Abnormal Accumulation Of Fluid Research Articles

Ascites in peripartum cardiomyopathy: case report

Ascites is the abnormal accumulation of excess fluid in peritoneal cavity.1 Normally, peritoneal cavity contains 25–50 mL of ascitic fluid, which allows for the movement of bowel loops past one other and helps hydrate serousal surfaces. Cirrhosis is the most common cause of ascites in the Western world (75%), followed by peritoneal malignancy (12%), heart failure (5%) (include peripartum cardiomyopathy), and peritoneal tuberculosis (2%). A 19-years-old woman diagnosed with peripartum cardiomyopathy. She came with chest pain and increased of her abdominal perimeter since 6 month ago, a month after she got cesarean delivery. She was given high protein and low sodium diet, water restriction, treated with furosemide 40 mg, spironolactone 25 mg, and abdominal paracentesis with total 1500 cc of yellowish ascites fluid was evacuated. Early detection is required in this case to ensure effective management without any complications. Treatment depends upon the cause of the ascites. Dietary sodium restriction and diuretics remains the first line therapy for its management. The use of diuretics needs close monitoring and follow up, including weight loss, electrolytes, and patient’s condition daily.

Full-mouth rehabilitation of a hydrocephalus patient

Dentists frequently encounter patients who are either medically, physically, or mentally compromised. One such medically compromised condition is “hydrocephalus.” Hydrocephalus is basically a neurological disorder caused by excessive intracranial pressure due to abnormal accumulation of cerebrospinal fluid within the ventricles or subarachnoid space of the brain and raised intracranial pressure. Ventriculoperitoneal shunt (VPS) is the most commonly used treatment, but ventriculoatrial shunt is another treatment option. To keep the intracranial pressure within normal range, the patients are kept on medications which make them more prone to dental caries. Because of poor oral hygiene, these patients require a regular dental care. This report discusses the dental management process employed for a 5-year-old patient with VPS-treated hydrocephalus.

Managing Chronic Health Needs in Child Care and Schools—Hydrocephalus and Shunts

Patient Education| 2021 Managing Chronic Health Needs in Child Care and Schools—Hydrocephalus and Shunts Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Managing Chronic Health Needs in Child Care and Schools—Hydrocephalus and Shunts. Pediatric Patient Education 2021; 10.1542/ppe_document025 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Managing Chronic Health Needs in Child Care Hydrocephalus is the abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. Hydrocephalus can be caused by a blockage of CSF flow (obstructive hydrocephalus) or failure to absorb CSF (communicating hydrocephalus). Hydrocephalus can be present at birth (congenital hydrocephalus) or develop later in life (acquired hydrocephalus). There are numerous causes of hydrocephalus, the most common being hydrocephalus associated with myelomeningocele and post- hemorrhagic hydrocephalus as a complication of preterm birth. One treatment of hydrocephalus is the placement of a shunt, which is a flexible tube, to carry the extra CSF from the ventricle of the brain to another area of the body. The most common distal site for a shunt is the peritoneal cavity in the abdomen. These shunts are ventriculoperitoneal shunts. A successful shunt relieves pressure on the brain, controlling the rate of head growth and maximizing... © 2019 American Academy of Pediatrics. All rights reserved. You do not currently have access to this content.

Complications Encountered with ETV in Infants with Congenital Hydrocephalus.

Hydrocephalus is an abnormal excessive accumulation of cerebrospinal fluid (CSF) in the cavity and spaces of the brain. Endoscopic third ventriculostomy (ETV) has been an established treatment modality for congenital hydrocephalus. However, in very young infants, the results are challenging. In our study, we have evaluated whether ETV really offers an acceptable complication-free postoperative course. To study the complication and mortality rate in infants having congenital hydrocephalus treated with ETV. This is a single-center prospective study conducted at the Department of Neurosurgery, K. G. M. U, Lucknow, from January 2019 to February 2020. We studied 40 infants presenting with clinical and radiological features suggestive of congenital hydrocephalus. Follow-up was done at the first, third, and sixth months after discharge. Nineteen infants (47.5%) required a second CSF diversion procedure at 6 months of follow-up. The failure rate was significantly higher in infants less than 3 months of age (P value of 0.04). The ETV site bulge was the most frequent complication encountered in the postoperative period, occurring in 20% of the cases. Eventually, all these infants required a ventriculoperitoneal shunt; 15% developed clinical features consistent with the diagnosis of post-ETV meningitis. The ETV site CSF leak occurred in 10% of the patients. Subdural hygroma developed in 7.5% of the patients; 17.5% of the patients contributed to mortality with a mean time of expiry of 22 days post-procedure. All these deaths had multifactorial causes and could not be said as a complication or failure of ETV. We do not recommend ETV for infants less than 3 months because of a high failure rate. The ETV site bulge was the most reliable and earliest marker of failure and a second CSF diversion surgery should be immediately considered.

Non-immune hydrops fetalis in Saudi family secondary to a rare genetic cause

Background: Non-immune hydrops fetalis (NIHF) is the abnormal accumulation of serous fluid in more than two fetal or neonatal interstitial spaces due to non-immune causes. It is a serious condition that requires extensive medical care as it indicates severe fetal compromise. Severe anemia, infections, heart or lung defects, and liver disease are all possible causes. Less common causes of NIHF include single gene defects and chromosomal abnormalities. Case Presentation: We report a 2-month-old girl born at 32 weeks of gestation and found to have polyhydramnios and massive congenital ascites. Whole exome sequencing (WES) identified a biallelic pathogenic variant c.617G>A p. (Cys206Tyr) in the thrombospondin 1 domain-containing protein 1 (THSD1) gene. She was misdiagnosed to have ascites secondary to liver dysfunction. Conclusion: Rare causes of fetal hydrops like THSD1 mutation need to be excluded in cases of recurrent non-immune hydrops with no obvious etiology.

An Abnormal Accumulation of Cerebrospinal Fluid in the Cavities Deep Within the Brain

An Abnormal Accumulation of Cerebrospinal Fluid in the Cavities Deep Within the Brain

Diagnostic Workup of Pleural Effusion and Medical Thoracoscopy –Current Status

Pleural effusion is a common clinical problem with diverse aetiologies accounting for around 4 patients in pulmonary practice. Pleural effusion results from an abnormal accumulation of fluid due to excessive production or decreased pleural fluid absorption and can be transudative or exudative depending on the fluid composition. Proper diagnostic workup of all pleural effusion cases must be done so that proper cause may be established and adequate treatment may then be started. About 20 to 25 of pleural effusion cases remain undiagnosed despite repeated thoracocentesis and closed pleural biopsies. Medical thoracoscopy is a minimally invasive procedure that allows complete visualization of the pleural space enabling the diagnostic and therapeutic procedures like pleural biopsy and talc insufflation for pleurodesis to be performed safely. Thoracoscopy increases the diagnostic yield in undiagnosed pleural effusion as it allows inspection of the pleural surfaces and permits pleural biopsy under direct visualization. The diagnostic yield of thoracoscopy in malignant and TB pleural effusion ranges from 91 to 95 and 93 to 100 respectively. The traditional instrument used for thoracoscopy has been the rigid thoracoscope. Development of the technique of semi-rigid thoracoscopy provided an alternate method to access the pleura using a scope which essentially resembles the flexible bronchoscope. Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. This article focuses on the simplified way on how to approach a case of pleural effusion with a simplified algorithm and also on the diagnostic and therapeutic utility of medical thoracoscopy.

Chemical pleurodesis using povidon-iodine for chylothorax treatment in newborns

Introduction. Chylothorax is a rare condition that results from abnormal accumulation of lymphatic fluid in the chest and one of the most common causes of pleural effusion in newborns. The aim of our study is to present our own experience of chemical pleurodesis using povidone-iodine in newborns with chylothorax.
 Materials and methods. In the present study, we studied data from 10 patients with chylothorax who, over the past years, starting in 2016, underwent chemical pleurodesis using the drug povidone-iodine. Congenital accumulation of lymph in the pleural cavity was recorded in 2 patients, acquired in 8 patients. The indications for this procedure were the absence of response to total parenteral nutrition for at least 10 days and the appointment of octreotide at the maximum dosage. Pleurodesis consisted in the introduction into the pleural cavity of a 4% solution of povidone-iodine with a calculated dose of 1 ml/kg. The povidone-iodine solution was kept inside the pleural cavity for the next 4 hours.
 Results. Chemical pleurodesis was successfully applied in all 10 patients. In 8 patients, a single prescription of the drug was sufficient, and in 2 remaining patients, the pleurodesis session was repeated. After the procedure of chemical pleurodesis, 2 patients developed respiratory distress syndrome caused by massive atelectasis of the homolateral lung, which was confirmed by X-ray examination. These patients required mechanical ventilation for 24 and 48 hours. The average time for the disappearance of chylothorax was 4 days. In the long-term follow-up, 1 patient died from progressive deterioration of pulmonary function against the background of lung hypoplasia.
 Conclusions. Our data demonstrate that povidone iodine pleurodesis is a effective treatment for chylothorax in newborns.

Electroosmosis Based Novel Treatment Approach for Cerebral Edema.

Cerebral edema characterized as an abnormal accumulation of interstitial fluid has not been treated effectively. We propose a novel edema treatment approach to drive edematous fluid out of the brain by direct current utilizing brain tissue's electroosmotic property. A finite element (FE) head model is developed and employed to assess the feasibility of the approach. First, the capacity of the model for electric field prediction is validated against human experiments. Second, two electrode configurations (S and D-montage) are designed to evaluate the distribution of the electric field, electroosmotic flow (EOF), current density, and temperature across the brain under an applied direct current. The S-montage is shown to induce an average EOF velocity of 7e-4 mm/s underneath the anode by a voltage of 15 V, and the D-montage induces a velocity of 9e-4 mm/s by a voltage of 5 V. Meanwhile, the brain temperature in both configurations is below 38 °C, which is within the safety range. Further, the magnitude of EOF is proportional to the electric field, and the EOF direction follows the current flow from anode to cathode. The EOF velocity in the white matter is significantly higher than that in the gray matter under the anode where the fluid is to be drawn out. The proposed electroosmosis based approach allows alleviating brain edema within the critical time window by direct current. The approach may be further developed as a new treatment solely or as a complement to existing conventional treatments of edema.

Conservative management of chylothorax in infants using octreotide

Background: Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates and infants. Chylothorax causes respiratory and nutritional problems and has a significant mortality rate. Octreotide is a long-acting somatostatin analogue that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.Methods: Infants with spontaneous chylothorax over a period of 3 years were included in this study. A prospective, observational study was done. All patients were nil per oral initially. Oral feeds were resumed once the ICD output declined. Octreotide was given subcutaneously for all patients at a dose of 40 microgram/kg/day in 3 divided doses. Octreotide was stopped once the ICD output was less than 70-80 ml/day. ICD was inserted in all patients and removed once drainage was below 50 ml/day.Results: Five patients were diagnosed with chylothorax over a period of 3 years out of which 3 were male and 2 were females. 1 patient had right sided and 4 patients had left sided chylothorax. The average age of presentation was 5.6 months. Octreotide was administered for an average of 14.4 days (8-22 days). The average duration of ICD was 18.2 days. All patients recovered well and were discharged.Conclusions: Spontaneous chylothorax is rare in infants. Conservative management is usually successful. Early institution of oral feeds with octreotide preserves the child’s nutrition and avoids invasive procedures, such as reinsertion of chest tubes or surgery.

Mechanisms and management of edema in pediatric nephrotic syndrome.

Edema is the abnormal accumulation of fluid in the interstitial compartment of tissues within the body. In nephrotic syndrome, edema is often seen in dependent areas such as the legs, but it can progress to cause significant accumulation in other areas leading to pulmonary edema, ascites, and/or anasarca. In this review, we focus on mechanisms and management of edema in children with nephrotic syndrome. We review the common mechanisms of edema, its burden in pediatric patients, and then present our approach and algorithm for management of edema in pediatric patients. The extensive body of experience accumulated over the last 5 decades means that there are many options, and clinicians may choose among these options based on their experience and careful monitoring of responses in individual patients.

Copaifera oleoresins as a novel natural product against acanthocephalan in aquaculture: Insights in the mode of action and toxicity

Tambaqui Colossoma macropomum is the main South American fish in continental aquaculture. However, its production has been hampered by acanthocephalan Neoechinorhynchus buttnerae. In this study, we evaluated the antiparasitic potential of five oleoresins (ORs): Copaifera duckei, Copaifera pubiflora, Copaifera reticulata, Copaifera paupera and Copaifera multijuga, as a novel treatment against N. buttnerae, describing their mode of action by histology of the parasite and their toxicity to the host. In in vitro assays, parasites were exposed to three concentrations (0.0467, 0.0934 and 0.1868 mg/ml) of ORs. At the lowest concentration tested (0.0467 mg/ml), none of the ORs had a significant effect on acanthocephalans (p > .05). At the intermediate concentration (0.0934 mg/ml), C. duckei, C. pubiflora and C. reticulata were significantly (p < .05) more effective than C. paupera and C. multijuga. At the highest concentration (0.1868 mg/ml), all species of Copaifera resulted in 100% mortality of the parasites after 24 hr, except C. multijuga. Acanthocephalans killed by the ORs showed generalized vacuolization in the tissues with abnormal accumulation of fluid (remarkable body swelling). We were able to relate the antiparasitic effect of ORs to their composition (ORs with highest concentration of diterpenes were most effective). In toxicity testing, tambaqui were exposed to the three most effective ORs (C. duckei, C. pubiflora and C. reticulata). All were classified as moderately toxic. In vitro and in vivo tests showed that Amazon ORs have the potential to be included in a list of products for therapeutic purposes in aquaculture.

Role of biochemistry, cytology, and biopsy in the etiological diagnosis of pleural effusion- a clinical study

Introduction:Pleural effusion is the most common pleural disorder. It refers to excessive or abnormal accumulation of fluid in the pleural space. It is a commonly occurring medical problem caused by various pathological conditions. To treat patients appropriately, it is important to establish an accurate etiological diagnosis. Material and Method: This is an observational study conducted at a tertiary health care center. The pleural effusion was assessed clinically, biochemically, bacteriologically, cytologically, and histopathologically. Result: Tuberculosis was the most common etiology, followed by malignancy. A pleural biopsy was done in 70 patients. Pleural tissue was obtained in 65 cases. On histopathology,Malignancy was diagnosed in 15, tuberculosis in 35, and non-specific inflammation in 13 cases. Out of 35 histological proven tuberculosis cases, 26 cases had adenosine de-aminase (ADA) more than 70 u/l. Conclusion:Every pleural effusion is not due to tuberculosis but can be due to other causes, malignancy should always be excluded. Pleural fluid cytology and biopsy can give a definite diagnosis in a significant number of cases of pleural effusion. Tuberculosis is still the most common cause of pleural effusion followed by malignancy.

Echo-Guided Pericardiocentesis: When and How Should It Be Performed?

Abnormal accumulation of pericardial fluid is a common cardiac condition with different etiologies. Draining of the pericardial fluid (pericardiocentesis) is often indicated for diagnostic and therapeutic purposes and is performed in an elective or emergent setting. Echocardiography is the primary imaging method for diagnosing, localizing, and quantifying pericardial effusion as well as evaluating its hemodynamic effects, including the presence of cardiac tamponade. In this manuscript, we review the indications for pericardiocentesis and provide practical step-by-step guidance for echo-guided pericardiocentesis. Echo-guidance is an effective method to improve the safety and efficacy of pericardiocentesis. In experienced hands and with a stepwise approach, procedural outcomes are excellent, and complication rates are very low. Asymptomatic small idiopathic effusions have a benign course and can be left untreated. Prolonged drainage with an indwelling pericardial catheter is key for preventing fluid re-accumulation, and the use of colchicine to prevent fluid recurrence is encouraged whenever possible. Understanding how to evaluate the significance of a pericardial effusion as well as the procedural steps in the performance of a pericardiocentesis are essential for optimal outcomes in treating patients with pericardial effusions and tamponade.

Fetal brain damage in congenital hydrocephalus.

Congenital hydrocephalus (HCP) is a developmental brain disorder characterized by the abnormal accumulation of cerebrospinal fluid within the ventricles. It is caused by genetic and acquired factors that start during early embryogenesis with disruption of the neurogerminal areas. As might be expected, early-onset hydrocephalus alters the process of brain development leading to irreparable neurological deficit. A primary alteration of the ependyma/neural stem cells (affecting vesicle trafficking and abnormal cell junctions) leads to its loss or denudation and translocation of neural progenitor cells (NPCs) and neural stem cells (NSCs) into the cerebrospinal fluid (CSF). Under these abnormal conditions, morphological and functional processes, underlying the concept of astroglial reaction, are initiated in an attempt to recover homeostasis in the periventricular zone. This astroglial reaction includes astrocyte hypertrophy, hyperplasia, and development of a new layer with reorganized functional features that resemble the ependyma. Despite decades of research, there is a lack of information concerning the biological basis of the brain abnormalities that are associated with HCP. The present review of current literature discusses the neuropathological changes during gestation following the onset of congenital hydrocephalus and the unanswered questions into the pathophysiology of the disease. A better understanding of those missing points might help create novel therapeutic strategies that can reverse or even prevent the ultimate neurological impairment that affects this population and improve long-term clinical outcome.

Claves diagnósticas en el paciente adulto con derrame pleural: revisión narrativa

El derrame pleural se define como la acumulación anormal de líquido en el espacio pleural, que se produce por el aumento en la producción o disminución en su drenaje. Es una entidad frecuente en la práctica clínica y obedece a múltiples causas, las cuales varían de acuerdo con la epidemiología local, los antecedentes y el contexto clínico. Es determinante el análisis del líquido pleural, cuando esté indicado, así como otras ayudas diagnósticas teniendo en cuenta la presentación clínica con énfasis en las condiciones comórbidas y las infecciones. De estas últimas, se destaca la tuberculosis y la neumonía, entidades bastante frecuentes en nuestro medio. El tratamiento va dirigido a la causa de base, aunque hasta en el 25 % de los pacientes no se identifica una causa evidente.

MT1-MMP deficiency leads to defective ependymal cell maturation, impaired ciliogenesis, and hydrocephalus.

Hydrocephalus is characterized by abnormal accumulation of cerebrospinal fluid (CSF) in the ventricular cavity. The circulation of CSF in brain ventricles is controlled by the coordinated beating of motile cilia at the surface of ependymal cells (ECs). Here, we show that MT1-MMP is highly expressed in olfactory bulb, rostral migratory stream, and the ventricular system. Mice deficient for membrane-type 1-MMP (MT1-MMP) developed typical phenotypes observed in hydrocephalus, such as dome-shaped skulls, dilated ventricles, corpus callosum agenesis, and astrocyte hypertrophy, during the first 2 weeks of postnatal development. MT1-MMP-deficient mice exhibited reduced and disorganized motile cilia with the impaired maturation of ECs, leading to abnormal CSF flow. Consistent with the defects in motile cilia morphogenesis, the expression of promulticiliogenic genes was significantly decreased, with a concomitant hyperactivation of Notch signaling in the walls of lateral ventricles in Mmp14-/- brains. Inhibition of Notch signaling by γ-secretase inhibitor restored ciliogenesis in Mmp14-/- ECs. Taken together, these data suggest that MT1-MMP is required for ciliogenesis and EC maturation through suppression of Notch signaling during early brain development. Our findings indicate that MT1-MMP is critical for early brain development and loss of MT1-MMP activity gives rise to hydrocephalus.

Parameter-robust multiphysics algorithms for Biot model with application in brain edema simulation

In this paper, we develop parameter-robust numerical algorithms for Biot model and apply the algorithms in brain edema simulations. By introducing an intermediate variable, we derive a multiphysics reformulation of the Biot model. Based on the reformulation, the Biot model is viewed as a generalized Stokes subproblem combining with a reaction–diffusion subproblem. Solving the two subproblems together or separately leads to a coupled or a decoupled algorithm. We conduct extensive numerical experiments to show that the two algorithms are robust with respect to the key physical parameters. The algorithms are applied to study the brain swelling caused by abnormal accumulation of cerebrospinal fluid in injured areas. The effects of the key physical parameters on brain swelling are carefully investigated. It is observed that the permeability has the biggest influence on intracranial pressure (ICP) and tissue deformation; the Young’s modulus and the Poisson ratio do not affect the maximum value of ICP too much but have big influence on the tissue deformation and the developing speed of brain swelling.

Malignant ascites drainage with indwelling abdominal catheters: can we predict and prevent infection complication?

Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity as a result of cancer. Its occurrence has been reported in numerous malignancies. Ascites is a sign of advanced disease and poor prognosis, with only 11% of patients surviving >6 months, except those with ovarian cancer. Patients with ascites experience numerous significant symptoms that deteriorate their quality of life. First-line interventions beyond treatment of the primary disease include dietary restriction, use of diuretics, and repeated paracentesis. Permanent insertion of catheters in the abdominal cavity is considered to avoid repeated paracenteses and multiple hospitalizations. Fluid drained from the peritoneal cavity can be directed evacuated outside the body, or directed to other body compartments. In the first case, evacuation of the ascitic fluid can be performed using percutaneous catheters inserted directly through the abdominal wall into the peritoneal cavity (e.g., peritoneal and venous catheters), or drains with a subcutaneous tunnel (e.g., PleurX, Tenckhoff, a peritoneal port) (1).

The use of octreotide in the treatment of chylothorax

Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space. Chylothorax is a rare case and generally occurs after thoracic and cardiac procedures. Chylothorax causes respiratory and nutritional problems and a significant mortality rate. Good knowledge of the underlying pathophysiology enables early diagnosis and prevention of the chronic complications related to immunodeficiency and malnutrition. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax. In gastrointestinal tract, somatostatin and octreotide act on somatostatin receptors to reduce intestinal blood flow by vasoconstriction of the splanchnic vessels; decrease gastrointestinal motility; and inhibit gastric, pancreatic, and biliary secretions, thus reducing intestinal fat absorption and lymphatic flow in the thoracic duct. Octreotide is generally considered to be safe, with only occasional side effects. The side effects of octreotide are mainly related to its vasoconstrictive and antisecretory actions. The general consensus is for conservative management with octreotide to be instituted for 1 week before consideration of surgery. In case of either high flow rate chylothorax, especially after oesophageal surgery, or failure of conservative treatment with octreotide, operation is indicated.