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https://www.readbyqxmd.com/read/28634518/role-of-albumin-in-cirrhosis-from-a-hospitalist-s-perspective
#1
REVIEW
Saqib Walayat, Daniel Martin, Jaymon Patel, Umair Ahmed, Muhammad N Asghar, Aparna U Pai, Sonu Dhillon
Albumin, a negatively charged globular protein encoded on chromosome 4, is one of the most abundant proteins in the plasma and accounts for approximately 75% of plasma oncotic pressure. The role of albumin in the management of various disease states has shown to be beneficial historically. Low serum albumin is a predictor of mortality and poor outcomes. In cirrhotics undergoing paracentesis, albumin infusion prevents rapid re-accumulation of ascitic fluid while simultaneously decreasing the risk of post-paracentesis related circulatory dysfunction...
January 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/28620570/perforated-bladder-as-a-cause-of-abdominal-ascites-in-a-patient-presenting-with-acute-onset-abdominal-pain
#2
Raj Shah, Madhuri Ramakrishnan, Beenish Ahmed, Khalil Abuamr, Osama Yousef
Bladder perforation, especially when atraumatic, is a rare cause of ascites and is often difficult to differentiate from other causes of abdominal pain and ascites in the acute setting.  A 43-year-old Caucasian woman with a history of multiple sclerosis presented with acute abdominal pain. A computed tomography (CT) scan of her abdomen and pelvis without contrast revealed ascites, acute kidney injury (AKI) was noted on laboratory workup, and very little urine was drained by Foley catheter. Over the next several days, the patient's clinical condition deteriorated with no definitive diagnosis...
May 11, 2017: Curēus
https://www.readbyqxmd.com/read/28616715/effects-of-intravitreal-injection-of-bevacizumab-with-or-without-anterior-chamber-paracentesis-on-intraocular-pressure-and-peripapillary-retinal-nerve-fiber-layer-thickness-a-prospective-study
#3
Masoud Soheilian, Saeed Karimi, Talieh Montahae, Homayoun Nikkhah, Seyed Aliasghar Mosavi
PURPOSE: To investigate the effects of intravitreal injection of bevacizumab (IVB) with or without anterior chamber paracentesis on intraocular pressure (IOP) and peripapillary retinal nerve fiber layer (PRNFL) thickness. METHODS: In this prospective randomized clinical trial, 90 eyes with center involving diabetic macular edema or wet type age-related macular degeneration (AMD) were randomly assigned to receive IVB either without (group A) or with (group B) anterior chamber paracentesis...
June 14, 2017: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/28611650/anterior-360%C3%A2-synechiolysis-in-a-case-of-late-iridocorneal-adhesions-after-25-g-vitrectomy-surgical-and-physiopathogenetic-aspects
#4
Raffaele Nuzzi, Francesca Monteu
We describe the case of an 86-year-old patient, pseudophakic in both eyes and with high myopia, who had previously had a 25-G vitrectomy with 20% C3F8 used as a tamponade due to a total retinal detachment with choroidal hemorrhages and macular hole. At the postoperative 4-month follow-up, we found 360° iridocorneal synechiae with elevated intraocular pressure due to angle closure in all sectors, with an adherent retina and in the absence of choroidal hemorrhage/detachment and of corneal edema or endothelial damage...
January 2017: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/28611533/functional-budd-chiari-syndrome-associated-with-severe-polycystic-liver-disease
#5
Precil Diego Miranda de Menezes Neves, Bruno Eduardo Pedroso Balbo, Elieser Hitoshi Watanabe, Vinicius Rocha-Santos, Wellington Andraus, Luiz Augusto Carneiro D'Albuquerque, Luiz Fernando Onuchic
A 50-year-old woman with end-stage renal disease secondary to autosomal dominant polycystic kidney disease was referred to a quaternary care center due to significantly increased abdominal girth. Her physical examination revealed tense ascites and abdominal collateral veins. A 10-L paracentesis improved abdominal discomfort and disclosed a transudate, suggestive of portal hypertension. A computed tomographic scan revealed massive hepatomegaly caused by multiple cysts of variable sizes, distributed throughout all hepatic segments...
2017: Clinical Medicine Insights. Gastroenterology
https://www.readbyqxmd.com/read/28597106/relative-ascites-polymorphonuclear-cell-count-indicates-bacterascites-and-risk-of-spontaneous-bacterial-peritonitis
#6
Philipp Lutz, Felix Goeser, Dominik J Kaczmarek, Stefan Schlabe, Hans Dieter Nischalke, Jacob Nattermann, Achim Hoerauf, Christian P Strassburg, Ulrich Spengler
BACKGROUND AND AIMS: Absolute polymorphonuclear (PMN) counts in ascites define spontaneous bacterial peritonitis (SBP), a severe form of bacterial infection in liver cirrhosis. Bacterascites, another form of ascites infection, can progress to SBP or may resolve spontaneously but is not reflected by absolute PMN counts. We investigated whether the relative ascites PMN count (the absolute PMN count divided by the absolute leukocyte count) provides additional information to detect bacterascites or predict SBP...
June 9, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28570095/differentiating-transudative-from-exudative-ascites-using-quantitative-b-mode-gray-scale-ultrasound-histogram
#7
Bulent Çekiç, Iclal Erdem Toslak, Yasin Şahintürk, Ayhan Hilmi Cekin, Yasemin Kocabas Koksel, Mert Koroglu, Terrence C Demos
OBJECTIVE: The purpose of this article is to differentiate exudative from transudative ascites using B-mode gray-scale ultrasound histogram analysis. SUBJECTS AND METHODS: Sixty-two consecutive patients with ascites were prospectively studied from June 2014 through June 2015. All underwent ultrasound (US) and paracentesis in the radiology department. Five patients were excluded (three with hemorrhage and two with peritoneal carcinomatosis). The remaining 57 patients were divided into those with exudative and transudative ascites according to results of paracentesis...
June 1, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28554223/outpatient-management-of-severe-ovarian-hyperstimulation-syndrome-a-systematic-review-and-a-review-of-existing-guidelines
#8
Amr Gebril, Haitham Hamoda, Raj Mathur
Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management...
May 29, 2017: Human Fertility: Journal of the British Fertility Society
https://www.readbyqxmd.com/read/28540466/drug-utilization-evaluation-of-albumin-in-a-teaching-hospital-of-mashhad-iran-an-interventional-pre-post-design-study
#9
Farzaneh Zolfagharian, Saba Ghazanfari, Sepideh Elyasi, Paria Iraji, Mohammad Reza Saberi, Nasser Vahdati-Mashhadian, Amir Hooshang Mohammadpour
Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre-post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016...
May 24, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28539992/bi-directional-hepatic-hydrothorax
#10
Madhan Nellaiyappan, Anastasios Kapetanos
A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia, and 4 mo of exertional dyspnea. He was noted to be tachypneic and hypoxic. He had a massive right sided pleural effusion with leftward mediastinal shift and gross ascites, with a tense, fluid-filled, umbilical hernia. Emergent paracentesis with drain placement and a large volume thoracentesis were performed. Despite improvement in dyspnea and drainage of 15 L of ascitic fluid, the massive transudative pleural effusion remained largely unchanged...
May 8, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28513500/rescue-vitrectomy-with-blocked-artery-massage-and-bloodletting-for-branch-retinal-artery-occlusion
#11
Chun-Ju Lin, Cheng-Wen Su, Huan-Sheng Chen, Wen-Lu Chen, Jane-Ming Lin, Yi-Yu Tsai
A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset...
April 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/28497416/internal-medicine-point-of-care-ultrasound-curriculum-consensus-recommendations-from-the-canadian-internal-medicine-ultrasound-cimus-group
#12
Irene W Y Ma, Shane Arishenkoff, Jeffrey Wiseman, Janeve Desy, Jonathan Ailon, Leslie Martin, Mirek Otremba, Samantha Halman, Patrick Willemot, Marcus Blouw
Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs...
May 11, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28494541/-new-therapeutic-paradigm-and-concepts-for-patients-with-cirrhotic-refractory-ascites
#13
S Z Wang, H G Ding
The activation of renin-angiotensin-aldosterone-vasopressin system is a key factor in the formation of ascites due to splanchnic vasodilation in cirrhosis. In theory, aldosterone antagonists, contraction of blood vessels, vasopressin V2 receptor, and angiotensin receptor antagonists are important targets for the prevention and treatment of cirrhotic ascites. The 15%-20% of patients with cirrhotic ascites that show no response to at least one week's treatment with potent diuretics (spironolactone 160 mg/d combined with furosemide 80 mg/d) are considered to have refractory ascites...
April 20, 2017: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28493448/utility-of-an-immunocytochemical-assay-using-aqueous-humor-in-the-diagnosis-of-feline-infectious-peritonitis
#14
Sandra Felten, Kaspar Matiasek, Stefanie Gruendl, Laura Sangl, Katrin Hartmann
OBJECTIVE: In cats suffering from feline infectious peritonitis (FIP) without effusion, antemortem diagnosis is challenging. Uveitis is common in these cats. It was the aim of this study to evaluate sensitivity and specificity of an immunocytochemical assay (ICC) in aqueous humor of cats suspected of having FIP. ANIMALS STUDIED: The study included 26 cats with immunohistochemically confirmed FIP and 12 control cats for which FIP was suspected due to similar clinical or laboratory changes, but which suffered from other diseases confirmed via histopathology...
May 10, 2017: Veterinary Ophthalmology
https://www.readbyqxmd.com/read/28491181/tips-performed-in-a-patient-with-complete-portal-vein-thrombosis
#15
Ashwani Kumar Sharma, David Charles Kaufman
Portal vein thrombosis is common in cirrhotic patients and results in increased morbidity and mortality. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements have led to improved TIPS outcomes that have encouraged an expanded application. Complete portal vein thrombosis has come a long way from being a contraindication to an indication for TIPS procedure...
June 2017: Radiology case reports
https://www.readbyqxmd.com/read/28489618/core-competencies-or-a-competent-core-a-scoping-review-and-realist-synthesis-of-invasive-bedside-procedural-skills-training-in-internal-medicine
#16
Ryan Brydges, Lynfa Stroud, Brian M Wong, Eric S Holmboe, Kevin Imrie, Rose Hatala
PURPOSE: Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training...
May 9, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28473429/atraumatic-chylous-ascites-an-unusual-presentation-of-bladder-cancer
#17
Ashish Srinivasan, Ross Apostolov, Amanda Leong, Douglas Johnson
We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition. A previously well, elderly ex-smoker with no prior history of abdominal surgery was referred for investigation of progressive dyspnoea, increasing peripheral oedema and new-onset ascites, on a background of long-standing alcohol consumption (four standard drinks daily). Liver biochemistry and coagulation profile were normal apart from marked hypoalbuminaemia. Doppler ultrasound of the liver demonstrated normal echotexture and patent vasculature...
May 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28468013/translating-our-current-understanding-of-ascites-management-into-new-therapies-for-patients-with-cirrhosis-and-fluid-retention
#18
Elisa Pose, Andres Cardenas
Ascites is the most common complication associated with cirrhosis resulting in poor quality of life, high risk of development of other complications of cirrhosis, increased morbidity and mortality associated with surgical interventions, and poor long-term outcome. Patients with cirrhosis and a first onset of ascites, have a probability of survival of 85% during the first year and 56% at 5 years without liver transplantation. Ascites is caused due to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28442933/drainage-of-malignant-ascites-patient-selection-and-perspectives
#19
REVIEW
Maciej Stukan
Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/28439354/residents-procedural-experience-does-not-ensure-competence-a-research-synthesis
#20
Jeffrey H Barsuk, Elaine R Cohen, Joe Feinglass, William C McGaghie, Diane B Wayne
BACKGROUND: Many medical certifying bodies require that a minimum number of clinical procedures be completed during residency training to obtain board eligibility. However, little is known about the relationship between the number of procedures residents perform and their clinical competence. OBJECTIVE: This study evaluated associations between residents' medical procedure skills measured in a simulation laboratory and self-reported procedure experience and year of training...
April 2017: Journal of Graduate Medical Education
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