Cytological Study of Effusions.

Background: Effusion fluid analysis plays an important role in clinical medicine. Clinicians rely on the reports of effusion fluids and use them as complement to their clinical assessment for the diagnosis and management. Aim: To study the incidence of neoplastic and non neoplastic effusions. Objectives: i) To study the gross and microscopic features of effusions; ii) To study the pattern of effusions in various neoplastic and non neoplastic conditions. Material and Method: 550 specimens of pleural, peritoneal and pericardial fluid were studied. Fluid samples were centrifuged for five minutes at 2000 rpm and smears prepared from deposit were stained by Haematoxylin and Eosin (H and E), Giemsa and Papanicolaou stains (Pap). Result: Out of 550, 315 were pleural effusions, 234 peritoneal and one was pericardial. Out of total 315 cases of pleural effusions, 297 were non neoplastic and 18 were neoplastic effusion. Out of total 234 peritoneal effusions 214 were non neoplastic and 20 neoplatic. Commonest malignancy in pleural and peritoneal fluid was adenocarcinoma. Conclusion: Pleural effusion was the commonest fluid in this study. Exudates were predominant in pleural effusion and transudates were predominant in peritoneal effusion. Common causes of exudates in pleural effusion were tuberculosis (TB), pneumonia and malignancy. Common causes of transudates in peritoneal effusion were liver cirrhosis and congestive cardiac failure (CCF). Adenocarcinoma was the commonest malignancy in both pleural and peritoneal effusion (30 cases).

Evaluation of some cytokine responses in ascitic fluid; their relation to circulating immune complexes

There is no clear consensus about the pattern of cytokine production and regulation that causes patients with chronic schistosomiasis to develop severe hepatosplenic disease, which is characterized by peri-portal fibrosis and portal hypertension. Circulating immune complexes [CICs], play an important role in the pathogenesis of many clinical syndromes during the course of hepatic schistosomiasis. Therefore, the aim of this study was to estimate interleukin-6 [IL-6] and tumor necrosis factor- alpha [TNF-alpha] levels in serum and ascitic fluid [AF] of schistosomal patients and to evaluate these cytokines response in relation to circulating immune complexes. The study enrolled 40 patients with hepatic schistosomiasis forming two groups; 20 patients with ascites [group I] and the other 20 patients without ascites [group II]. Apart from complete history taking, clinical examination, and routine laboratory work, blood and ascitic fluid [AF] samples were collected from the patients after hospital admission. Estimation of IL-6 and TNF- alpha in serum and AF according to the manufacturer instructions. Moreover, serum circulating immune complexes [CICs] were assayed as well. The mean serum level of IL-6 was 156.9 +/- 150.82 pg/ml in schistosomal ascitic patients and 121.63 +/- 68.47 pg/ml in non-ascitic cases. The mean serum concentration of TNF- alpha was 88.5 +/- 70.59 pg/ml in group I and 66 +/- 46.76 pg/ml in group II patients. IL-6 concentration in the ascitic fluid of schistosomal patients had a mean of 284.4 +/- 280.08 pg/ml while ascitic fluid TNF- alpha had a mean of 113.25 +/- 58.97 pg/ml. Schistosomal patients with ascites were shown to have significantly higher levels of IL-6 and TNF- alpha in their ascitic fluid than in serum. A significant positive correlation was detected between the serum and AF concentrations of IL-6 [r-=0.559*], and TNF- alpha [r-=0.556*], P<0.05 in each case. Ascitic patients had a significantly higher mean CIC [21.33 +/- 5.4 micro g Eq/ml] than the non-ascitic cases [15.51 +/- 5.27 micro g Eq/ml]. There was a significant positive correlation between serum level of IL-6 and CICs in schistosomal patients with ascites [r-=0.446*, P<0.05], and another significant positive correlation was demonstrated between ascitic fluid TNF- alpha and CICs in the same patients [r-=0.448*, P<0.05]. The study concluded that schistosomal patients with ascites had significantly higher levels of IL-6 and TNF- alpha in their ascitic fluid than in serum, while there was no significant differences between their serum levels in the ascitic and non-ascitic groups. Moreover, a significant positive correlation was detected between CICs and serum IL-6 in patients with ascites

Study of some parameters of infection of ascitic fluid in patients with liver cirrhosis

Spontaneous bacterial peritonitis [SBP] is one of the most serious complications of ascites in patients with liver cirrhosis. The aim of this study was to investigate the role of ascitic fluid fibronectin, C3 and C4 in patients with liver cirrhosis and ascites. The study was carried out on thirty patients with ascites classified into three groups, group I; 10 patients with SBP, group II; 10 patients with ascites and ascitic fluid total protein more than 1.5 gm/dl and group III: 10 patients with ascitic fluid total protein less than 1.5gm/dl. C3 and C4 were measured by nephelometery while fibronectin was measured by radial-immunodiffusion. The mean values of fibronectin [mg/dl] in groups I, I and III were 56.90 +/- 11.29, 78.50 +/- 15.99 and 60.70 +/- 5.86 respectively, C3 [mg/dl] 11.6 +/- 2.87, 22.8 +/- 8.39 and 16.9 +/- 1.28 respectively and C4 [mg/dl] 4.27 +/- 2.13, 7.4 +/- 2.22 and 5.3 +/- 0.3 respectively. There was significant positive correlation between fibronectin in ascitic fluid and C3 and C4 as well as between fibronectin and ascitic fluid total protein. Fibronectin in ascitic fluid can be used as a biochemical risk factor indicator of spontaneous bacterial peritonitis

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication

Peritoneal fluid and serum concentration of the cytokine rantes and its correlation with the severity of endometriosis

This study is aimed to measure the cytokine RANTES concentration in both the peritoneal fluid and serum of women with and without endometriosis, to test the potential utility of this cytokine as a non-invasive marker of endometriosis. This study includes 30 patients for whom laparoscopy was done for various indications, 15 of them were having endometriosis of various degrees of severity, were taken as group I [cases]. The other 15 patients were having normal laparoscopic findings and were classified as group II [control]. RANTES concentrations were measured in peritoneal fluid and serum of both groups using [ELISA] technique. It was found that there is a highly significant increase of RANTES concentration [P < 0.001] in both peritoneal fluid [2299.4 +/- 1417 pg/ml] and serum [93.1 +/- 29.1 pg/ml] of patients in group I than that in peritoneal fluid [6.50 +/- 289.8 pg/ml] and serum [45.56 +/- 22.27 pg/ml] of patients in group II. It is concluded from this study that peritoneal fluid and serum concentration of RANTES is significantly increased in patients with endometriosis with a significant positive correlation with the increased severity of the disease and its measurement in the serum could be used as a non-invasive marker in patients with endometriosis

Peritonite bacteriana espontânea: uma complicaçäo séria nos cirróticos / Spontaneous bacterial peritonitis: a very serious complication in cirrhotics

É apresentado um caso de Peritonite Bacteriana Espontânea - uma complicaçäo grave que pode desenvolver-se em cirróticos com ascite. O dignóstico precoce e um tratamento imediato diminuíram a mortalidade de episódios da doença. Infelizmente, existe uma alta taxa de recorrência da mesma e o seu aparecimento num cirrótico indica um péssimo prognóstico

Avaliaçäo da textura ecográfica do líquido ascítico e de sua distribuiçäo na cavidade peritoneal / Evaluation of ascitic fluid echographic aspect and its distribution in the peritoneal

Com a finalidade de avaliar a textura ecográfica do líquido ascítico e a sua distribuiçäo na cavidade peritoneal, foram estudados, prospectivamente, 153 pacientes com ascite de diversas etiologias. Em relaçäo à distribuiçäo do líquido na cavidade peritoneal verificou-se que esta näo mantém relaçäo com a etiologia da ascite. O recesso subfrênico direito é o que se encontra preenchido por líquido ascítico no maior número de pacientes, sendo o recesso mais precocemente ocupado nas ascites mínimas; o recesso esplenorrenal acha-se preenchido por líquido ascítico no menor número de pacientes, sendo o espaço mais tardiamente ocupado nas ascites volumosas. Observa-se maior frequência de pacientes com ascite volumosa nos grupos diagnósticos hepatopatia e cardiopatia. Näo se verifica relaçäo entre as características físicas do líquido ascítico e o seu aspecto ecográfico no diagnóstico etiológico da ascite

Assessment of the plasminogen level in the peritoneal fluid as an indicator of ovulation in infertile women

Peritoneal fluid [PF] samples were collected from 60 infertile with regular menses at different time of spontaneous cycle. In 35 patients, the PF sample was collected via laparoscopy while in the remaining 25 patients, the PF sample was collected via culdocentesis. Radial immunodiffusion assay for the plasmingoen level in the collected PF samples was done. Dating of the endometrium was done for each patient in the same time. Twenty six patients were found to be in the proliferative phase while 34 patients were studied during the luteal phase. The luteal phase group was further subdivided into 3 subgroups based on histologic dating of the endometrium a] Early luteal phase group: post ovulatory 1 - 4 days. B] Mid luteal phase group: post ovulatory 5-9 days. c] Late luteal phase group: post ovulatory 10-14 days. This study demonstrated that the plasminogen level in PF is significantly elevated shortly after ovulation [during the early luteal phase], reaching a level of mean [6.2 mg/d1] then declining gradually during the mid and late luteal phases. Its mean level in the preovulatory phase is much lower reaching 3.4 mg/d1

Isolation & characterization of tumour angiogenesis factor from solid tumours & body fluids from cancer patients.

Tumour angiogenesis factor (TAF) was isolated from malignant solid tumours (10) and from pleural and peritoneal fluids (10) collected from cancer patients. Normal tissues and body fluids from individuals with no clinical history of cancer did not show any detectable levels of TAF. Also, no angiogenic activity was detectable in the benign tumour samples studied (2). The TAFs isolated were all ribonucleoproteins. Molecular weight determination by SDS-PAGE (9%) of the TAFs isolated by DEAE cellulose chromatography of tumour extracts showed them to be 18,000 dalton (D) ribonucleoproteins, while the TAFs isolated by immunoaffinity chromatography (using immobilized anti-TAF IgG) of solid tumour extracts and body fluids had a molecular weight of 38,000 D. The TAFs isolated by both the methods were found to be angiogenic by the chick chorioallantoic membrane and the mouse intradermal assays. Immunoaffinity chromatography could be used for the one-step purification of TAF from solid tumour extracts as well as from body fluids.

Differential diagnosis of ascitic fluid: evaluation and comparison of various biochemical criteria with a special reference to serum ascites albumin concentration gradient and its relation to portal pressure.

Among various biochemical indices measured in 93 patients with ascites, ascitic LDH estimation was proved to be indiscreminatory, while ascites/serum LDH ratio has shown a diagnostic accuracy of 85 per cent. Ascitic total protein levels and ascites/serum total protein ratio (accuracy rates of 72 and 77% respectively) were limited, especially in differentiating the ascites due to heart failure. Serum ascites albumin gradient, showed a strong correlation to portal pressure (r, + 0.83 + 0.88), and was found to be the best diagnostic index (with an overall accuracy of 97 per cent) in distinguishing the 'transudative' from 'exudative' ascites. However, no index could discreminate the 'mixed' cases and provide the etiological diagnosis of the ascites.

Quantificaçäo do volume do líquido ascítico pela ultra-sonografia baseada em comprovaçäo laparoscópica / Determination of ascitic fluid volume by ultrasonography setted in laparoscopic examination

Foi feito um estudo comparativo entre os métodos laparoscópico e ultra-sonográfico em 22 pacientes com ascite, para quantificar volumetricamente a ascite ao ultra-som

Ascite pancreática: valor da determinaçäo do pH no derrame peritoneal / Pancreatic ascitis: value of pH determination of the ascitic fluid

Os autores estudaram o pH do líquido de ascite em seis casos de um total de nove pacientes que tiveram a oportunidade de tratar com ascite de origem pancreática. Näo houve correlaçäo entre os níveis do pH e a atividade de amilase no líquido de ascite. Concluem que a medida do pH isoladamente näo parece ser útil para o esclarecimento diagnóstico de uma ascite de origem pancreática

Peritonite bactérica espontânea numa paciente com fibrose hepática congênita e doença de Caroli / Spontaneous bacterial peritonitis in a patient with congenital hepatic fibrosis and Caroli's disease

É descrito, cremos que pela primeira vez na literatura, um caso de peritonite bactérica espontânea (PBE) numa paciente com fibrose hepática congênita e doença de Caroli. A etiopatogenia da PBE é discutida

Diagnóstico de ascitis transudativa o exudativa en base a proteinas totales y diferencia entre albumina serica y ascitica / Ascitic fluid total protein and serum-ascites albumin difference in the diagnosis of transudative and exudative ascites

En este trabajo se evaluó la utilidad del dosaje de proteínas totales en líquido ascítico (PT) y la diferencia albúmina sérica-albúmina en las ascitis (Alb S-A) en el diagnóstico diferencial de las ascitis de tipo transudativo (hipertensión venosa) y exudativo. Se estudiaron en forma consecutiva 105 pacientes con ascitis secundaria a cirrosis hepática en 67 (9 con hepatoma), insuficiencia cardíaca congestiva en 7, carcinomatosis peritoneal en 27 y ascitis exudativa no neoplásica en 4. En 10 pacientes con cirrosis (18%) y 5 con ascitis cardíaca (71%) las PT fueron mayores de 2,5 g/dl. La Alb S-A fue mayor de 1,1 en 13 de los 15 pacientes con ascitis de tipo transudativo y PT elevadas. Cinco pacientes (19%) con mayores de 1,1. La sensibilidad, especificidad, valores predictivo/negativo y eficacia (%) en el diagnóstico diferencial de las ascitis fueron de 93,80, 66, 97 y 84 para las PT y 84, 97, 93, y 93 para la Alb S-A. Este estudio demuestra, en coincidencia con publicaciones previas, que la Alb S-A tiene una eficacia diagnóstica superior a las PT y por lo tanto debería ser incluida en el examen rutinario de los pacientes con ascitis

Peritonite pós-operatória causada por reaçäo de hipersensibilidade ao amido da luva cirúrgica / Postoperative peritonits caused by hypersensitivity to storch glave powder

Os autores apresentam um caso de peritonite pós-operatória causada por hipersensibilidade ao amido da luva cirúrgica. Chamam a atençäo para as dificuldades de ordem diagnóstica e alertam os cirurgiöes para esta possibilidade ressaltando as medidas de ordem profilática

A eletroforese de proteínas do líquido ascítico / Electrophoresis of ascitic fluid proteins

Os autores dosaram a concentraçäo de proteínas totais do soro e do líquido ascítico de 39 doentes; em 35 casos, conseguiram efetuar a eletroforese de proteínas do soro e do líquido ascítico. Em relaçäo às proteínas totais e às fraçöes albumina, beta e gama - globulina, o valor médio mais alto para o cociente ascite/soro foi encontrado nos pacientes com tuberculose peritonial; a seguir, na insuficiência cardíaca e depois nos cancerosos, sendo menor nos enfermos com cirrose hepática. O cociente ascite/soro da tuberculose foi superior ao das outras enfermidades, nas proteínas totais e em todas as fraçöes eletroforéticas, exceto a alfa 1 - globulina. Nesta, pelo contrário, os tuberculosos apresentaram o valor médio mais baixo

Ascite / Ascite

Os autores fazem uma revisäo dos principais aspectos patogênicos, etiológicos e laboratoriais do líquido de ascite, por considerá-los importantes para o adequado manejo do paciente com ascite