Formation Of Ascitic Fluid Research Articles

INDIRECT AND DIRECT DETERMINATION OF THE PORTAL VEIN PRESSURE IN NORMAL AND ABNORMAL DOGS AND NORMAL CATS1

Portal hypertension resulting in ascites and portosystemic shunts leading to hepatoencephalopathy are major clinical manifestations of hepatic circulatory disease. Diffuse liver disease impairing sinusoidal blood flow can induce portal hypertension, portosystemic shunts, or both. The liver may also be involved secondarily in posthepatic hypertension and become the site of ascitic fluid formation. Portosystemic shunts may or may not be associated with portal hypertension. Selective catheterization of the hepatic and portal veins permits one to record pressures and to outline gross and subgross vascular anomalies by injecting contrast medium. Sequential pressure recordings in the caudal vena cava, in a free and wedged hepatic vein position, in the splenic pulp, and directly in the portal vein are the bases for the differentiation of prehepatic, liver‐induced, and posthepatic portal hypertension. In addition to localizing the disease process along the postcaval‐portal vein axis, pressure measurements are a reliable basis for the prognosis and selection of the most appropriate therapy. In dogs with portacaval shunts, wedge hepatic vein pressure recordings assist in the detection of hepatic sinusoidal anomalies that limit blood flow and preclude surgical ablation of the shunts. The various technics and their suitability for direct and indirect portal vein pressure recording are described and evaluated. Normal portal vein pressure values in 11 dogs and two cats, using different technics, are provided. The clinical usefulness of the various technics of pressure recording and angiography was illustrated in ten dogs with ascites, hepatoencephalopathy, or both.

Palliation of carcinomatosis with ascites by means of hemisulfur mustard (2-chloro-2'-hydroxydiethyl sulfide).

THE preparation of hemisulfur mustard, the rationale that led to discovery of its palliative properties and its effect after administration to patients with malignant tumors have been reported. § When palliation was observed, it generally consisted of suppression of ascitic-fluid formation in patients with peritoneal carcinomatosis as well as decrease in size of any tumor masses present, and of decrease in pain and increase in appetite, strength and ability to get around. The greatest benefit was observed in patients with carcinoma of the ovary. The present report deals with improvement in the method of administration and presents the results of treatment . . .

Relationship of portal hypertension to ascites in Laennec's cirrhosis

The effect of portacaval anastomosis on the fluid and electrolyte balance of five selected patients with Laennec's cirrhosis and chronic ascites was studied. In these persons ascites disappeared following the shunt operation, although marked peripheral edema developed in several cases. These observations are presented in support of the importance of the role of portal hypertension in the formation of ascites in Laennec's cirrhosis. Portacaval anastomosis is not advocated as a general method of treating chronic ascites, although it may be beneficial in some patients. In two additional patients cited ascites made its first appearance shortly after portacaval anastomosis was established. A possible mechanism is postulated. The formation of ascitic fluid in experimental animals in whom hepatic venous pressure is elevated is also discussed. It is considered that these results apply to the formation of ascites in certain clinical conditions but do not necessarily apply in the case of Laennec's cirrhosis.

Experience with radioactive colloidal gold in the treatment of ovarian carcinoma

1.1. In 247 patients, cul-de-sac aspirations at the time of dilation and curettage revealed no abnormal cells.2.2. In 275 patients, peritoneal washings at laparotomy revealed abnormal cells in 17 instances. Fourteen had ovarian cancer, 2 extensive uterine malignancy, and one instance was a false positive.3.3. Five patients with cystadenocarcinoma showed no clinical evidence of spread yet abnormal cells were found in the peritoneal washings.4.4. Patients with Stage I and IIA ovarian carcinoma are now treated with abdominal total hysterectomy, bilateral salpingo-oophorectomy, and Au198.5.5. The remainder of the patients with ovarian carcinoma are treated with surgery, external irradiation, and radioactive gold when feasible.6.6. The majority of patients tolerate Au198 with minimal complications.7.7. Colloidal gold is of value in controlling formation of ascitic fluid in certain patients.8.8. Sufficient time has not elapsed to evaluate 5 year survival rates but results seem encouraging.

Experiences in the use of a low sodium diet in the management of ascites.

SINCE sodium excretion is greatly reduced in cirrhotic patients forming ascitic fluid1and the formation of ascitic fluid has been shown to be directly proportional to sodium intake,2a logical plan of therapeutic management might include consideration of this factor. We have studied the influence of restricted sodium intake on the clinical course of ascites in patients with Laennec's cirrhosis. All the patients presented a clearcut picture of the disease, with ascites as a prominent feature. During a control period the patients received a high protein, high carbohydrate, low fat diet without salt restriction. In addition, during their period of hospitalization they received supplementary vitamins, methionine and liver extract intramuscularly. After the control period a special diet was instituted, consisting of 3,400 calories and containing 135 Gm. of protein and 605 mg. of sodium. Records were kept of the daily weight fluid intake and output and urinary chloride

Passage of radioactive erythrocytes from the peritoneal cavity into the blood stream during experimental ascites.

Intraperitoneal injection of red cells tagged with radioiron into dogs with experimental ascites demonstrated that such cells were rapidly transferred into the circulating blood. When the experimental animals were not actively producing ascitic fluid, 43.4, 67.0, and 56.4 per cent respectively, of the administered radioactive red cells passed to the blood in 72 hours. In the same three dogs during active ascitic fluid formation, 25.9, 51.2, and 38.8 per cent of the administered radioactivity was removed in a similar period. The amount of radioactivity in the blood stream, consequent on the passage of red cells from the peritoneal cavity into the circulation, becomes nearly constant in 48 hours, whereas for radioactive plasma proteins the plateau is attained in 24 hours (Fig. 1). In normal dogs (16), the passage of red cells from the peritoneal cavity was complete in 72 hours, while in ascitic dogs, 5 to 47 per cent of the injected tagged red cells remained behind in the peritoneum after the same period.