Chemical ingredient groups B and C in Kansui Radix stir-fried with vinegar affect diversity of gut microbiota in rat model of malignant ascites induced by Walker-256 cells / 中国中药杂志

This study aims to explore the effects of chemical ingredient groups B and C in Kansui Radix stir-fried with vinegar on the diversity of gut microbiota in the rat model of malignant ascites, identify the key differential microbial taxa, and reveal the biological mechanism of water-expelling effect of the two chemical ingredient groups. The rat model of malignant ascites induced by Walker-256 cells was established, and phenolphthalein was used as the positive drug. The rats were orally administrated with corresponding agents for consecutive 7 days. On day 6, fresh feces samples were collected from the rats, and 16 S rDNA high-throughput sequencing and GC-MS were employed to determine the composition of gut microbiota and the content of short-chain fatty acids, respectively. On day 7, serum and intestinal tissue samples were collected for the determination of related indicators. Compared with the control group, the model group showed decreased feces volume and urine volume(P<0.01), increased volume of ascites and levels of Na~+, K~+, and Cl~- in urine(P<0.01), down-regulated mRNA and protein levels of intestinal AQP8(P<0.01), lowered abundance of beneficial Lactobacillus(P<0.01) while risen abundance of potential pathogenic Lachnospiraceae and Anaeroplasma(P<0.01), and reduced content of short-chain fatty acids(P<0.01). Compared with the model group, administration with chemical ingredient groups B and C alleviated all the above indicators(P<0.01). In conclusion, chemical ingredient groups B and C in Kansui Radix stir-fried with vinegar could alleviate the disordered gut microbiota in rats with malignant ascites to expel water through increasing the abundance of beneficial Lactobacillus and reducing the abundance of harmful Lachnospiraceae and Anaeroplasma. This study can provide a reference for the reasonable clinical application of Kansui Radix stir-fried with vinegar.

Ascitis secundaria a chlamydia trachomatis tras procedimiento de reproducción asistida / Ascites secondary to chlamydia trachomatis after assisted reproduction procedure

El desarrollo de ascitis moderada o severa es infrecuente tras una enfermedad inflamatoria pélvica por Chlamydia trachomatis, una de las principales causas de infección de transmisión sexual a nivel mundial. Caso clínico: Paciente de 29 años que tras aborto diferido (gestación tras inseminación artificial) que inicia a las seis semanas con cuadro de dolor abdominal inespecífico y ascitis de predominio linfocitario. El diagnostico se realizo mediante PCR (Werfen®) tanto el liquido ascítico como en exudado endocervical. La paciente recibió tratamiento antibiótico con doxiciclina. Conclusión: Las enfermedades de transmisión sexual deben ser consideradas cuando se realiza un diagnóstico diferencial de una mujer sexualmente activa con dolor abdominal y ascitis, instaurar tratamiento antibiótico y evitar pruebas e intervenciones quirúrgicas innecesarias.

The development of moderate or severe ascites is infrequent after a pelvic inflammatory disease from Chlamydia trachomatis, one of the main causes of sexually transmitted infection worldwide. Clinical case: A 29-year-old patient who, after a delayed abortion (gestation after artificial insemination), started at six weeks with symptoms of non-specific abdominal pain and predominantly lymphocytic ascites. The diagnosis is made by PCR (Werfen®) both the ascitic fluid and the endocervical exudate. The patient received antibiotic treatment with doxycycline. Conclusion: Sexually transmitted diseases should be considered when making a differential diagnosis of a sexually activated woman with abdominal pain and ascites. Establishing antibiotic treatment, and avoiding unnecessary tests and surgical treatments.

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.

Vascular Endothelial Growth Factor Levels in Ascites Between Chemonaive and Chemotreated Patients

PURPOSE: Vascular endothelial growth factor (VEGF) levels in malignant ascites have high diagnostic value for their discrimination from asictes of non-malignant origin. However, there have been no reports on the comparison of VEGF levels between malignant ascites of chemonaive and chemotreated patients. MATERIALS AND METHODS: VEGF levels were measured in 44 ascites patients (cirrhosis ascites, 10; chemonaive patients, 21; chemotreated patients, 13) and compared to the level of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). The diagnostic parameters of sensitivity, specificity, and correlation among 3 markers were evaluated. RESULTS: VEGF levels in malignant ascites of chemonaive and chemotreated patients were significantly higher than those in cirrhotic ascites (p<0.05). VEGF levels in ascites of chemonaive patients were significantly higher than those in chemotreated patients (p<0.05). A cutoff value of 10.4pg/mL was calculated using receiver operating characteristic curves (ROCs) for VEGF in chemotreated and chemonaive patients, which gave sensitivities of 75.0% and 53.8% and specificities of 69.6% and 47.1%, respectively. Positive correlations were observed between VEGF and CEA (r=0.353, p<0.05) as well as between VEGF and CA19-9 (r=0.367, p<0.05) in ascites. CONCLUSION: VEGF levels could be a useful tumor marker for malignant ascites, but its value should carefully be interpreted because of lesser reliability in chemotreated ones.

Immunomodulatory and antitumor activity of Biophytum sensitivum extract.

An alcoholic extract of Biophytum sensitivum was studied for its immunomodulatory and antitumor activity. The extract was 100% toxic at a concentration of 0.5 mg/ml to Dalton's lymphoma ascites (DLA) and Ehrlich ascites carcinoma (EAC) cells. B. sensitivum extract was also found to be cytotoxic towards L929 cells in culture at a concentration of 0.1 mg/ml. Administration of B. sensitivum extract (500 microg/dose/animal) could inhibit the solid tumor development in mice induced with DLA cells and increase the lifespan of mice bearing Ehrlich ascites carcinoma tumors by 93.3%. B. sensitivum treatment significantly (p<0.001) reduced the tumor cell glutathione (GSH) levels as well as serum gamma glutamyl transpeptidase (GGT) and nitric oxide (NO) levels in ascites tumor bearing animals. The total WBC count was also increased to 14,087 cells/mm(3) on the 12th day in BALB/c mice. The number of plaque forming cells also enhanced significantly (p<0.001), and bone marrow cellularity and beta-esterase positive cells were also increased by the administration of B. sensitivum extract.

Ascite pancreática: tratamento com octreotide: relato de caso / Pancreatic ascites: treatment with octreotide: case report

Ascite pancreática é uma condição rara, com menos de 250 casos publicados. É definida como ascite exsudativa causada por doença pancreática não-maligna, tendo como características laboratoriais diagnósticas elevadas concentrações de amilase (geralmente > 1.000 UI/L) e de proteína (< 3,0g/dl) no líquido ascítico. O objetivo deste trabalho é descrever a evolução de um caso de ascite pancreática o tratamento proposto. O caso estudado foi de um paciente masculino, 37 anos, com diagnóstico prévio de pancreatite crônica internou com queixa de dor abdominal. Ao exame físico, apresentava ascite, a qual foi puncionada, evidenciando proteínas totais de 4,2g/dl e amilase 11.457 UI/L. Iniciou-se o tratamento para ascite pancreática com nutrição parenteral total e octreotide, sendo este mantido por 28 dias. O paciente com redução progressiva da ascite e sem dor abdominal, mantendo-se assintomático em revisão ambulatorial de 3 e 6 meses. O tratamento da ascite pancreática é ainda controverso. Divide-se basicamente em conservador e intervencionista, sendo este último subdividido em tratamento endoscópio e cirúrgico. Apesar do sucesso do tratamento com octreotide no caso relatado, e diante de poucas e controversas evidências na literatura, um número maior de pacientes é necessário para determinar o melhor tratamento para ascite pancreática, permanecendo este motivo de debate.

The Significance of Urine Sodium Measurement after Furosemide Administration in Diuretics-unresponsive Patients with Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: The diagnosis of refractory ascites means a poor prognosis for patients with liver cirrhosis. The definition of refractory ascites has already been established, but using the dosage of diuretics that correlates with the definition of refractory ascites in an out-patient department will lower the compliance of the patient, as well as causing serious complications, such as hepatic encephalopathy and hyponatremia, as the dosage of diuretics is increased. Due to this fact, it is very difficult to apply this definition of refractory ascites to patients in a domestic out-patient department. In this study, in situations where there are difficulties in applying the diuretics dosage according to definition of refractory ascites, we tried to find out whether measuring the value of urine sodium after the administration of intravenous furosemide can be the standard in early differentiation of the response to diuretics treatment. METHODS: We reviewed 16 cases of liver cirrhosis with ascites and classified them into two groups by the response to diuretics. The diuretics-responsive ascites group was 8 cases and the diuretics-unresponsive ascites group consisted of 8 cases. After admission, we examined the patients' CBC, biochemical liver function test, spot urine sodium, and 24 hour creatinine clearance. After the beginning of the experiment, all diuretic therapy was stopped for 3 days. Daily we examined the patients' CBC, biochemical liver function test, and in the 3rd experiment day, we measured 24-hour urine volume and sodium. In the 4th experiment day, after sampling for ADH, plasma renin activity and plasma aldosterone level, we administrated the furosemide 80 mg I.V, and measured the amount of 8 hour urine volume and sodium. RESULTS: The plasma aldosterone level was significantly higher in the diuretics- unresponsive ascites group than in the diuretics-responsive ascites group. In the 4th experiment day, the amount of urine volume and sodium was very significantly lower in the diuretics-unresponsive ascites group than in the diuretics-responsive ascites group (1297.5 +/- 80.9 vs 2003.7 +/- 114.6 ml, p<0.005, 77.3 +/- 8.2 vs 211.8 +/- 12.6 mEq, p<0.001). CONCLUSIONS: In out-patient departments, the measurement of urine sodium 8 hours after administrating 80 mg of intravenous furosemide, will help in differentiating ascites patients with lower treatment response to diuretics.

Eosinophilic gastroenteritis in children-report of one case.

Eosinophilic gastroenteritis is rare in pediatric patients. The three main manifestations, defined by Klein et al. in 1970, were (a) predominant mucosal, (b) predominant muscular-layer, and (c) predominant subserosal disease. The predominant subserosal type is the rarest of the three. We report on a 43-month-old boy who, on admission, suffered from recurrent abdominal pain, vomiting and diarrhea for one week, with ascites and pleural effusion noted. The white blood cell (WBC) count of ascites fluid was 8,000/mm3, with a differential count of 99% eosinophils. The peripheral WBC count was 44,000/mm3, with 78% eosinophils. Three days after diagnosis, ascites, pleural effusion and other gastrointestinal symptoms were gradually relieved using steroid therapy, with the peripheral eosinophil count returning to normal. The steroid therapy was discontinued after two months with tapering dose. The boy was in good health with no recurrence of symptoms in a follow-up conducted after one year.

Ascites due to hypothyroidism in a patient with alcoholic cirrhosis

Myxedema is the cause of ascites in less than 1 per cent of new-onset ascites cases, where as only 4 per cent of patients with hypothyroidism present ascites. When ascites is the first manifestation of thyroid insufficiency, there is usually a delay in diagnosis. We report here a case of myxedema ascites occuring in a patient with alcoholic cirrhosis, that was first thought to be the cause of the ascites, and review the features of 48 cases previously reported. Some clinic and analytical findings that have been commonly reported, are the prompt response (with resolution of ascites) to thyroid replacement treatment, a high total protein concentration in ascitec fluid, white moderate white blood cell counts and a lymphocyte predominance. Serum-ascites albumin gradient has been postulated to be high in myxedema ascites, but we believe this has been studied in too few cases thus far, to be conclusive.

Effects of Captopril on cirrhotic patients with refractory ascites: a preliminary report

To determine the effect of Captopril on cirrhotic patients with refractory ascites. A prospective study of effect of Captopril on twelve patients with biopsy proven liver cirrhosis with refractory ascites over a period of two weeks. Setting: Medical Unit IV, Civil Hospital Karachi. Twelve patients, eight males and four females, between the ages of 23 to 59 years with biopsy proven liver cirrhosis and ascites not responding to intense diuretic therapy. All patients had serum albumin > 2.5 gm/dl. None of the patient had SBP or electrolyte imbalance. All patients were given 12.5 mg/day to 25 mg/day Captopril along with Spironolactone and Furosemide. Reduction of body weight and increase in 24 hours urine output after two weeks of Captopril therapy along with diuretics. After starting of Captopril at a dose of 12.5 mg/day and then increases to 25 mg/day after one week along with Spironolactone and Furosemide, the body weight reduced to 1.2 kg [mean] from the initial pre-treatment weight at the end of first week, and 2.3 kg at the end of second week. The 24 hours urine output increased from 1.4 L to 1.6 L and 1.8 L after the first and second weeks of treatment respectively, which is an increase of 0.4 L in 24 hours. The blood pressure and serum electrolytes showed no significant variation. There were no major adverse effects apart from a non-significant dry cough in six patients. Captopril along with diuretics has a beneficial effect on cirrhotic patients with refractory ascites

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

Paracentese associada a dextran-70 no tratamento da ascite de hepatopatas crônicos / Paracentesis associated to dextra-70 in the treatment of ascites in patients with chronic liver disease: a randomized therapeutic study

O tratamento da ascite de grande volume em hepatopatas foi avaliado através do presente estudo, onde comparamos diuréticos com paracentese e infusäo de Dextran-70. Eficácia terapêutica, complicaçöes e permanência hospitalar foram as variáveis estudadas. De 38 pacientes, 20 foram randomizados e avaliados através de critérios clínicos, laboratoriais e/ou histológicos: 10 pacientes no grupo paracentese com Dextran-70 e 10 no grupo diurético. Os grupos foram semelhantes quanto a idade, diagnóstico, classificaçäao de Child-Pugh; entretanto o sexo masculino predominou sobre o feminino no grupo paracentese com Dextran-70. Em cada paracentese retirou-se em média 9,41 litros de líquido ascítico (4,5 a 14 L). O período médio de hospitalizaçäao no grupo paracentese com Dextran-70 foi de 10,5 dias (8-14), significativamente menor quando comparado ao grupo diurético: 24,4 dias (14-48). No grupo diurético observou-se em um paciente complicaçöes como hiperpotassemia, elevaçäo de uréia e creatinina e no grupo paracentese com Dextran-70, um paciente apresentou temperatura acima de 38§C durante o tratamento. Os resultados sugerem que a paracentese associada ao Dextran-70 pode representar uma alternativa terapêutica para hepatopatas com ascite na nossa populaçäo. Este tratamento foi eficaz, näo apresentou efeitos colaterais importantes, diminuiu a permanência hospitalar e, conseqüentemente, deve diminuir o custo e o risco de complicaçöoes de pacientes com hospitalizaçäo prolongada

Haemothorax and ascites associated with endometriosis

A young patient with pleuroperitoneal endometriosis presented with an haemorrhagic effusion. Two years later, she developed massive ascites with resolved after treatment with oral Danazol and Depo-Provera injections.

Ascitis. Fisiopatología y tratamiento

Cirrhosis of the liver is the main cause of ascitis. Recent studies have shown in compensated cirrhotics a 40 percent chance to develop ascitis after five years of follow up. The presence of ascitis is usually associated with advanced liver disease, and higher mortality than patients with compensated cirrhosis. Many theories have been proposed to explain ascitis formation being the most important the presence of portal hypertension and sodium retention. Extravascular fluid accumulation depends directly of a balance between hydrostatic and colloid-osmotic pressure (Starling law). Hepatic sinusoids differ from splanchnic ones in regard to the presence of fenestrae, that allows albumin and other substances to flow freely from the sinusoid to the extravascular space. For these reasons the sinusoids lacks colloid-osmotic pressure, and the hydrostatic pressure regulates the flow of fluids passing through them. In cirrhosis, diffuse fibrosis and nodule formation cause functional obstruction to the hepatic blood flow, and a secondary increase in the sinusoidal pressure, that leads to exit of fluids from the sinusoids to the hepatic lymphatics and the thoracic duct. When the amount of fluid that leaves the sinusoids exceeds the capacity of the thoracic duct, fluids accumulate in the abdominal cvity (ascitis). A new theory about ascitis formation states that the first event is a diffuse peripheral arterial vasodilation that cause ineffective plasma volume that triggers the production of humoral factors directed to retain sodium in the kidney...

Angiotensin converting enzyme[ACE] inhibition versus conventional treatment of cirrhotic ascites: impact of either treatment on the renin angiotensin system

Plasma renin activity [PRA] and serum aldosterone were estimated in 10 healthy males and in 30 males with hepatic ascites before and after either angiotensin converting enzyme, ACE, inhibition by captopril 50 mg/day [n = 10], spironolactone 50 mg + Furosemide 40 mg/day [n = 10] or restriction of salt and water [n = 10]. Body weight [Wt] and abdominal girth [Gth], serum sodium, potassium and liver function tests [LFT's] were also checked before and after treatment for 3 weeks. Ascetics had higher PRA and aldosterone compared with controls [P < 0.01]. After captopril, PRA increased and aldosterone decreased [P < 0.05 and P < 0.01] with a significant decrease in Wt and Gth [P < 0.01]. After diuretics, PRA and oldosterone significantly increased [P < 0.05] with non-significant decrease in wt and Gth. Restriction of salt and water caused nonsignificant increase in PRA and a significant increase in aldosterone [P < 0.05] with non-significant increase in Wt and Gthd. Electrolytes and LFT's were not significantly affected by the 3 treatment modalities. The antiascitic effect; delta Wt and delta Gth; by captopril was significantly more than the diuretic effect [P < 0.05]. It is concluded that suppression of renin-angiotensin aldosterone system by captopril, has a significant antiascitic effect in patients with hepatic ascites. In addition, the diuretic induced hyperaldosteronism, a potential risk for failed diuresis on the long term, might be prevented by the addition of an ACE inhibition

Methoxyphenyl maleamic acid augments the activity of cytotoxic drugs against murine tumours.

The anti-tumour effects of methoxyphenyl maleamic acid (MPMA) and cytotoxic drugs, in combination were investigated on P388 leukaemia and S180 (ascites) tumours. Simultaneous administration of MPMA with CTX or HN2 resulted in enhancement of anti-tumour activity. The increased activity was observed against P388 leukaemia, whereas S180 (ascites) tumour was not responsive to the combined treatment. The possible mechanism (s) of action, responsible for the modulation of activity of CTX and HN2 against P388 tumour have been postulated.