Effects Of Paracentesis Research Articles

FACTORS INCREASING INTRA-ABDOMINAL PRESSURE IN PATIENTS WITH A COMPLICATED COURSE OF ACUTE PANCREATITIS

Relevance. The frequency of development of intra-abdominal hypertension in patients with a complicated course of acute pancreatitis is 60-70% and leads to an increase in the mortality rate up to 62%. Acute peripancreatic fluid collection, occurring in 65.2-88.9% of patients with moderate and severe acute pancreatitis in the early period of the disease, is one of the causes of increased intra-abdominal pressure.
 Objective: to assess the effect of acute peripancreatic fluid collection on intra-abdominal pressure and the effectiveness of paracentesis with drainage of the abdominal cavity as a method of treatment of intra-abdominal hypertension in patients with complicated course of acute pancreatitis in the early period of the disease.
 Methods. The study included 60 patients with a complicated course of acute pancreatitis, who were divided into two groups depending on the features of the selected treatment tactics: the main group (paracentesis, drainage of the abdominal cavity was additionally performed) – 30 patients, the comparison group (conservative therapy was applied) - 30 patients. Intra-abdominal pressure indicators were compared in the studied groups and performed a comparative analysis of the dependence of its changes on the amount of exudate removed from the abdominal cavity.
 Results. When using paracentesis and drainage of the abdominal cavity in the early period in patients with a complicated course of acute pancreatitis, a significant difference was obtained between the intra-abdominal pressure indicators in the studied groups after one day (8.7±1.5 vs. 14.7±3.3 mm Hg (p<0.0001)) and after 7 days (10.5±1.3 vs. 12.7±2.5 mm Hg (p=0.0001)). In the patients of the main group, a decrease in intra-abdominal pressure was observed on the first day after paracentesis, followed by an increase after three days and stabilization after 6 days, and an average negative correlation was found between the amount of exudate removed from the abdominal cavity and changes in intra-abdominal pressure with the Pearson coefficient r = - 0.4418.
 Conclusions. The use of paracentesis, drainage of the abdominal cavity in patients with complicated course of acute pancreatitis in the early period of the disease can be considered as a safe and effective method of treatment of intra-abdominal hypertension in this category of patients.

Effect of paracentesis on the survival of patients with terminal cancer and ascites: a propensity score-weighted analysis of the East Asian Collaborative Cross-cultural Study to Elucidate the Dying Process.

Paracentesis is among the most widely utilized treatments for malignant ascites (MA). However, paracentesis in patients with MA has the potential to be associated with life-shortening effects. Thus, this study aimed to investigate whether paracentesis affected the duration of survival in such patients. We performed a post hoc analysis of a prospective multicenter observational study investigating the dying process and end-of-life care in patients with terminal cancer, admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used inverse probability of treatment weighting (IPTW) to control for baseline covariates between groups. Among the 1896 initially enrolled patients, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The primary tumor site was the pancreas (51.9%, n = 295), followed by the gastrointestinal tract (22.7%, n = 129). Non-adjusted median durations of survival were 22days (95% confidence interval [CI]: 16-25) and 12days (95% CI: 11-13) in the paracentesis and non-paracentesis groups, respectively (hazard ratio [HR]: 0.69, 95% CI: 0.54-0.88; p = 0.003). The IPTW-adjusted median survival durations were 22 (95% CI: 16-25) and 16days (95% CI: 12-22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64-1.24; p = 0.492). No serious adverse events occurred in the paracentesis group. Paracentesis does not negatively affect the survival of patients with cancer and MA and can be a standard treatment in palliative care settings.

Effect of Paracentesis on the Survival of Patients with Terminal Cancer and Ascites: A Propensity Score-Weighted Analysis of the East-Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process

Effect of Paracentesis on the Survival of Patients with Terminal Cancer and Ascites: A Propensity Score-Weighted Analysis of the East-Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process

Effect of paracentesis on the survival of patients with terminal cancer and ascites: A propensity score-weighted analysis of the EASED study.

e24063 Background: Malignant ascites (MA) is associated with progressive deterioration in quality of life and poor prognosis of patients with cancer. Paracentesis is among the most widely utilised treatments for MA. However, reports on the usefulness of paracentesis in patients with MA are limited. Thus, this study aimed to investigate whether paracentesis affects the duration of survival in such patients. Methods: We performed a post - hoc analysis of a prospective multicentre observational study that investigated the dying process and end-of-life care in patients with terminal cancer, who were admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used the inverse probability of treatment weighting (IPTW) method to control for baseline covariates between the two groups. Furthermore, subgroup analyses were performed to investigate the IPTW-adjusted hazard ratio (HR) of the paracentesis and non-paracentesis groups according to some of the baseline covariates, including age, sex, Karnofsky Performance Status, primary tumor site, liver dysfunction, and renal dysfunction. Results: Among the 1,896 patients, who were initially enrolled, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The most common primary tumour site was the gastrointestinal tract (51.9%, n = 295), followed by the pancreas (22.7%, n = 129). The non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16–25) and 12 days (95% CI: 11–13) in the paracentesis and non-paracentesis groups, respectively (HR: 0.69, [95% CI: 0.54–0.88]; p = 0.003). The IPTW-adjusted median durations of survival were 22 days (95% CI: 16–25) and 16 days (95% CI: 12–22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64–1.24; p = 0.492). There were no serious adverse events in the paracentesis group. According to the baseline covariates, a weighted subgroup analysis was performed to compare the survival of patients in the non-paracentesis and paracentesis groups. There was no significant heterogeneity across all subgroups. Paracentesis was not associated with a significant survival risk in any of the subgroups. Conclusions: Paracentesis does not negatively affect the survival of patients with cancer and MA; hence, it can be used as a standard treatment in palliative care settings.

Effect of paracentesis on metabolic activity in patients with advanced cirrhosis and ascites

ABSTRACTObjective Patients with decompensated cirrhosis often suffer from malnutrition. To enable appropriate nutritional supplementation a correct estimation of resting energy expenditure (REE) is needed. It is, however, unclear whether the volume of ascites should be included or not in the calculations of the REE. Material and methods In 19 patients with cirrhosis and ascites, measurements of REE by indirect calorimetry were performed before paracentesis, after paracentesis, and four weeks after paracentesis. Moreover, handgrip strength (HGS), dual X-ray absorptiometry (DXA), and biochemistry were assessed. Results Calculated and measured REE differed more than 10% in 63% of the patients at baseline. By including the weight of ascites in the calculation of REE, the REE was overestimated by 283 (−602–1381) kJ/day (p = 0.69). By subtracting the weight of ascites in the calculation of REE, it was underestimated by −379 (−1915 − 219) kJ/day, (p = 0.06). Patients in whom measured REE decreased after paracentesis had higher middle arterial pressure (MAP) (p = 0.02) and p-sodium (p = 0.02) at baseline. Low HGS (M: <30 kg; W < 20 kg) was evident in 68% of the patients. T-scores revealed osteopenia and osteoporosis in 58% and 16%, respectively. Reduced vitamin D levels (<50 nmol/l) were found in 68%. Conclusions The presence of ascites seems to increase REE, why we suggest that when REE is calculated, the weight of ascites should be included. Indirect calorimetry is, however, preferable for REE estimation. More than two-third of patients with ascites suffer from muscle weakness and/or osteopenia.

Randomized trial comparing human albumin and hydroxyethyl starch 6% as plasma expanders for treatment of patients with liver cirrhosis and tense ascites following large volume paracentesis

Background and study aims Cirrhosis is the commonest cause of ascites accounting for almost 85% of all cases. Approximately 10% of patients with cirrhosis develop diuretic-resistant tense ascites that requires other therapeutic interventions. Large-volume paracentesis with plasma expander infusion, mainly albumin, has been used for the management of ascites in cirrhotic patients. We aimed at investigating whether human albumin can be substituted by a less expensive plasma expander, hydroxyethyl starch 6% following paracentesis. Patients and methods One-hundred and thirty-five patients (60% with cirrhosis and schistosomal periportal fibrosis combined, 26.7% with posthepatitic cirrhosis and 13.3% with schistosomal periportal fibrosis) with tense ascites were randomized to treatment by one-session of a nearly-total paracentesis plus intravenous human albumin (68 patients) or hydroxyethyl starch 6% (67 patients). These were given at a dose of 8 g/l of ascitic fluid removed. The two groups were compared for incidence of complications, recurrence of massive ascites after hospital dismissal and survival rate. Results Both groups showed no significant changes in renal or hepatic function or serum electrolytes. The incidence of complications following paracentesis was similar in both groups. The number of readmissions during follow up and causes of readmission and survival were also comparable. The effect of paracentesis on the effective intravascular volume was indirectly assessed by plasma renin activity and plasma aldosterone concentration before treatment, 2 and 6 days after treatment. None of the mean values of these changed significantly in the two groups after paracentesis. Postparacentesis transient hypotension was observed more in the hydroxyethyl starch 6% group than in those treated with albumin (23.9% versus 8.8%, p = 0.018). Conclusions Hydroxyethyl starch 6% is safe and as effective as human albumin in protecting patients treated with nearly-total paracentesis from developing renal and electrolyte complications. Transient hypotension following paracentesis was, however, commoner in the hydroxyethyl starch group.

The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome

To compare and contrast the pathophysiology of ovarian hyperstimualtion syndrome (OHSS) with known syndromes of increased intraabdominal pressure (IAP), and to explore the relationship of increased IAP with symptom severity in OHSS. Literature review. Correlation of OHSS symptoms with IAP; effects of paracentesis on IAP in patients with OHSS. Academic Research Institution. None. OHSS involves a rapid accumulation of volume (from 1.5-17 liters) in the peritoneal cavity that can lead to organ dysfunction, including respiratory impairment and oliguria. In published reports of 20 moderate-to-severe OHSS patients in whom IAP was measured, IAP was found to be elevated to a pathologic range. The increased IAP indicates that OHSS may be considered a compartment syndrome and meets criteria for abdominal compartment syndrome in advanced cases. For this reason, management of OHSS should include reduction of pressure by paracentesis to avoid morbidity and syndrome progression. In addition, measurement of IAP may help to classify the stage of OHSS. IAP was found to be elevated in the few cases of OHSS in which it was measured, substantiating the conclusion that OHSS may be considered a compartment syndrome. An understanding of the pathophysiology of increased intrabdominal pressure is useful in the management of OHSS.

Anterior chamber paracentesis in patients with acute elevation of intraocular pressure

Dear Editors, We read with interest on your article by Arnavielle et al. [1] on the potential benefits of anterior chamber (AC) paracentesis in patients with acute angle-closure glaucoma. Lam et al. [2, 3] first proposed this technique in treating patients with acute angle-closure glaucoma. His pilot study recruited ten eyes in eight patients, and IOP was maintained at normal range 2 hours after paracentesis. The effect of paracentesis was found to be temporary, with subsequent rise of IOP at 30 minutes, and therefore medications were still needed for breaking the pupil block and to substantiate the IOP-lowering effects. However in your study, IOP was only measured at 10 minutes, 1 day, 7 days, 30 days and 1 year after the paracentesis. In addition, most of your cases received additional surgical interventions such as laser iridotomy and cataract extraction subsequently. Hence, we believed that your study only reflected the overall management of the cases, and the IOP measurements had little relevance on the true effect of the AC paracentesis. The potential long-term complications could be increased risks of peripheral anterior synechiae, and further loss of endothelial cells counts caused by the shallow anterior chamber from the paracentesis. It would be useful to know the angle status in long term in such cases with AC paracentesis performed compared to those without. However, your study did not provide information in this regard. We believe a prospective randomized controlled trial with larger sample size, post-operative gonioscopic findings and endothelial counts in the long term is necessary. The pathogenesis of secondary angle-closure glaucoma is widely varied and they are notoriously difficult in management. Inclusions of secondary angle-closure glaucoma in your study could confound the results, and have to be interpreted with caution. In fact, AC paracentesis was not found to be useful in secondary angle-closure cases in your study. With paracentesis, additional risks of hyphema from neovascular irides and even tumour seeding (in the case of choroidal melanoma) could occur if not managed correctly. We therefore do not recommend AC paracentesis in cases with secondary angle-closure glaucoma. From the limited studies in the literature, AC paracentesis provides a methodology which is quick and effective in lowering IOP in the immediate stage of acute angle-closure glaucoma, and the effect seems to be maintained with the help of the topical and oral glaucoma medications. The complications reported so far in the limited literature are trivial. However, it is important to note that AC paracentesis is not a treatment that alleviates the true cause of the acute angle closure, which is mainly because of pupillary block with increased posterior chamber pressure. The possible side effects of ocular tissue injury, decompression retinopathy [4], suprachoroidal haemorrhage, aqueous misdirection and infection could be drastic and equally vision-threatening. Long-term risks of peripheral anterior synechiae and corneal endothelial cell loss are also not clear. We believe that it has a place in cases where IOP control is not readily effective or contraindicated due to systemic diseases, or in situations where laser such as ALPI or PI is not readily available or not possible to perform due to corneal oedema, AC paracentesis can be a treatment of choice [2, 3]. Graefes Arch Clin Exp Ophthalmol (2008) 246:463–464 DOI 10.1007/s00417-007-0675-5

Nutritional problems in end-stage liver disease: contribution of impaired gastric emptying and ascites.

To evaluate gastric emptying before and after paracentesis in patients with cirrhosis. Patients with ascites often report early satiety. The effect of paracentesis on gastric emptying has not been studied previously. Twelve patients who required therapeutic paracentesis were studied (mean age, 57 years; range, 47-69 years). Gastric emptying was performed with radionuclide scintigraphy. Satiety was evaluated with a visual analogue scale. Wilcoxon signed-rank tests were used for comparison between pre-and poststudies. The causes of cirrhosis included alcohol (seven patients), a combination of alcohol and hepatitis C (two), chronic hepatitis C only (one), primary biliary cirrhosis (one), and cryptogenic (one). The median volume of ascitic fluid removed at paracentesis was 5,450 mL (range, 2,500-7,200 mL). Median 2-hour gastric emptying was 65.5% before paracentesis and 61.5% after ( p > 0.05). Median 4-hour gastric emptying was 92.5% before paracentesis and 96.5% after ( p > 0.05). Both satiety score and caloric intake were significantly improved after paracentesis ( p < 0.05). Although satiety and calorie intake improve after large-volume paracentesis in patients with cirrhosis, these changes do not seem to correspond with improved gastric emptying. Therefore, other mechanisms most likely contribute to satiety.

Nutritional problems in end-stage liver disease: Contribution of impaired gastric emptying and ascites

Goals: To evaluate gastric emptying before and after paracentesis in patients with cirrhosis. Background: Patients with ascites often report early satiety. The effect of paracentesis on gastric emptying has not been studied previously. Study: Twelve patients who required therapeutic paracentesis were studied (mean age, 57 years; range, 47-69 years). Gastric emptying was performed with radionuclide scintigraphy. Satiety was evaluated with a visual analogue scale. Wilcoxon signed-rank tests were used for comparison between pre- and poststudies. Results: The causes of cirrhosis included alcohol (seven patients), a combination of alcohol and hepatitis C (two), chronic hepatitis C only (one), primary biliary cirrhosis (one), and cryptogenic (one). The median volume of ascitic fluid removed at paracentesis was 5,450 mL (range. 2,500-7,200 mL). Median 2-hour gastric emptying was 65.5% before paracentesis and 61.5% after (p > 0.05). Median 4-hour gastric emptying was 92.5% before paracentesis and 96.5% alter (p > 0.05). Both satiety score and caloric intake were significantly improved after paracentesis (p < 0.05). Conclusions: Although satiety and calorie intake improve after large-volume paracentesis in patients with cirrhosis, these changes do not seem to correspond with improved gastric emptying. Therefore, other mechanisms most likely contribute to satiety.

Treatment of ascites with A single total paracentesis

Repeated large-volume paracentesis (4–6 L/day) is an effective and safe therapy of ascites in patients with cirrhosis provided albumin is infused intravenously. To investigate whether ascites can be safely mobilized in only one paracentesis session (“total paracentesis”), 38 cirrhotic patients with tense ascites were treated with total paracentesis plus intravenous albumin (6–8 g/L ascites removed). Standard liver tests and renal function tests, glomerular filtration, free water clearance, plasma volume, plasma renin activity or plasma aldosterone and norepinephrine concentrations were measured before and after treatment. Total paracentesis was effective in mobilizing ascites in all but one patient and did not impair any of the parameters studied. The volume of ascitic fluid removed and the duration of the procedure was 10.7 + 0.5 L (mean + SEM) and 60 + 3 min, respectively. Five of the 38 patients (13%) developed complications during the first hospital stay (hepatic encephalopathy and gastrointestinal hemorrhage in 2 patients each and culture-negative bacterial peritonitis in 1). No patient developed renal impairment. The complication rate, as well as the clinical course of the disease during follow-up, estimated by the probability of readmission to hospital, causes of readmission and survival probability after treatment, was similar to that reported in patients treated with repeated large-volume paracentesis. These results indicate that total paracentesis associated with intravenous albumin can be safely performed in cirrhotic patients with tense ascites and suggest that these patients could be treated in a single-day hospitalization regime. To investigate whether albumin can be substituted by less expensive plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis, 88 patients (16 with renal failure) submitted to this therapeutic procedure were randomly assigned to receive IV albumin (43 patients) or dextran-70. Both substances were given at a dose of 8 g/L of ascitic fluid removed. Patients were discharged from the hospital with diuretics, and cases developing tense ascites during follow-up were treated according to their initial schedule. Total paracentesis was effective in eliminating the ascites in all but two cases in each group. Neither paracentesis plus IV albumin infusion nor paracentesis plus IV dextran-70 infusion was associated with significant changes in renal and hepatic function or serum electrolytes. The incidence of renal impairment (one case in each group), hyponatremia (three and four cases, respectively), and other complications (hepatic encephalopathy, gastrointestinal hemorrhage, bacterial infections) after paracentesis, and the clinical course of the disease, as estimated by the probability of readmission to hospital during follow-up, causes of readmission, probability of survival, and causes of death were similar in the two groups of patients. The effect of paracentesis on effective intravascular volume was indirectly assessed by measuring plasma renin activity and aldosterone concentration before and 2 and 6 days after treatment, the patients being without diuretics. In patients treated with albumin, no significant changes in renin and aldosterone were observed during the entire period of observation. In contrast, both parameters increased significantly on the 6th day of treatment in patients receiving dextran-70. A significant increase in plasma renin activity and aldosterone concentration (30% over baseline values) was observed in 51% of patients treated with dextran-70 and in only 15% of patients treated with albumin (x 2 = 10.4; p = 0.0012). These results indicate that although dextran-70 is less efficacious than albumin in protecting cirrhotic patients treated with total paracentesis from the decrease in effective intravascular volume, it appears to be capable of preventing the renal and electrolyte complications induced by this therapeutic procedure.

Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis: Results of a randomized study

To investigate whether albumin can be substituted by less expensive plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis, 88 patients (16 with renal failure) submitted to this therapeutic procedure were randomly assigned to receive IV albumin (43 patients) or dextran-70. Both substances were given at a dose of 8 g/L of ascitic fluid removed. Patients were discharged from the hospital with diuretics, and cases developing tense ascites during follow-up were treated according to their initial schedule. Total paracentesis was effective in eliminating the ascites in all but two cases in each group. Neither paracentesis plus IV albumin infusion nor paracentesis plus IV dextran-70 infusion was associated with significant changes in renal and hepatic function or serum electrolytes. The incidence of renal impairment (one case in each group), hyponatremia (three and four cases, respectively), and other complications (hepatic encephalopathy, gastrointestinal hemorrhage, bacterial infections) after paracentesis, and the clinical course of the disease as estimated by the probability of readmission to hospital during follow-up, causes of readmission, probability of survival, and causes of death were similar in the two groups of patients. The effect of paracentesis on effective intravascular volume was indirectly assessed by measuring plasma renin activity and aldosterone concentration before and 2 and 6 days after treatment, the patients being without diuretics. In patients treated with albumin, no significant changes in renin and aldosterone were observed during the entire period of observation. In contrast, both parameters increased significantly on the 6th day of treatment in patients receiving dextran70. A significant increase in plasma renin activity and aldosterone concentration (30% over baseline values) was observed in 51% of patients treated with dextran-70 and in only 15% of those treated with albumin (× 2 = 10.4; P = 0.0012). These results indicate that although dextran-70 is less efficacious than albumin in protecting cirrhotic patients treated with total paracentesis from the decrease in effective intravascular volume, it appears to be capable of preventing the renal and electrolyte complications induced by this therapeutic procedure.

Effect of paracentesis on ocular cloxacillin concentration.

The effect of anterior chamber puncture on cloxacillin concentration in the rabbit eye after intravenous injection was studied using a radioactive tracer method. The enhancement in drug concentration caused by paracentesis was most immediate and significant in the iris-ciliary body preparation. It was soon followed by high cloxacillin concentration in the aqueous humour, which contributed to elevated cloxacillin levels in the cornea, lens and anterior vitreous body, when compared to normal material. Contrary to normal eyes, cloxacillin concentration in the cornea of the punctured eyes was higher than in the limbal area. The morphological changes occurring after paracentesis are discussed. The breakdown of the hydrodynamic equilibrium in the eye, suggested as the only change after paracentesis by Raviola (1974), cannot merely explain the cloxacillin concentration changes measured in the punctured eye.

Inhibition of increased permeability of the blood-aqueous barrier by non-steroidal anti-inflammatory compounds as demonstrated by fluorescein angiography

Inhibitory effects of non-steroidal anti-inflammatory compounds such as indomethacin, indoxole and pirprofen on breakdown of the blood-aqueous barrier by paracentesis and sodium arachidonate were studied, using fluorescein angiographic technique. Sodium arachidonate (1%) administered topically affected the vascular integrity of the iris and, to a lesser extent, of the ciliary processes, whereas the effects of paracentesis were predominantly on the ciliary processes. Indomethacin, indoxole and pirprofen (0·125%) administered topically prevented the breakdown of the blood-aqueous barrier after arachidonate much more effectively than that caused by paracentesis.

Effect of paracentesis on protein content of aqueous humour.

Effect of paracentesis on protein content of aqueous humour.