omentum...
2016: International Journal of Molecular Sciences
Loheetha Ragupathi, Drew Johnson, Gregary D Marhefka
Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites...
August 2016: Texas Heart Institute Journal
Takayuki Takahama, Kazuko Sakai, Masayuki Takeda, Koichi Azuma, Toyoaki Hida, Masataka Hirabayashi, Tetsuya Oguri, Hiroshi Tanaka, Noriyuki Ebi, Toshiyuki Sawa, Akihiro Bessho, Motoko Tachihara, Hiroaki Akamatsu, Shuji Bandoh, Daisuke Himeji, Tatsuo Ohira, Mototsugu Shimokawa, Yoichi Nakanishi, Kazuhiko Nakagawa, Kazuto Nishio
INTRODUCTION: Next-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been developed to overcome resistance to earlier generations of such drugs mediated by a secondary T790M mutation of EGFR, but the performance of a second tumor biopsy to assess T790M mutation status can be problematic. METHODS: We developed and evaluated liquid biopsy assays for detection of TKI-sensitizing and T790M mutations of EGFR by droplet digital PCR (ddPCR) in EGFR mutation-positive non-small cell lung cancer (NSCLC) patients with acquired EGFR-TKI resistance...
August 16, 2016: Oncotarget
Kamlesh Gidwani, Kaisa Huhtinen, Henna Kekki, Sandra van Vliet, Johanna Hynninen, Niina Koivuviita, Antti Perheentupa, Matti Poutanen, Annika Auranen, Seija Grenman, Urpo Lamminmäki, Olli Carpen, Yvette van Kooyk, Kim Pettersson
BACKGROUND: Measurement of serum cancer antigen 125 (CA125) is the standard approach for epithelial ovarian cancer (EOC) diagnostics and follow-up. However, the clinical specificity is not optimal because increased values are also detected in healthy controls and in benign diseases. CA125 is known to be differentially glycosylated in EOC, potentially offering a way to construct CA125 assays with improved cancer specificity. Our goal was to identify carbohydrate-reactive lectins for discriminating between CA125 originating from EOC and noncancerous sources...
October 2016: Clinical Chemistry
Francesca Ratti, Federica Cipriani, Raffaella Reineke, Marco Catena, Laura Comotti, Luigi Beretta, Luca Aldrighetti
BACKGROUND AND AIM: Aim of the study was to assess the impact of ERAS approach ("fluid restrictive and drainless") on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery. STUDY DESIGN: 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients)...
October 2016: Digestive and Liver Disease
S Voleva, St Ivanova, B Marinov, P Genova-Kalou, V Manolov, V Vasilev
UNLABELLED: Viral infections during pregnancy, along with some form of accompanying pregnancy diseases such as diabetes, cardiovascular, gastrointestinal, kidney and others, are a major cause of arising complications and mortality of mother and fetus. AIM: To improved the laboratory diagnostic approach in the study of women with pathological pregnancy, including improve treatment and prognostic character of the outcome of pregnancy, with the inclusion of two infectious agent parvovirus B19 and Chlamydia trachomatis...
2016: Akusherstvo i Ginekologii︠a︡
Cornelius Engelmann, Sandra Krohn, Delia Prywerek, Jan Hartmann, Adam Herber, Albrecht Boehlig, Katharina Zeller, Stephan Boehm, Thomas Berg
BACKGROUND: The prognostic relevance of bacterial DNA (bactDNA) detection in ascitic fluid of patients with cirrhosis is still under debate. Using quantitative real-time PCR with broad-range primers targeting the V3 and V4 variable region of the 16S rRNA gene, we measured bactDNA concentrations in patients with and without leukocytic ascites and evaluated the impact on short-term survival. PATIENTS AND METHODS: Ascites samples from 173 patients with decompensated cirrhosis were consecutively collected between February 2011 and December 2012...
November 2016: European Journal of Gastroenterology & Hepatology
Amanullah Abbasi, Abdul Rabb Bhutto, Mohammad Tanveer Alam, Muhammad Aurangzaib, Mohammad Masroor
OBJECTIVE: To determine the frequency of hepatic hydrothorax and its association with Child Pugh Class in patients with liver cirrhosis. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, (Ward- 7), from June 2012 to May 2013. METHODOLOGY: All patients with established diagnosis of decompensated chronic liver disease were included. Detailed history, thorough physical examination, routine laboratory investigations, chest X-ray and abdominal ultrasound were carried out in all patients to find out the presence of pleural effusion and ascites, respectively...
July 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
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