Effusion Ascites Research Articles

Sensitivity, specificity, negative and positive predictive values of adenosine deaminase in patients of tubercular and non-tubercular serosal effusion in India.

BackgroundIn India, tuberculosis is an endemic disease. Delay in diagnosis results in poor prognosis and fast spread of the disease. The objective of the present study is to look for an effective and acceptable diagnostic test, which may be helpful to initiate early treatment to improve prognosis and reduce spread.MethodsThree hundred and thirty patients with pleural, ascitic, meningeal and synovial effusion were selected and divided depending upon the etiology and the involvement of serosal membranes. Serosal aspirated fluid was subjected to biochemical tests and adenosine deaminase estimation. Cutoff taken is above 40 for pleural, peritoneal or synovial fluid and above 10 for CSF.ResultsIn cases of pulmonary and extra-pulmonary disease, sensitivity was 92.80% and 94.29%; specificity 90.00% and 92.16%; positive predictive value 92.86% and 89.00%; and negative predictive value 90.00% and 95.92% respectively.ConclusionsAdenosine deaminase estimation is not only a fairly sensitive and specific test (more than 90%), helpful in differentiating tubercular from non-tubercular etiology both in pulmonary and extra-pulmonary disease, but is also simple, inexpensive and rapid. For this reason this test may help in early diagnosis, improve the prognosis and reduce spread of disease and sequlae.KeywordsAdenosine deaminase; Serosal effusion; Tubercular; Non-tubercular; Pulmonary; Extra-pulmonary

Biliary Cyst (aka Choledochal Cyst): A Case Report of an Unusual Cause of End Stage Liver Disease in an 11-year old Female

Results: A previously healthy 11-year old female with a two year history of intermittent sharp epigastric pain was found to have malrotation on barium examination of the upper gastrointestinal tract. At the time of laparoscopic surgical repair, her liver was noted to be grossly cirrhotic. Post-operatively, she developed jaundice and pruritus. On exam, she was jaundiced and had splenomegaly. Her total bilirubin was 14.8 mg/dL, with a conjugated fraction of 6.6 mg/dL, ALT was 75 U/L, AST was 98 U/L, alkaline phosphatase was 590 U/L, albumin was 2.3 g/dL, and INR was 1.22. Evaluation for chronic liver diseases was performed and negative. White blood count was 5.3 k/uL, hemoglobin was 12.3 g/dL, and platelets were 85/uL. She developed ascites and a right-sided pleural effusion; cell count and culture were not suggestive of infection. Abdominal ultrasound demonstrated cirrhosis, splenomegaly, dilated extrahepatic biliary ducts, and portal hypertension. MRCP showed a grossly dilated extrahepatic biliary tree, as well as marked intrahepatic biliary dilation, compatible with a choledochal, or biliary cyst. ERCP was performed, showing a massively dilated biliary tree, with an aberrant low takeoff of the cystic duct and distal stenosis of the common bile duct. Two stents were placed with relief of her obstruction. Her ascitic pleural effusion and ankle edema were controlled with diuretic therapy. After the procedure, her bilirubin showed a downward trend, but she developed recurrent episodes of cholangitis. Repeat liver biopsy demonstrated cirrhosis, with proliferation of bile ducts and neutrophilic infiltration, consistent with biliary cyst and ascending cholangitis. Due to her recurrent symptoms and underlying cirrhosis, she underwent liver transplantation. Conclusion: Congential biliary cysts are irregular dilations of the bile ducts which are due to an abnormality in the ductal wall, possibly ductal stricture and thought to result from pancreaticobiliary malunion, which allows reflux of pancreatic juice into the bile duct, that can cause chemical and inflammatory changes in the duct wall, leading to weakness and dilation. To avoid the complications of these cysts, which include cholelithiasis, cholangitis, pancreatitis, intrahepatic abscess, biliary cirrhosis, portal hypertension and cancer, cysts should be excised surgically. This will involve bile duct resection with hepaticojejunostomy, as well as, partial hepatectomy in patients with intrahepatic involvement. In cases such as ours, with end stage liver disease, or those with Caroli disease, liver transplant is necessary.

Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer

Endoscopic ultrasound (EUS) is known to detect smaller effusion volumes than computerised tomography (CT), yet the outcomes for patients diagnosed with oesophageal carcinoma and EUS-defined pleural, pericardial or ascitic fluid effusions (EDFE) are unknown. The aim of this study was to determine the outcome of multidisciplinary stage directed treatment for such patients. Forty-nine (9.2%) out of a consecutive 527 patients diagnosed with oesophageal cancer from a single regional upper gastrointestinal (GI) cancer network were found to have evidence of EDFE undetected by CT. Thirty-nine (79.6%) patients had pleural effusions, eight (16.3%) pericardial effusions, and two (4.1%) ascites. Twelve (24.4%) underwent surgery, 3 (6.1%) received neoadjuvant chemotherapy without subsequent surgery, 12 (24.5%) received definitive chemoradiotherapy (dCRT), and 22 (44.9%) received palliative treatment. Survival in patients with EDFE was significantly shorter (median and 2-year survival 15.6 months and 24%, respectively) when compared with patients without EDFE (26.7 months and 40%, respectively, p = 0.001), and was unrelated to EDFE type (p = 0.192). Two-year survival after oesophagectomy with or without neoadjuvant therapy was 45% in patients with EDFE compared with 42% in patients without EDFE (p = 0.668). EDFE was an important adverse prognostic indicator, but patients deemed to have operable tumours should still be treated with radical intent.

Dostinex use for OHSS prevention does not affect IVF success

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life-threatening complication of gonadotropin therapy. The etiology of OHSS has been linked with over expression of vascular endothelial growth factor (VEGF) and its receptor 2 (VEGFR2). VEGF is presumably the cytokine responsible for the increased microvascular permeability leading to ascitic, pleural and pericardial effusions. It also enhances angiogenesis, which is a fundamental step in implantation. In humans, Dostinex (cabergoline) appears to ameliorates OHSS, but may have a negative effect on angiogenesis and implantation.

Striking response with bevacizumab and chemotherapy in a woman with heavily pretreated breast cancer: a case presentation

In pretreated breast cancer, encouraging therapy responses are regularly achieved by applying innovative therapies. We present here a case report of a woman with a 10-year history of breast cancer with continuous progression despite multiple therapies. Ultimately, ascitic effusion developed, massively disturbing her quality of life. A combination of bevacizumab and mitoxantrone/methotrexate chemotherapy led to a striking, response on liver metastasis and effusion generation, with great clinical benefit. Our case highlights previous observations that bevacizumab is beneficial in inhibiting the production of malignant effusion.

Hydrops fetal no inmune

Non-immune hydrops fetalis (NIHF) is characterized by abnormal accumulation of serous fluid in the skin (edema) and body cavities (pericardial, pleural or ascitic effusions), without evidence of circulating antibodies against red blood cell antigens. This entity is caused by a heterogeneous group of disorders, including cardiovascular, gastrointestinal, pulmonary, chromosomal, hematological and infectious diseases. NIHF is an important cause of perinatal loss, with mortality ranging from 50% to 98%, depending on the etiology.

Massive postoperative ascites following pancreatic cysts fenestration in a patient with von Hippel-Lindau disease

Pancreatic lesions in von Hippel Lindau disease (VHLD) are frequent and mainly consist of cystic lesions, which should not be resected because of their benign evolution. Solid lesions, mostly pancreatic endocrine tumors (PET), are rare and usually occur in combination with cystic lesions. We report a case of a patient with VHLD who underwent PET enucleation in a polycystic pancreas requiring fenestration of multiple adjacent cysts, to ensure complete resection with free resection margins. The postoperative course was complicated by massive ascitic fluid effusion, probably related to pancreatic-cyst fenestration. Although this complication is well-known after liver-cyst fenestration, it has not been reported after pancreatic-cyst fenestration. This observation emphasizes that morbidity from surrounding pancreatic polycystic disease should not be underestimated in pancreatic surgery for VHLD.

Simultaneous analysis of HER-2/neu gene amplification and protein overexpression in single cells of pleural and ascitic effusions from patients with breast and ovarian cancer

Simultaneous analysis of HER-2/neu gene amplification and protein overexpression in single cells of pleural and ascitic effusions from patients with breast and ovarian cancer

Demons-Meigs syndrome. Report of 2 cases and review of the literature

The authors report a case of Demons-Meigs syndrome associated in two women. This syndrome associates ascitic effusion, pleural effusion and benign ovarian fibrothecoma. The evolution is favourable after total excision of the tumor. The authors underline the clinical, therapeutic and pronosis features of the syndrome.

Complications and Benefits from Drainage of Massive Pleural Effusions

In their contribution to Images in Emergency Medicine in the October 2006 issue of Annals of Emergency Medicine, Platts-Mills and Burg nicely illustrate reexpansion pulmonary edema as one of the possible complications of rapid drainage of a large pleural effusion.1Platts-Mills T.F. Burg M.D. Reexpansion pulmonary edema.Ann Emerg Med. 2006; 48: 475Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar A second lesser known but actually more severe complication of tube thoracostomy can occur if severe hypoalbuminemia exists; a rapid fluid shift depletes intravascular volume leading to cardiovascular collapse.2Kinaswetz G.T. Keddiss J.I. Hepatic hydrothorax.Curr Opin Pulm Med. 2003; 9: 261-265Crossref PubMed Scopus (56) Google Scholar Occurring particularly in cirrhotic patients with transudative ascitic effusions, known as hepatic hydrothorax, the negative intrathoracic pressure promotes ongoing leakage of plasma and proteins into the pleural space. As the thoracostomy tube continues to drain uncontrolled, the patient’s plasma is siphoned off leading quickly to hypovolemia and shock.3Garcia N. Mihas A.A. Hepatic hydrothorax: pathophysiology, diagnosis, and management.J Clin Gastroenterol. 2004; 38: 52-58Crossref PubMed Scopus (58) Google Scholar It is similar to the hypotension that may occur after large volume paracentesis, except occurring at smaller volumes due to the much more rapid fluid shift from the leakage of capillaries and lymphatics (intra-abdominal pressure is positive while intra-pleural pressure is negative, encouraging further plasma outflow). A hepatic hydrothorax should be managed primarily by aggressive medical management, including sodium restriction and diuretics, but if respiratory distress necessitates thorascentesis, no more than 1.5 L should be removed acutely.2Kinaswetz G.T. Keddiss J.I. Hepatic hydrothorax.Curr Opin Pulm Med. 2003; 9: 261-265Crossref PubMed Scopus (56) Google Scholar, 3Garcia N. Mihas A.A. Hepatic hydrothorax: pathophysiology, diagnosis, and management.J Clin Gastroenterol. 2004; 38: 52-58Crossref PubMed Scopus (58) Google Scholar There are other times when rapid drainage of a massive pleural effusion may be the definitive life-saving therapy. A massive fluid collection under pressure can compress and shift the mediastinum, giving the same clinical picture of a tension pneumothorax: tachycardia, tachypnea, arterial hypotension with jugular venous distension possibly leading to cardiopulmonary arrest.4Pifarre R. Martinez C. Rosell A. Shock and cardiorespiratory arrest secondary to massive pleural effusion.Archivos de Bronconeumologia. 1997; 33: 594-595PubMed Google Scholar Immediate relief of symptoms occurs with rapid pleural drainage reducing the compression of the superior vena cava and pericardium, thereby allowing normal venous return and ventricular filling. This disorder is known to occur after thoracic surgery or trauma if the thoracic duct is disrupted, allowing lymph to rapidly fill the pleural space, and is known as tension chylothorax. The fluid will often have a cloudy, milky appearance consistent with chyle, but it may also be straw-colored and resemble a typical serous effusion.5Karwande S.V. Wolcott M.W. Gay W.A. Postpneumonectomy tension chylothorax.Ann Thorac Surg. 1986; 42: 585-586Abstract Full Text PDF PubMed Scopus (15) Google Scholar, 6Glyn-Jones S. Flynn J. Traumatic tension chylothorax.Injury, Int. J care Injured. 2000; 31: 549-550Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In replyAnnals of Emergency MedicineVol. 49Issue 4PreviewWe thank Dr. Shiber for explaining the risks inherent in hepatic hydrothorax evacuation and for elucidating how tension chylothorax occurs following trauma or thoracic surgery. Full-Text PDF

Cancer immunotherapy using dendritic/tumour-fusion vaccine induces elevation of serum anti-nuclear antibody with better clinical responses

Dendritic cell (DC) vaccines might induce both anti-tumour immunity and autoimmunity. In this report, we demonstrate elevated levels of anti-nuclear antibody (ANA) in the sera of patients with cancer who had received immunotherapy with a dendritic/tumour-fusion vaccine. Twenty-two patients were treated with DC vaccine of fusion cells composed of autologous DCs and tumour cells (DC/tumour-fusion vaccine), which was generated by treating each cell type with polyethylene glycol. Nine of the 22 patients were treated with both the DC/tumour-fusion vaccine and systemic administration of recombinant human interleukin (rhIL)-12. Serum levels of ANA were examined with an enzyme-linked immunosorbent assay kit. One patient with gastric carcinoma (patient 1, DC/tumour-fusion vaccine alone), one patient with breast cancer (patient 2, DC/tumour-fusion vaccine alone) and one patient with ovarian cancer (patient 3, DC/tumour-fusion vaccine + rhIL-12) showed significant elevations of serum ANA levels during treatment. In patient 1 malignant ascitic effusion resolved and serum levels of tumour markers decreased. Patients 2 and 3 remained in good physical condition during treatment for 24 and 9 months, respectively. Immunoblot analysis indicated antibody responses to autologous tumour cells after vaccination in patient 2. None of the treated patients showed clinical symptoms suggesting autoimmune disease. Patients with elevated serum levels of ANA had significantly longer treatment periods than those without it. Elevated serum levels of ANA after DC/tumour-fusion cell vaccine might be associated with anti-tumour immune response induced by the vaccination.

Struma ovarii: a rare form of presentation and clinical review

Struma ovarii: a rare form of presentation and clinical review

Fibrome de l’ovaire associé à un syndrome de Demons-Meigs et à une élévation du CA 125

We report a rare case of ovarian fibroma in a young woman. When ovarian masse is associated with Meigs' syndrome and elevated CA 125 serum level a malignant process may be suspected. But a negative cytological examination of ascitic effusion and absence of peritoneal implant recommend performing limited surgical procedures.

Elevated levels of angiostatin in effusions from patients with malignant disease

The aim of this study was to determine the presence of angiostatin in ascitic and pleural effusions from cancer patients, as well as of metalloproteinases (MMPs) and urokinase-type plasminogen activator (uPA), both involved in angiostatin generation in in vitro models. Ascitic fluids, pleural exudates, and sera from 21 cancer patients were analyzed for the presence of angiostatin by western blot, whereas gelatinases MMP-2 and MMP-9, and uPA were evaluated by zymography. Our study revealed elevated levels of angiostatin in effusions of cancer patients, contrasting with mostly intermediate levels in less than half of their sera, and undetectable levels in normal sera. Despite the observation of enhanced levels of HMW-uPA and MMP-2 in malignant effusions from cancer patients, their analysis in individual samples showed no association between angiostatin presence and the enzymes, suggesting that the latter would not play an unimportant role, if any, in in vivo generation of angiostatin.

Chylous Ascites and Pleural Effusion Secondary to Constrictive Pericarditis Presenting With Signs of Lymphatic Obstruction

Chylous ascites is a clinical entity characterized by accumulation of milky fluid containing high amounts of triglycerides in the peritoneal cavity. The cause is usually lymphatic obstruction secondary to neoplastic processes. Constrictive pericarditis rarely causes cylous ascites through elevated venous pressure and lymphatic stasis. To the best of our knowledge, there is no report of constrictive pericarditis leading to chylous ascites in a patient presenting with objective lymphangiographic findings of lymphatic obstruction rather than stasis. We present a case of chylous ascites and pleural effusion secondary to constrictive pericarditis presenting with signs of lymphatic obstruction in lymphangio-graphy, in whom complete clinical and laboratory improvement was achieved after pericardiectomy.

Amplification of the pericentromeric region of chromosome 1 in a newly established colon carcinoma cell line

The LRWZ cell line was established from an ascitic effusion of a colon adenocarcinoma. We studied the karyotype of LRWZ cells using G-banding and chromosome painting. The cell line is near triploid and is characterized by several chromosome rearrangements and pronounced intermetaphase variation. Chromosome painting probes revealed numerous labeled regions on different chromosomes, indicating that several translocations occurred during the evolution of the cell population. The 10 recurrent marker chromosomes identified (M1–M10) were derived from complex rearrangements involving up to three different chromosomes. M2 is a particularly interesting marker that originated from the amplification of the pericentromeric region of chromosome 1 and has a peculiar organization comprising five copies of the region included between 1p21 and 1q21 and is surprisingly stable: it is present in all the metaphases analyzed, has telomeric DNA at both termini, and contains one active and four inactivated centromeres. To provide insights into the molecular mechanisms that generated M2, we performed fluorescence in situ hybridization experiments using a panel of probes mapping near the centromere of chromosome 1 and three probes for different satellite sequences; the formation of chromosome M2 required the intervention of several rearrangements including unequal exchange, chromatid breakage followed by fusion of the sister chromatids, and loss of centromeric heterochromatin.

Establishment of a new scirrhous gastric cancer cell line with loss of heterozygosity at E-cadherin locus.

Scirrhous gastric carcinoma, characterized by carcinoma cell proliferation and infiltration with extensive fibrosis in the stroma, frequently causes peritoneal metastasis. We describe here a newly established cell line, OCUM-6, derived from ascites effusion of a scirrhous gastric cancer patient. The cells are floating and round shape, similar to other scirrhous gastric carcinoma cell lines previously reported. Histologic findings of xenografted tumor obtained from OCUM-6 cells showed medullary growth with a poorly differentiated adenocarcinoma containing signet ring cells. LOH at E-cadherin locus 16q22 was observed in the OCUM-6 cells. LOH at E-cadherin locus might be closely associated with histologic findings and metastatic process of scirrhous gastric cancer. The scirrhous gastric cancer cell line, OCUM-6, may be useful for investigation of the mechanisms of peritoneal dissemination and carcinogenesis.

Endoscopic ultrasonography in portal hypertension

In the evaluation of patients suffering from portal hypertension, a knowledge of morphofunctional characteristics of the portal tree and of the shunts with the systemic circulation is fundamental. To the methods traditionally used for this purpose such as endoscopy, transabdominal sonography, angiography, magnetic resonance, and computed tomography, endosonography has been recently added as a minimally invasive and sensitive technique. By endosonography, it is possible to visualize portal branches, esophageal-gastric and rectal varices, collateral extraparietal veins, and small ascitic effusions that other diagnostic methods may miss.

Diagnostic accuracy of effusion cytology.

The aim of this investigation was to report on the diagnostic accuracy of conventional effusion cytology. Cytological diagnoses of 300 pleural effusions and 300 ascites were compared with clinical and/or histological follow-ups of the respective patients. Sensitivity of our cytological diagnoses on pleural effusions was 50.0%, specificity 97.0%, positive predictive value 95.7%, and negative predictive value 86.4%. Sensitivity in ascitic effusions was 62.4%, specificity 98.0%, positive predictive value 100.0%, and negative predictive value 88.3%; 5.8% of diagnoses for pleural and 4.4% for peritoneal effusions were suspicious or doubtful. The overall false-positive rate was 0.5%, while the false-negative rate was 31.5%. False-negative results were due to sampling errors in 71% of pleural and 73% of peritoneal effusions and to screening errors in 29% and 27%, respectively. Our data and those from the literature show that diagnostic accuracy of effusion cytology is still unsatisfactory and should be improved. Therefore, the use of different adjuvant methods is recommended.

Hyperdiploidy and apparent aneusomy in mesothelial cells from non-malignant effusions as detected by fluorescence in situ hybridization (FISH).

Interphase cytogenetics by fluorescence in situ hybridization (FISH) can be used to detect malignant cells characterized by chromosomal aneuploidy. However, apparent aneusomy in normal "control" tissues has to be considered when using FISH as diagnostic tool. In effusions as model tissue exposed to metastasis, the definition of cut-off levels for background aneusomy by FISH was aimed in this study. Using centromeric probes representing chromosomes 7, 8, 11, 12, 17 and 18, extensive chromosome copy number enumeration by single-color FISH analysis was performed in pleural and ascitic effusions derived from 15 patients with various, non-malignant diseases. In all effusions, cells with gain of hybridization signals for several or all chromosomes tested were found (in up to 1.94% of cells). A consistent finding was high grade hyperdiploidy (>4 centromeric signals). Mesothelial elements mainly contributed to hyperdiploidy in effusions, as demonstrated by a combined analysis of FISH and immunocytochemistry with staining for cytokeratin. Dual-color FISH analysis showed that hyperdiploidy was predominantly corresponding to polyploidization; however, there were always minor cell populations classified as aneuploid by dual-color FISH. In conclusion, stringent criteria have to be applied to distinguish malignancy-related aneuploidy from background aneusomy by FISH.