[Clinical observation of effect of xiao gu san on cirrhosis ascites]

OBJECTIVE

To observe the clinical effect of Xiao Gu San on cirrhosis ascites.

METHOD

Groups were randomly divided into treating group and group of western medicine comparision.

RESULT

30 cases of the treating group were observed with the following result: first class curative effect 7; second class 12; the third class 9; effectiveless 2; total effective rate 93.33%. 30 cases of the Group of Comparison: first class curative effect 2; second class 6; the third class 15; effectiveless 7; total effective rate is 76.67%.

CONCLUSION

The curative effect of Xiaogu San combined with Western medicine on cirrhosis ascites is better than that of Western medicine alone.

Prediction of GFR in liver transplant candidates

BACKGROUND

Kidney function frequently is impaired in patients with cirrhosis; however, glomerular filtration rate (GFR) is difficult to estimate in these patients by using standard clinical markers. The aim of our study is to compare GFR calculated from renal clearance of iodine 125-labeled iothalamate ((125)I-iothalamate) with the plasma decay technique and the Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (CG) prediction equations.

METHODS

We performed a cross-sectional study of patients with liver cirrhosis being evaluated for transplantation (50% Child's class C); 89% had ascites or edema and 44% were men aged 55 +/- 2 years. Average pretest blood urea nitrogen level was 16 +/- 2 mg/dL (5.7 +/- 0.7 mmol/L); serum creatinine, 1.0 +/- 0.1 mg/dL (88 +/- 9 micromol/L; range, 0.6 to 1.7 mg/dL [53 to 150 micromol/L]); plasma albumin, 3.14 +/- 0.16 g/dL (31.4 +/- 1.6 g/L); and total bilirubin, 4.0 +/- 0.7 mg/dL (67 +/- 11.3 micromol/L). Kidney function was measured by means of simultaneous plasma and renal clearance of (125)I-iothalamate (Glofil-125; Cypros Pharmaceutical Corp, Carlsbad, CA) and the MDRD and CG equations.

RESULTS

GFRs were 58.2 +/- 5.1 mL/min/1.73 m(2) by renal clearance of (125)I-iothalamate and 76.7 +/- 7.2 mL/min/1.73 m(2) by the plasma decay technique (+18.5 mL/min, or 32%; P = 0.0004). GFR by the MDRD equation was 76.9 +/- 7.8 mL/min/1.73 m(2) (+18.7 mL/min, or 32%; P = 0.0004 versus renal iothalamate; r(2) = 0.57). GFR by the CG equation was the least accurate (+30.1 mL/min, or 52%; P = 0.0001 versus renal iothalamate).

CONCLUSION

The current clinically used CG and MDRD equations to estimate kidney function in patients with cirrhosis and volume excess and the (125)I-iothalamate plasma decay technique are inaccurate because they overestimate GFR. It seems very unlikely that accurate and reliable formulas will be developed that are able to replace the formal measurement of GFR in patients with liver cirrhosis. Therefore, we conclude that despite the additional complexity, renal clearance techniques should be used to assess GFR accurately in patients with liver cirrhosis and ascites.

Elevation of cytokines in peritoneal fluid and blood in patients with liver cirrhosis

BACKGROUND/AIMS

Liver cirrhosis, described as the endstage of a necroinflammatory process, is often accompanied by ascites formation. The rationale for this study was the hypothesis that patients with liver cirrhosis have a low-grade chronic inflammatory response, which leads to an increased amount of proinflammatory cytokines accumulated in ascites. Twenty-five patients with liver cirrhosis complicated by ascites and twelve healthy volunteers were prospectively included in the study.

METHODOLOGY

Ascites and blood samples from the patients were obtained for analysis of inflammatory cytokines using enzyme-linked immunosorbent assay methodology. Blood samples were taken from the healthy volunteers to obtain reference values.

RESULTS

Plasma and ascites concentrations of interleukin-1alpha, interleukin-6, and tumor necrosis factor-alpha were significantly elevated in the patients compared with plasma levels in the group of healthy controls. Significant elevation of interleukin-10 concentrations was found in ascites but not in plasma in the patients. There was no significant difference in interleukin-10 levels between patient and control plasma.

CONCLUSIONS

The findings suggest that elevated cytokine concentrations in ascites and serum could perpetuate an inflammatory reaction that may be a source of preservation of an ongoing systemic inflammatory reaction. This may contribute to the maintenance, and even progress, of the liver dysfunction, leading to exaggerated ascites development.

Cancer antigen 125 levels in patients with ascites

BACKGROUND/AIMS

Cancer antigen 125 is a glycoprotein of 220 kDA molecular weight, that is released from coelomic epithelium during embryonic development. It has a low specificity, and high levels have been shown in many benign and malignant diseases. High correlation was detected between its level and ascites, especially in cirrhotic patients. In this study, we aimed to evaluate cancer antigen 125 levels in patients with ascites and determine the relationship between these levels and the amount of ascites.

METHODS

Fifty-eight patients (25 men, 33 women, mean age 54.34 years) with ascites, hospitalized in our clinic, were included in the study. The patients with ovarian cancer were not included. For all patients, physical examination and abdominal USG were done and blood samples for routine screening and cancer antigen 125 were obtained and studied on the same day.

RESULTS

Mean cancer antigen 125 levels in all patients were higher than normal. The highest levels were detected in patients with massive ascites and cirrhosis. With regard to diagnosis, the levels of cancer antigen 125 between groups were insignificant. According to USG results, there was a weakly positive but important correlation between groups. Although no correlation was present between cancer antigen 125 and ALT levels, a weak but positive correlation was present with AST levels.

CONCLUSION

Our study showed that a correlation is present between cancer antigen 125 levels and the presence and amount of ascites. We also suggest that if cancer antigen 125 levels are above normal, the presence of ascites not detected by physical examination should be kept in mind.

[Clinical significance of serum CA 125 in patients with chronic liver diseases]

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.

Acute nontraumatic hemoabdomen in the dog: a retrospective analysis of 39 cases (1987-2001)

The medical records of 39 dogs with acute nontraumatic hemoabdomen were identified and reviewed. Anemia and hypoalbuminemia were identified in 36/37 (97%) and 25/33 (76%) dogs, respectively. Coagulopathies were identified in 26/31 (84%) dogs. When a definitive diagnosis was obtained, malignant neoplasia was diagnosed most frequently and occurred in 24/30 (80%) dogs. Hemangiosarcoma accounted for 21/30 (70%) diagnoses. Sixteen dogs underwent exploratory laparotomy, of which seven (44%) survived the perioperative period. Of the dogs that did not undergo surgery, 9/23 (39%) survived to be discharged from the hospital.

Haematological characteristics predicting susceptibility for ascites. 1. High carbon dioxide tensions in juvenile chickens

1. Male broilers of two different genetic stocks, a pure broiler sire line (A) and commercially available Ross broilers (B), were used to study the effect of haematological characteristics in juvenile chickens on the development of clinical ascitic signs. Production performance (body weight gain (BWG), feed intake (FI), feed conversion ratio (FCR)) from 448 birds per stock was measured from 2 to 5 weeks of age. Mortality was recorded from 2 to 6 weeks of age. The birds were housed at a low ambient temperature to stimulate the incidence of ascites. 2. From each stock, 32 birds with the highest (high risk: HRc) and 32 birds with the lowest (low risk: LRc) carbon dioxide tensions (pCO2) in venous blood were selected at 11 d of age. These birds were marked for future blood sampling to determine changes in pCO2 with age to relate these values to ascites susceptibility. 3. At 2 weeks of age all birds (including HRc and LRc birds) were allotted to 32 floor pens (one HRc and one LRc in each pen) per stock. Venous blood samples were collected weekly from HRc and LRc birds for blood gas analysis and haematocrit, and at week 5 also for thyroid hormone (T3, T4) concentrations in plasma. At 5 weeks of age all HRc and LRc birds were examined post-mortem, relative heart, lung, and liver weights and arterial pressure index (API) values were recorded. 4. Birds from stock A showed a lower BWG and FCR and notably higher ascites mortality compared with stock B. An effect of pCO2 tensions at d 11 was found on the incidence of ascitic signs in selected birds of both stocks up to week 5. From the HRc groups 30% of the birds showed ascitic signs, whereas this was only 8% in the LRc group. LRc birds of stock B in particular showed constant low API values (20 +/- 3%) and none of these birds showed signs of ascites. 5. Our results suggest that the ascites problem in Ross birds can be eliminated by selection for low pCO2 tensions in venous blood. Stock effects on API, liver weight, lung weight, and plasma thyroid hormone independent of pCO2 showed a more complex picture of the ascitic signs in stock A compared with B. 6. We concluded that in this experiment a high pCO2 tension in venous blood measured at d 11 was a reliable predictor for ascites susceptibility observed at 5 weeks of age. A low pCO2 tension provides an appropriate criterion for genetic selection, whereas a high pCO2 tension emphasises the necessity for intensive management in poultry houses.

Haematological characteristics predicting susceptibility for ascites. 2. High haematocrit values in juvenile chickens

1. Male broilers of two different genetic stocks, a pure broiler sire line (A) and commercially available Ross broilers (B), were used to study the effect of differences in haematocrit values in 12-d-old chickens on the development of ascitic symptoms. Body weight gain (BWG), feed intake (FI) and feed conversion ratio (FRC) were measured from 2 to 5 weeks of age. Mortality was recorded from 2 to 6 weeks. The birds were kept at a low ambient temperature to stimulate the incidence of ascites. 2. From each stock 32 birds with the highest (High Ht) and 32 birds with the lowest (Low Ht) haematocrit values in venous blood were selected at 12 d of age for an examination on susceptibility for the ascites syndrome at 5 weeks. 3. At 2 weeks 448 birds per stock (including High Ht and Low Ht birds) were allotted to 32 floor pens (1 High Ht and 1 Low Ht in each pen). Venous blood samples were taken weekly in High Ht and Low Ht birds for haematocrit measurements and at week 5 also thyroid hormone (T3, T4) concentrations in plasma were measured. At 5 weeks all High Ht and Low Ht birds were examined post-mortem and arterial pressure index, heart weight, lung weight and liver weight (all relative to body weight) were recorded. High values for arterial pressure index, relative heart and liver weights and low values for relative lung weights and plasma thyroid hormone were considered to be indicators for ascites susceptibility. 4. Stock A, with the highest ascites mortality, had lower values for BWG and FCR than stock B. Throughout, a clear difference in Ht values between High Ht and Low Ht birds was maintained. No significant effects of 12-d haematocrit values were found on the incidence of ascitic symptoms until week 5. High Ht values tended to correlate with low relative lung weights and low plasma T3 concentrations in High Ht birds. 5. Within the groups of selected birds, there was an effect of stock on ascitic symptoms (arterial pressure index, relative heart weight and T3 values) at week 5. This is consistent with a higher ascites mortality in flock A than in flock B, over the whole period up to 6 weeks. Until 4 weeks both A and B were similar with respect to mean Ht values of High Ht and Low Ht groups. After 4 weeks Ht values were very high in the High Ht birds of stock A, possibly as a result of the susceptibility for ascites of stock A. There was a significant interaction between stock and Ht values on the ascites-related variable arterial pressure index. Only in stock A was high arterial pressure at 5 weeks related to high Ht values at d 12. 6. Overall it was concluded that a high Ht in blood of juvenile chickens has limited practical value in predicting incidence of ascites at 5 weeks of age.

An angiotensin converting enzyme inhibitor, benazepril can be transformed to an active metabolite, benazeprilat, by the liver of dogs with ascitic pulmonary heartworm disease

To examine whether an angiotensin converting enzyme (ACE) inhibitor, benazepril, can be transformed to the active metabolite, benazeprilat, by severely injured liver of dogs with ascitic heartworm disease, benazepril hydrochloride was administered orally to dogs once daily for 7 consecutive days at a dose rate of 0.29 mg/kg to 0.63 mg/kg of body weight, and plasma benazepril and benazeprilat concentrations were determined on the 1st and 7th administration days. In 7 dogs with ascitic pulmonary heartworm disease, plasma benazeprilat concentrations tended to be higher than in 7 control dogs both on the 1st and 7th administration days. The peak concentration and area under the concentration-time curve tended to be greater in dogs of the ascites group than in control dogs, but the statistics could not detect significant differences in the time to peak concentration and t(1/2) between the control and ascites groups. Plasma ACE activities decreased after administration of benazepril. In dogs with ascitic heartworm disease, benazepril was readily transformed to benazeprilat by the liver, and was effective for suppression of plasma ACE activity.

[Significances of plasma levels of neuropeptide Y pre- and post-treatment in patients with decompensated cirrhosis and ascites]

OBJECTIVE

To observe changes of plasma neuropeptide Y(NPY) level in ascitic patients with decompensated cirrhosis pre- and post-treatment, there fore to understand the correlation of NPY with liver function and ascitic formation.

METHODS

NPY plasma levels in 20 patients with decompensated cirrhosis and ascites were detected by radioimmunological assay.

RESULTS

Plasma NPY levels in patients with cirrhotic ascites were significantly lower than those in normal subjects(P < 0.01) in spite of the increases of NPY after ascites decreased (P < 0.01), which were still lower than those in normal subjects(P < 0.01).

CONCLUSION

Decreased plasma NPY levels are correlated with the severity of liver damage and may be responsible for the changes of hemodynamics and ascitic formation in patients with liver cirrhosis.

Clinical and neurohumoral response to posture, physical exercise, and ascites treatment in Child-Pugh C liver cirrhosis: randomized prospective trial

AIM

To assess clinical and neurohumoral response to posture, physical exercise, and ascites treatment in patients with Child-Pugh C liver cirrhosis and tense ascites.

METHOD

Fifty patients with Child-Pugh C liver cirrhosis and tense ascites were randomly allocated into 5 groups. Thirty patients were treated with paracentesis of 6 L of acites paralleled by plasma volume expansion with 200 mL of 20% low sodium albumin (10 patients), 600 mL fresh frozen plasma (10 patients), or 900 mL solution of synthetic gelatine (10 patients), ie, doses with comparable oncotic power, and bed rest for 24 h before and after the procedure. They were compared with 10 patients treated with paracentesis of 6 L of ascites without plasma volume expansion and no bed rest, and 10 patients treated with 40 mg of furosemide IV daily and no bed rest. Mean arterial pressure, heart rate, body weight loss, urine flow rate, creatinine clearance, plasma renin activity, plasma aldosterone concentration, and plasma atrial natriuretic peptide (ANP) were measured before the procedure and 6 hours, 2, 3, and 6 days after the procedure.

RESULTS

Diuretic treatment and paracentesis of 6 L of ascites without plasma volume expansion and no bed rest 24 h before and after the procedure were associated with significant hypotension (p<0.01) during 6 days of the trial, tachycardia (p<0.01) on day 1 and 2 (p=0.012), lower total body weight loss (p=0.007), increase in plasma renin activity 6 hours after the beginning of the study (p=0.025) and on day 6 (p=0.024), increase in plasma aldosterone concentration on day 6 (p=0.030), no significant change in plasma ANP levels, and decrease in creatinine clearance on day 6 (p=0.046). Albumin was superior to the other plasma expanders. Comparison between groups treated with plasma volume expansion did not show significant differences in measured parameters at any time during the study. The differences were found in the amount of needed volume of each substitute, daily sodium balance on day 1 of the trial, increase in plasma aldosterone concentration in bed rest-paracentesis-polygeline group on day 6, and the increase in plasma ANP on day 1 (p=0.077), which was proportional to the amount of infused volume.

CONCLUSION

Therapeutic paracentesis of 6 L of ascites, bed rest 24 h before and after the procedure, and intravenous substitution of volume with albumin, fresh frozen plasma, and solution of synthetic gelatine were safe, rapid, and effective treatments, provided that intravascular volume was substituted simultaneously.

Erythropoiesis regulation during the development of ascites syndrome in broiler chickens: a possible role of corticosterone

The ascites syndrome in broiler chickens is attributed to metabolic burdening, which results from intensive genetic selection for rapid growth coupled with exposure to extreme environmental conditions, such as low ambient temperature. These conditions impose on the broilers difficulties in fulfilling tissue demands for oxygen, and the birds exhibit a decrease in blood oxygen saturation and high hematocrit values. It is unknown whether the increase in hematocrit results from alteration in erythropoiesis or from fluid exudation out of the blood system to the abdominal cavity. The present study was conducted to examine the association between abnormal stress response and erythropoiesis process in ascitic broilers. Ascitic chickens revealed a uniquely continuous stress response: expressing an increase (P < or = 0.05) in plasma corticosterone concentration 2 to 3 wk before death. At 5 wk of age, ascitic broilers exhibited an increase (P < 0.05) in hematocrit, blood cell count, and packed cells and blood volumes, with no significant change in plasma volume. These results confirm an accelerated erythropoiesis process in ascitic birds. Increased blood cell production in ascitic birds was matched by an increase (P < 0.05) in the proportion of immature red blood cells (23%) in comparison with broilers that remained healthy (7%), and by decreased (P < 0.05) hemoglobin content relative to red blood cells. We conclude that continually increased corticosterone concentrations, as an inducer of erythropoiesis proliferation and differentiation arrest, in ascitic chickens, resulted in increased production of red blood cells (partially immature) with decreased hemoglobin content; this decrease in hemoglobin might have contributed to enhanced development of hypoxemia and to aggravation of the syndrome.

Cancer antigen 125 associated with multiple benign and malignant pathologies

BACKGROUND

Cancer antigen (CA) 125 tumor-associated antigen is a high molecular glycoprotein used for follow-up of epithelial ovarian cancer. The test is often requested as a differential diagnosis in patients with pleural or peritoneal fluid. This study analyzes the prevalence of CA-125 increases in a population of patients attending a general hospital and discusses the possible clinical implications of increased levels.

METHODS

On 4 different days, 380 CA-125 assays were performed in randomly selected patients attending our hospital. Serum CA-125 was measured with a commercial enzyme immunoassay, and clinical records were reviewed for assessment of clinical parameters.

RESULTS

Sixty-one patients (16%) had increased CA-125. The pathologies of these patients were heart failure in 9 (14.7%), lung disease 11 (18%), hepatic cirrhosis in 7 (11.4%), malignant tumors in 9 (14.7%), intra-abdominal nonhepatic disease in 6 (10%), previous surgery in 17 (27.8%), and miscellaneous in 2 (3%). Effusions were seen in 34 patients (55.7%).

CONCLUSIONS

Our data confirm the variety of benign and malignant pathologies coursing with increased CA-125. Cardiovascular and chronic liver disease were the most frequent diagnoses in patients with increased CA-125; this supports the opinion that CA-125 lacks utility as a marker for malignancy. CA-125 could have a role in the follow-up of cardiovascular, hepatic, and tumoral diseases with serosal involvement.

The effect of beta-blocker on intractable ascites in cirrhotic patients undergoing hepatectomy for hepatocellular carcinoma

BACKGROUND/AIMS

Intractable ascites is one of the serious complications after hepatectomy. Only little is known about their effect on postoperative ascites in patients with liver cirrhosis although beta-blockers have been used for cirrhotic complications including ascites.

METHODOLOGY

Here, we report five cases of intractable ascites after hepatectomy, which were treated by propranolol (1 mg/kg/body).

RESULTS

In three patients, plasma renin activity and aldosterone concentrations were markedly increased before propranolol administration, but fell to normal levels thereafter. Ascites subsided in all subjects except one, who developed cardiac dysfunction.

CONCLUSIONS

Beta-blockers might be a promising drug for intractable ascites in cirrhotic patients undergoing hepatectomy.

Pericardial effusion in the nephrotic syndrome

Hydropericardium is a known cause of pericardial effusion related to severely expanded extracellular fluid volume. Nephrotic patients have expanded extracellular fluid volume but obviously may have other causes for pericardial effusion. We tested the hypothesis that pericardial effusion is related to inflammation and not to hydropericardium in patients with nephrotic syndrome. Twenty nephrotic patients with systemic lupus erythematosus (SLE) were compared to 20 patients with nephrotic syndrome of other causes. No patient in either group had symptoms or signs of pericardial disease. Pleural effusion and ascites were equally common in SLE-nephrotic patients compared to non-SLE-nephrotic patients. However, 8 SLE patients had pericardial effusion, while none of the non-SLE-nephrotic patients had pericardial effusion. We suggest that hydropericardium is rare in nephrotic patients and that an inflammatory or other secondary cause should be considered when pericardial effusion complicates nephrotic syndrome.

An unusual presentation of struma ovarii mimicking a malignant process

BACKGROUND

Struma ovarii is a rare form of ovarian neoplasm, composed entirely or predominantly of thyroid tissue. This tumor is generally benign, although malignant transformation has been reported.

CASE

We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with a large amount of ascites, a markedly elevated CA 125 serum level, and a large complex pelvic mass thereby mimicking an ovarian cancer.

CONCLUSION

This case serves to remind clinicians that clinical features highly suspicious for ovarian cancer do not necessarily confirm a malignancy.

Direct and maternal genetic effects for ascites-related traits in broilers

The objective of the present study was to estimate heritabilities for ascites-related traits in broilers and to assess the importance of maternal genetic effects for these traits. Several traits related to ascites were measured on more than 4,000 broilers kept under cold conditions. Heritabilities were estimated using an animal model with a direct genetic effect and a model with direct and maternal genetic effects. Estimated heritabilities from the direct genetic effects model were 0.46 for hematocrit value, 0.42 for BW, 0.47 for right ventricular weight, 0.46 for total ventricular weight, 0.45 for ratio of right ventricular weight to the total ventricular weight, 0.32 for total mortality, and 0.18 for fluid accumulation in the heart sac. Maternal effects significantly influenced the traits BW, total ventricular weight, and total mortality. Direct and maternal heritabilities, respectively, for BW were 0.21 and 0.04, for total ventricular weights were 0.29 and 0.03, and for total mortality were 0.16 and 0.05. The heritability estimates for ascites-related traits and the significance of maternal genetic effects for most of these traits indicate that direct and maternal genetic effects play an important role in the development of the ascites syndrome.

Plasma endothelin-1 concentrations in children with cirrhosis and their relationship to renal function and the severity of portal hypertension

BACKGROUND

Plasma endothelin-1 (ET-1) is a potent vasoconstrictor peptide involved in the pathogenesis of several disorders. Endothelin-1 concentrations are increased in adult patients with cirrhosis. However, little is known about ET-1 concentrations in children with cirrhosis.

METHODS

Radioimmune assay was used to measure plasma ET-1 concentrations in 19 children with cirrhosis (8 patients with ascites, and 11 without ascites), and 11 age- and sex-matched healthy children. The plasma ET-1 concentrations were correlated with the mean blood pressure, creatinine clearance, and severity of portal hypertension, as measured by portal flow volume and portal flow velocity.

RESULTS

Patients with cirrhosis and ascites had increased plasma ET-1 concentrations compared with patients who did not have ascites (6.8 pg/mL +/- 0.62 pg/mL vs. 4.6 pg/mL +/- 0.35 pg/mL; mean +/- SEM; < 0.01) and controls (3.6 pg/mL +/- 0.27 pg/mL; mean +/- SEM; < 0.0005). Plasma ET-1 concentrations were higher in patients with cirrhosis who did not have ascites compared with controls ( < 0.005). No significant differences were observed between concentrations of the patients with cholestasis and those without cholestasis (5.4 pg/mL +/- 0.52 pg/mL vs. 5.2 +/- 0.32 pg/mL; mean +/- SEM; = 0.1). Plasma ET-1 concentrations correlated positively with the mean blood pressure ( = 0.58; < 0.05) and negatively with renal function, as measured by creatinine clearance ( = -0.7; <0.005). However, no correlation was detected between ET-1 concentrations and portal flow volume ( = -0.02; = 0.4) or portal flow velocity ( = -0.16; = 0.4).

CONCLUSIONS

Plasma ET-1 concentrations are increased in children with cirrhosis, with or without ascites, compared with controls. Patients with cirrhosis and ascites have increased ET-1 concentrations compared with those without ascites. The degree of increase does not relate to the severity of portal hypertension. This increase tends to maintain systemic blood pressure but is associated with a decrease in renal function.

Serum, pleural effusion, and ascites CA-125 levels in ovarian cancer and nonovarian benign and malignant diseases: a comparative study

OBJECTIVES

Cancer antigen-125 (CA-125) is not a specific tumor marker and it is synthesized by normal and malignant cells of different origins. Recently it has been shown that various diseases are associated with increased CA-125 levels, especially in the presence of serosal fluid. The aim of this study is to investigate serum and fluid CA-125 levels in patients with different diseases.

METHODS

A total of 133 patients and 23 healthy control cases were included in the study and divided into eight groups on the basis of disease and the presence of fluid in the serosal cavities. Serum and serosal fluid CA-125 levels were measured by a commercial enzyme immunoassay kit at the same time. Comparisons among the groups were made.

RESULTS

Abnormal levels of serum CA-125 were observed in 76% of ovarian cancer patients; 96% in patients with ascites and 56% in patients without ascites. Moreover, elevated serum CA-125 levels were detected in 52% of patients with hepatic diseases, in 100% of patients with nongynecologic peritoneal carcinomatosis, and in 87% of patients with pleural effusion. Serum and fluid CA-125 levels were significantly higher in cases of ovarian cancer with ascites than in the other groups (P < 0.01). A positive correlation between serum CA-125 levels and ascites amounts was observed in cases of ovarian cancer with ascites (P < 0.01, r = 0.81). Furthermore, no correlation was observed between ovarian mass volume and serum CA-125 levels in ovarian cancer patients with stage I disease without ascites (P = 0.08, r = 0.48).

CONCLUSIONS

Although CA-125 levels may be considered a sensitive tumor marker in patients with epithelial ovarian cancer, it was determined that high serum CA-125 levels were closely related to the presence of serosal fluids and serosal involvement, whatever the origin is. These results should be considered in the interpretation of CA-125 elevation in patients with ovarian cancer.

Increased plasma levels of neuropeptide Y in hepatorenal syndrome

BACKGROUND/AIMS

To investigate the relationship between neuropeptide Y (NPY), a potent renal vasoconstrictor peptide released upon marked stimulations of sympathetic nervous system (SNS), and renal and circulatory function in cirrhosis.

METHODS

Plasma levels of NPY (radioimmunoassay) and norepinephrine and renal function parameters were determined in 17 healthy controls, nine patients with cirrhosis without ascites, and 37 patients with cirrhosis and ascites, of whom 12 had hepatorenal syndrome (HRS).

RESULTS

Patients with ascites showed circulating levels of NPY similar to those of patients without ascites and controls (73+/-4, +/-4 and 68+/-4 pmol/l, respectively; NS). However, patients with HRS had significantly increased levels of NPY with respect to the other groups (110+/-6 pmol/l; P<0.001). NPY levels correlated inversely with renal plasma flow and glomerular filtration rate and directly with norepinephrine. In patients with HRS (n=6) treatment with terlipressin and albumin was associated with a marked improvement in circulatory and renal function and marked suppression of NPY and norepinephrine levels.

CONCLUSIONS

Patients with HRS have increased levels of NPY which are related to circulatory dysfunction and SNS activation and may contribute to renal vasoconstriction.

Reduced neutrophil sequestration in lung tissue after laparoscopic lavage in a rat peritonitis model

Laparoscopy to treat abdominal infections is becoming more and more popular. The effects of the CO(2) pneumoperitoneum have not yet been completely clarified. In a rat peritonitis model, therefore, we investigated the influence of laparoscopic lavage in comparison with the conventional technique. A defined multibacterial fecal specimen was installed in the abdominal cavities of 80 rats. These animals were randomized to three groups: group 1 (n = 32), no intervention; group 2 (n = 24), conventional; group 3 (n = 24), laparoscopic lavage. At 1, 2, and 8 hours after the surgical intervention, animals were killed and autopsied. The main outcome measures were bacteremia, interleukin-6 (IL-6) in plasma and ascites, changes in the blood count, and myeloperoxidase (MPO) activity in lung, liver, kidney, and pancreas. Differences of bacteremia were not found. In the ascites a marked increase in IL-6 was observed after 8 hours, which was lower in the treatment groups than in the controls (p <0.025). MPO activity as a measure of the granulocytes present in the tissue showed significant changes only in lung tissue. Two hours after the surgical intervention, the MPO in the lung in the laparoscopy group was significantly lower than that in the controls and the laparotomy group. In conclusion, conventional and laparoscopic lavage reduce inflammation. In this model, laparoscopic lavage with a CO(2) pneumoperitoneum appeared to have no negative influence on the inflammatory reaction during the early postoperative phase. Reduced neutrophil sequestration in lung tissue following laparoscopic lavage reflects the lower level of trauma caused by laparoscopy.