Chlorambucil and ascorbic acid-mediated anticancer activity and hematological toxicity in Dalton's ascites lymphoma-bearing mice.

Chlorambucil is an anticancer drug with alkylating and immunosuppressive activities. Considering various reports on the possible antioxidant/protective functions of ascorbic acid (vitamin C), it was aimed at to explore the modulatory effect of ascorbic acid on therapeutic efficacy and toxicity induced by chlorambucil. Dalton’s ascites lymphoma tumor serially maintained in Swiss albino mice were used for the present experiments. The result of antitumor activity showed that combination treatment with ascorbic acid and chlorambucil exhibited enhanced antitumor activity with 170% increase in life span (ILS), which is significantly higher as compared to chlorambucil alone (ILS 140%). Analysis of apoptosis in Dalton’s lymphoma tumor cells revealed a significantly higher apoptotic index after combination treatment as compared to chlorambucil alone. Blood hemoglobin content, erythrocytes and leukocytes counts were decreased after chlorambucil treatment, however, overall recovery in these hematological values was noted after combination treatment. Chlorambucil treatment also caused morphological abnormalities in red blood cells, majority of which include acanthocytes, burr and microcystis. Combination treatment of mice with ascorbic acid plus chlorambucil showed less histopathological changes in kidney as compared to chlorambucil treatment alone, thus, ascorbic acid is effective in reducing chlorambucil-induced renal toxicity in the hosts. Based on the results, for further devel­opment, hopefully into the clinical usage, the administration of ascorbic acid in combination with chlorambucil may be recommended.

Clinical Significance of Serum CA-125 in Korean Females with Ascites

PURPOSE: Mycobacterium tuberculosis is endemic in Korea. Because tuberculous peritonitis is characterized by ascites, abdominal pain, abdominal mass and elevation of serum CA-125, it can be confused with ovarian malignancies. The aim of this study was to evaluate the significance of serum CA-125 level in the differential diagnosis of tuberculous peritonitis and ovarian malignancy in a Mycobacterium tuberculosis-endemic area. MATERIALS AND METHODS: The medical records of patients diagnosed with tuberculous peritonitis (n=48) or epithelial ovarian malignancy (n=370) at Samsung Medical Center from January 2000 to October 2009 were retrospectively reviewed. RESULTS: Median serum CA-125 level in the epithelial ovarian cancer group was significantly higher than that in the tuberculous peritonitis group (p< or =0.01). Only one patient (2.1%) in the tuberculous peritonitis group had a serum CA-125 level over 2000 U/mL. However, 109 patients (29.5%) in the epithelial ovarian cancer group had a serum CA-125 level over 2000 U/mL. At the CA-125 ranges of 400 to 599 and 600 to 799, the proportions of those with tuberculous peritonitis were 24% and 21.9%, respectively. At a serum CA-125 level over 1000 U/mL, however, the proportion of tuberculous peritonitis was much lower (2.1%). CONCLUSION: Tuberculous peritonitis should be considered in the evaluation of female patients with ascites and high serum CA-125.

Ascitis hemorrágica y caquexia en mujer de 39 años / Hemorrhagic ascites and cachexia in 39 years old woman's

El problema diagnóstico fundamental radica en el enfrentamiento a una ascitis hemorrágica de casi 3 años de evolución con un patrón inflamatorio dado el gradiente suero ascítico de albúmina (GSAA), de indudable valor operativo en este caso.1 Otro elemento que induce a pensar en un proceso inflamatorio severo es el elevado conteo plaquetario aunque las cifras de VSG no fueron relevantes. El estudio por ultrasonido de vena porta, más el valor en 0,3 del GSAA, las TAC de abdomen y la biopsia hepática permitieron llegar a la conclusión que no se trataba de una hipertensión portal de ningún tipo...

Presión coloidosmótica plasmática, índice de Briones y ascitis en preeclampsia-eclampsia / Plasma colloid osmotic pressure, Briones index and ascites in preeclampsia-eclampsia

Introducción: La fuga capilar en la preeclampsia-eclampsia se puede evaluar calculando la presión coloidosmótica de las proteínas plasmáticas (PCO) y el índice de Briones. El objetivo de la presente investigación fue informar los valores de la PCO y del índice de Briones en preeclampsiaeclampsia, y comparar su correlación con ascitis. Material y métodos: Se estudiaron 225 pacientes gestantes con preeclampsia-eclampsia. Se calculó la PCO y el índice de Briones como grupo total y en tres categorías: a) preeclampsia severa sin síndrome HELLP, b) preeclampsia severa con síndrome HELLP y c) eclampsia. Se comparó la correlación de ambos parámetros entre sí y con la ascitis. Pruebas estadísticas: t de Student, coeficiente de correlación de Pearson (r). Resultados: La PCO total fue de 20.14 ± 2.52 mm Hg, en 148 casos (65.78 %) resultó normal (21.54 ± 1.60 mm Hg) y en 77 (34.22 %) fue baja (17.55 ± 1.71 mm Hg) (p = 0.058). No hubo diferencia entre las tres categorías (p > 0.05). El índice de Briones total fue de 0.18 ± 0.03, en 87 casos (38.67 %) resultó normal (0.22 ± 0.01) y en 138 (61.33 %) se encontró bajo (0.16 ± 0.01) (p = 0.07). No hubo diferencia entre las tres categorías (p > 0.05). Se documentó ascitis (627.27 ± 85.21 ml) en 11 pacientes (4.89 %). La r de la PCO versus índice de Briones fue de 0.55, PCO versus ascitis fue de −0.03 y del índice de Briones versus ascitis fue de −0.43. Conclusiones: Se encontraron valores bajos de la PCO en 34.22 % y del índice de Briones en 61.33 %. Ambos parámetros tuvieron correlación negativa con la ascitis.

BACKGROUND: Capillary leak in preeclampsia-eclampsia (P-E) can be evaluated by calculating the plasma colloid osmotic pressure (COP) and the Briones index (BI). We undertook this study to report the values of plasma COP and BI in patients with P-E. We compared their correlation with ascites. METHODS: We studied 225 pregnant patients with P-E. We calculated plasma COP and BI as a total group and in three categories: 1) severe preeclampsia (SP) patients without HELLP syndrome, 2) SP patients with HELLP syndrome and 3) patients with eclampsia. We compared the correlation of both parameters as well as the correlation of each with ascites. Student's t test and Pearson correlation coefficient (r) were used for statistical analysis. RESULTS: Total COP was 20.14 +/- 2.52 mmHg. In 148 cases (65.78%) the results were normal (21.54 +/- 1.60 mmHg) and in 77 cases (34.22%) results were low (17.55 +/- 1.71 mmHg) (p = 0.058). There was no difference among the three categories (p >0.05). Total BI was 0.18 +/- 0.03, in 87 cases (38.67 %) it was normal (0.22 + 0.01) and in 138 cases (61.33 %) it was low (0.16 +/- 0.01) (p = 0.07). There were no differences among the three categories (p >0.05). We documented ascites of 627.27 +/- 85.21 ml in 11 patients (4.89%). The r of the COP vs. BI was 0.55, COP vs. ascites was -0.03 and BI vs. ascites was -0.43. CONCLUSIONS: We found low levels of COP in 34.22% and BI in 61.33% of patients. Both parameters had negative correlation with ascites.

[ blood serotonin levels in ascitic and non ascitic broilers]

Modern strains of broiler are highly susceptible to heart failure. Heart related mortalities are observed predominantly in fast growing broiler chickens. The aim of this study was to investigate serotonin levels in ascitic and non ascitic broilers of three strains [Ross, Arbor Acres plus and Cobb]. In this respect, a factorial test in CRD method applied for the statistical analyses. In each of these three strains, 12 ascitic and 12 non-ascitic broilers were selected. After tagging and blood sampling, blood were collected and divided in two parts. One part was applied for some blood hematological assessment and other part was used for determining serum serotonin levels. The results showed significant differences among the strains [p<0.05]. The blood serotonin levels of ascitic chickens were significantly lower than the non ascitic ones [p<0.05]. There was a significant interaction between strain and disease in blood serotonin levels [p<0.05]

Comparison of role of serum- ascites albumin gradient and ascitic fluid total protein in liver cirrhosis patients

To compare the diagnostic sensitivity of serum/ ascites albumin gradient and ascitic fluid total protein in liver cirrhosis patients, using ultrasonography as gold standard. Validation Study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi and Department of Radiology CMH/ MH Rawalpindi from 15 Jul 2007 to 15 May 2008. Seventy three patients of liver cirrhosis were enrolled in the study by non-probability convenience sampling. Liver cirrhosis was confirmed on ultrasound abdomen. Ascitic fluid and 3 ml of blood were obtained simultaneously for analysis of serum albumin, ascitic fluid albumin and total proteins. Sensitivity of serum ascitic albumen gradient [SAAG] and serum ascitic fluid total protein [AFTP] was calculated by comparing with liver ultrasonographic findings [gold standard]. Among 73 patients, 52 [71%] were males and 21 [29%] females. Mean ages was 57 years. Age range was 30-80 years. It was observed that sensitivity of SAAG in liver cirrhosis was 97% and that of AFTP was 53% only. Diagnostic sensitivity of SAAG in liver cirrhosis is significantly higher than AFTP in workup of ascites related to portal hypertension

The Association Between the Serum Sodium Level and the Severity of Complications in Liver Cirrhosis

BACKGROUND/AIMS: Dilutional hyponatremia associated with liver cirrhosis is caused by impaired free water clearance. Several studies have shown that serum sodium levels correlate with survival in cirrhotic patients. Little is known, however, regarding the relationship between the degree of dilutional hyponatremia and development of cirrhotic complications. The aim of this study was to evaluate the association between the serum sodium level and the severity of complications in liver cirrhosis. METHODS: Data of inpatients with cirrhotic complications were collected retrospectively. The serum sodium levels and severity of complications of 188 inpatients were analyzed. RESULTS: The prevalence of dilutional hyponatremia, classified as serum sodium concentrations of < or =135 mmol/L, < or =130 mmol/L, and < or =125 mmol/L, were 20.8%, 14.9%, and 12.2%, respectively. The serum sodium level was strongly associated with the severity of liver function impairment as assessed by Child-Pugh and MELD scores (p<0.0001). Even a mild hyponatremia with a serum sodium concentration of 131-135 mmol/L was associated with severe complications. Sodium levels less than 130 mmol/L indicated the existence of massive ascites (OR, 2.685; CI, 1.316-5.477; p=0.007), grade III or higher hepatic encephalopathy (OR, 5.891; CI, 1.490-23.300; p=0.011), spontaneous bacterial peritonitis (OR, 2.562; CI, 1.162-5.653; p=0.020), and hepatic hydrothorax (OR, 5.723; CI, 1.889-17.336; p=0.002). CONCLUSIONS: Hyponatremia, especially serum levels < or =130 mmol/L, may indicate the existence of severe complications associated with liver cirrhosis

Biochemical, hematological and pathological alterations associated with ascites in broilers and the role of oxygen-derived free radicals

Three hundred and fifteen day -old chickens were used to test the relationship between oxygen- derived free radicals and the biochemical, hematological and pathological alterations[associtd with ascites]. They were randomly divided into three experimental groups and ascites were developed in two groups of animals by exposing them to low temperature or administration of triiodothyronine [T[3],], and the third group was used as control. Different hematological, biochemical and pathological tests were used to determine the incidence of ascites in birds. These include total red blood cell [RBC], hematochrit [PCV], activities of alanine transaminase [ALT] and aspartate transaminase [AST] and the ratio of right ventricular weight to total ventricular weight [RV/TV]. Two hydroxylated salicylic acid [SA] metabolites, 2, 3- and 2, 5-dihydroxy benzoic acids [2, 3- and 2, 5-DHBA], were measured. by HPLC system to detect the generation of hydroxyl [OH] radicals. An analysis of variance [ANOVA] was used to determine the differences between different experimental groups. Ascites syndrome was observed in T[3] and low temperature treated groups as shown by necropsy changes and significant increases [p < 0.05] in the amount of RBC, PCV, ALT, AST and the ratio of RV/TV. While the significant increase was shown in the amounts of 2,3- and 2,5-DHBAfrom day 11, the alteration in the values of enzymes and hematoloic parameters and ratio of RV/TV occurred from days 18, 25 and 32 respectively. It can be concluded that OH radicals may be involved in the initiation of ascites syndrome, but the biochemical, hematological and pathological changes induced by these agents, can cause ascites and other alterations

Gastroenterite eosinofílica com ascite e sem i-obstrução intestinal: relato de caso e revisão da literatura / Eosinophilic gastroenteritis with ascites and intestinal pseudo-obstruction: report of a case and literature review

A gastroenterite eosinofílica (GE) é considerada uma doença pouco comum, com menos de 300 casos relatados na literatura. É caracterizada por infiltração eosinofílica das camadas da parede do tubo digestivo. A patogênese não é bem conhecida. Há algumas evidências da participação de fatores imunológicos ou alérgicos. Em geral, o prognóstico é favorável, embora a doença tenha caráter recorrente. Relata-se o caso de paciente, 21 anos, sexo masculino/ que apresentou quadro de dor abdominal, náusea, vômitos, emagrecimento e eliminação reduzida de flatos e fezes. Ao exame físico, foram observadas distensão abdominal, dor à palpação e ascite tensa. Os exames laboratoriais demonstraram eosinofilia no sangue periférico, variando de 15 a 60%. Exames parasitológicos de fezes seriados não mostraram ovos ou larvas. Ao estudo radiológico, identificaram-se espessamento da parede do intestino delgado e redução do lume. Infiltração eosinofílica da mucosa do cólon distal foi verificada pelo exame anatomopatológico. Com base nesses achados, o diagnóstico de GEfoi realizado e instituído o tratamento com prednisona, ocorrendo remissão da doença. Apesar de ser considerada doença rara e de causa ainda desconhecida, a GEdeve ser incluída no diagnóstico diferencial dos quadros de eosinofilia periférica com comprometimento do trato gastrintestinal (TGI).

Clinical Significance of Serum CA 125 in Patients with Chronic Liver Diseases / 대한소화기학회지

BACKGROUND/AIMS: The clinical significance of serum CA 125 levels in patients with chronic liver disease has not been widely appreciated in relation to the severity of the disease. We examined serum CA 125 levels in patients with chronic liver disease according to the severity of liver disease and the presence of ascites. METHODS: Fasting serum CA 125 levels were measured by a commercial RIA kit in 92 patients with chronic liver disease: 22 with chronic hepatitis and 70 with liver cirrhosis (Child class A, 19; B, 28; C, 23). Forty-one patients (45%) had ascites. RESULTS: The patients with Child class C liver cirrhosis had significantly higher mean serum CA 125 level than those with class A (p<0.05). In Child class B patients, the mean serum CA 125 level was significantly higher in patients with ascites than in those without (p<0.05). A multiple regression analysis showed that the presence of ascites, serum albumin, and prothrombin time were independent factors related to the increase of serum CA 125 levels. CONCLUSIONS: The presence of ascites is more closely related to the increase of CA125 levels in patients with liver cirrhosis than the severity of liver disease.

Eficacia diagnóstica del gradiente de albumina en distintas causas de ascitis / Diagnostic efficacy of albumin gradient in different causes of ascitis

Se estudiaron 98 pacientes en forma prospectiva comparando el gradiente de albúmina (GS-A), con el concepto de trasudado-exudado en la clasificación de las ascitis. El segundo objetivo fue analizar el valor predictivo y eficacia del GS-A, proteínas totales en líquido ascítico, LDH, razones y colesterol en líquido ascítico en pacientes con hepatopatía crónica y ascitis malignas. El concepto de trasudado-exudado clasificó correctamente a los pacientes con ascitis sólo en el 65.6 por ciento, en contraste con el GS-A que lo hizo en el 95.7 por ciento de los pacientes. En el diagnóstico diferencial de ascitis causada por hepatopatía crónica o enfermedad maligna las pruebas más eficaces fueron el colesterol en líquido ascítico (98 por ciento), (valor predictivo del 97 por ciento), y el GS-A con una eficacia del 94 por ciento y valor predictivo del 94 por ciento. En conclusión el GS-A es superior al concepto de trasudado-exudado en la clasificación de las ascitis. La prueba más eficaz para discriminar entre ascitis por hepatopatía crónica o enfermedad maligna fue el colesterol en líquido ascítico.

Could beta blockers be used in th treatment of cirrhotic ascites? the role of serum-ascites albumin gradient estimation

This study included 30 portal hypertensive cirrhotic ascitic patients assigned into 3 groups of 10 patients each, well matched as regards age and sex. Groups I, II and III were put on diuretics, beta blocker propranolol, and both, respectively, and restudied 1 month latter. Serum-ascites albumin gradient [S-AAG] was found to correlate positively with grade of esophageal varices and portal vein diameter [P <0.001] and the reduction of portal blood flow [P <0.05]. Diuretics with or without beta blockers propranolol gave a good therapeutic response as regards body weight [P <0.001], 24-hour urine output [P <0.001] and sodium excretion [P <0.05], whereas propranolol alone was found to have deleterious effect on ascites. There was a decrease in renal blood flow in the 3 groups which was more by the use of propranolol. It was concluded that S-AAG is a good predictor of portal hypertension and its response to beta blockers. The portal hypotensive effect of beta blockers showed no beneficial effect on ascites for renal hemodynamic changes resulting in less water and sodium excretion

Tense ascites redefined: renal consequences of tense ascites in decompensated cirrhotics.

Cirrhotics with tense ascites fail to achieve increased diuresis in the supine position. To assess the role of inferior vena cava compression in this phenomenon, we studied cirrhotics with mild to moderate (n = 11) and tense (n = 2) ascites, and patients with membranous inferior vena cava obstruction (n = 2) before and after balloon dilatation, in the sitting, supine and 10 degrees head down tilted positions for 2 hours each. Urinary output (p < 0.005), creatinine clearance (p < 0.025) and sodium excretion (p < 0.025) increased in cirrhotics with mild to moderate ascites in the supine position, and further in the head down position. Similar changes occurred in patients with inferior vena cava membrane. In cirrhotics with tense ascites, these parameters did not change significantly in the supine position, but increased in the head down position. We conclude that failure to augment diuresis in the supine position in cirrhotics with tense ascites is not due to inferior vena cava obstruction alone but is probably also due to compression of the collateral vessels. This clinical observation may serve as a criterion for diagnosing tense ascites.

Prognostic value of preoperative tests in the surgical treatment of ascites with the implant of Le Veen shunts in cirrhotics

No período de janeiro de 1978 a outubro de 1982, 32 válvulas de Le Veen foram implantadas em 20 pacientes, dos quais 16 eram cirróticos alcoólicos e quatro pós-necróticos. No presente estudo foram correlacionados dados laboratoriais pré-operatórios destes pacientes com sua evoluçäo pós-operatória. Foram comparados os resultados clínicos dos pacientes que sobreviveram mais de 30 dias (13 pacientes = 65%), com os resultados daqueles que morreram dentro do mesmo período (sete pacientes = 35%). Foram realizadas 14 provas laboratoriais visando definir níveis séricos de hematócrito, hemoglobina, uréia, creatina, sódio, potássio, bilirrubina, aminotransferases, fosfatase alcalina, fibrinogênio, gamaglutamiltransferase e atividade de protrombina. Após análises estatísticas, observou-se que seis dos 14 testes realizados podem ser considerados de valor prognóstico, segundo ordem decrescente de importancia: fibrinogênio, fosfatase alcalina, uréia, gamaglutamiltransferase, bilirrubina e atividade de protrombina. Observou-se que todos os sete pacientes que prematuramente faleceram, tinham três ou mais destes alterados, quando comprados com valores padröes. Baseados nestes dados, conclui-se que estes säo fatores importantes em determinar o prognóstico da sobrevida imediata de cirróticos submetidos ao implante da válvula de Le Veen. Conclui-se, também, que quando três ou mias destes fatores estäo alterados, este procedimento cirúrgico dever ser contra-indicado