Non-malignant Ascites Research Articles

Ascitic Fluid Analysis for the Differentiation of Malignancy-Related and Nonmalignant Ascites

The differentiation between malignancy-related ascites(MRA) and non-malignant ascites (NMA) is important for further diagnostic and therapeutic purposes. Although many parameters were investigated, none has provided a complete distinction between MRA and NMA. We investigated several ascitic fluid parameters to determine the differential power, and to differentiate malignant-related from nonmalignant-related ascites with a sequence of sensitive parameters followed by specific parameters. For the present study, 80 patients with ascites were divided into two groups: MRA and NMA, The MRA group was consisted of 27 patients with proven malignancy by image study, biopsy, and follow up: 21 of these patients had peritoneal carcinomatosis, but the remaining 6 showed no evidence of peritoneal carcinomatosis. The NMA group was consisted of 53 patients with no evidence of malignancy: among these patients, one had SLE, and others had liver cirrhosis, The samples of blood and ascites were obtained simultaneously, and then the levels of ascites cholesterol, CEA. protein and LDH, cytology, albumin gradient, ascites/serum concen-tration ratios of LDH(LDH A/S), and ascites/serum concentration ratios of protein(protein A/S) were measured. Applying cut-off limits for determined parameters, we estimated the diagnostic efficacy of each parameter, Among the eight parameters investigated, ascites fluid cholesterol yielded the best sensitive value of 93%(cut-off value 30mg/dl), and cytologic examination and the protein A/S(cut-off value 0.5) showed the most specific value of 100% and 96%, respectively. Based on the above results, the diagnostic sequence with cholesterol as a sensitive parameter followed by the combination of cytologic examination and protein A/S as specific parameters, was tested in 80 patients. This diagnostic sequence identified 81.5% of patients with malignancy, and all patients with peritoneal carcinomatosis were classified as malignancy-related ascites. In spite of many limitations, this proposed diagnostic sequence may permit a cost-effective and simple differentiation of malignancy-related ascites from nonmalignant ascites.

Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease

Clinical data clearly indicate a correlation between tumor neovascularization, aggressiveness of tumor growth, and metastatic spread. One of the key factors capable of stimulating tumor angiogenesis is vascular endothelial growth factor (VEGF). Using an immunoassay for VEGF, we assessed the levels of soluble VEGF in the sera and effusions of patients with malignant and nonmalignant disease as well as in the sera of healthy controls. Using a sandwich enzyme-linked immunoadsorbent assay, the concentration of VEGF was measured in serum specimens (n=445) and effusions (n=56) collected from a total of 212 patients with various types of cancer, 88 patients with nonmalignant disease, and 145 healthy individuals. Low and rather stable levels of VEGF were detected in the serum of healthy individuals (median, 294 pg/mL; range, 30-1752 pg/mL; 95th percentile, 883 pg/mL). Compared with healthy individuals, serum levels in patients with acute infections were elevated (P=0.03), whereas patients with chronic cirrhosis had lower serum VEGF levels. Among patients with various types of neoplasia, VEGF serum levels in patients with ovarian or gastrointestinal carcinoma were significantly higher than in healthy individuals. Moreover, VEGF concentrations in sera from patients with metastatic disease were higher than in sera from patients with localized tumors. Maximum serum concentrations of VEGF (median, 1022 pg/mL; range, 349-7821 pg/mL) were found in patients with metastatic ovarian carcinoma. Median VEGF levels (and ranges) in malignant effusions were up to 10-fold higher than in matched serum samples: 5528 pg/mL (468-49269 pg/mL) in ovarian carcinoma, 885 pg/mL (77-14,337 pg/mL) in breast carcinoma, and 813 pg/mL (372-18,331 pg/mL) in gastrointestinal carcinoma. In contrast, ascitic fluid from patients with cirrhosis contained only 303 pg/mL (median, range 116-676 pg/mL) of VEGF, corresponding to the low serum levels in this patient group. Depending on the tumor type, elevated levels of VEGF are detectable in the serum of only 0-20% of patients with localized cancer but in 11-65% of patients with metastatic cancer. Of cytology-proven malignant ascites or peritoneal exudates from various malignancies, 46-96% show VEGF levels above the upper limit (95th percentile, 676 pg/mL) of nonmalignant ascites. Maximum VEGF concentrations in malignant effusions indicate abundant local release of VEGF within the pleural or peritoneal cavity. These results suggest that VEGF might play an important role in tumor progression and the formation of malignant effusions. Further studies are warranted to determine the clinical value of soluble VEGF as a tumor marker, a prognostic factor, and a surrogate indicator of tumor angiogenesis.

Protein profiling of non-malignant and malignant ascites by SELDI-TOF MS: Proof of principle

Ascites is a common clinical symptom in liver cirrhosis, inflammatory disorders of the abdomen and a major late manifestation of metastatic malignancies. Standard cytopathological techniques and immunocytochemistry have specificities and sensitivities of approximately 95 and 60%, respectively for the presence of tumor cells. Development of faster and more accurate screening methods would be of great clinical utility. In this work we examined differential analysis of the unbound proteins in the supernatant of ascites fluid by Protein-Chip SELDI mass spectrometry. There were 21 tumor cell-positive and 34 tumor cell-negative samples. We used principal component analysis coupled with linear regression applied to the mass spectra of the samples to distinguish between the sample groups. Two sample sets for statistical analysis were created after randomization, a training set with 37 samples and a validation set with 18 samples resulting in a specificity of 93% and a sensitivity of 83% on the training set. The validation set yielded a specificity and sensitivity of 75%. This study suggests that SELDI-TOF mass spectrometry appears to have great potential as a surrogate diagnostic tool to evaluate effusion specimens.

Multivariate discriminant analysis of biochemical parameters for the differentiation of clinically confounding liver diseases

We describe a series of studies on the contribution of laboratory medicine to the differential diagnosis of clinically confounding diseases in the field of chronic hepatobiliary diseases. Ascitic cholesterol and lactate dehydrogenase (LD), selected by multivariate discriminant analysis (MDA) from a multitude of serum and ascitic analytes, correctly classified 100% of patients with malignant ascites or non-malignant ascites. In addition, ascitic pseudouridine differentiated hepatocarcinoma (HC) from cirrhotic ascites with a diagnostic effectiveness (overall discrimination power) of 90%. A panel of analytes constituted by serum gamma-glutamyltransferase (GGT), the GGT isoenzyme complexed with low- and very low-density lipoprotein, aspartate aminotransferase, copper, hepatic alkaline phosphatase (AP), the LD-5 isoenzyme and alpha-fetoprotein (AFP), selected by the MDA, correctly classified 93% of about 200 cases of cirrhosis or HC. Finally, MDA also identified an equation, based on serum values of the LD-4/LD-5 and carcinoembryonic antigen/AFP ratios, AP and iron that correctly classfied 96% of HC or secondary liver neoplasia cases in 100 patients. This approach based on panels of analytes selected by a sophisticated statistical analysis is a rapid and non-invasive contribution to the differential diagnosis of chronic liver disease including neoplasia.

In vitro NMR proton measurements in peritoneal ascites

The proton spin - lattice relaxation rate in malignant and non-malignant ascites was measured with an FT NMR spectrometer operating at 60 MHz. The mean relaxation rate in non-malignant ascites was significantly smaller than that of malignant ascites. However, the of malignant ascites overlaps with that of non-malignant ascites over all concentrations of total protein (TP) in samples. The in non-malignant ascites correlates strongly with TP, whilst the in malignant ascites shows only a moderate correlation. measurements before and after addition of ascorbic acid (reductant) suggest that there is a small paramagnetic contribution of ions to the in malignant ascites. The least-squares fitting of versus TP for non-malignant data gives a linear relationship, and suggests that the mechanism in non-malignant ascites is caused by a fast chemical exchange of water molecules between protein-bound water and free water.

Human chorionic gonadotropin-beta in the differentiation of malignancy-related and nonmalignant ascites.

The clinical value of the tumor marker human chorionic gonadotropin-beta (hCG-beta) in ascitic fluid for the differentiation of malignancy-related and non-malignant ascites was evaluated. Ascitic fluid protein, cholesterol and cytological examination were determined for comparison. Thirty-six patients with malignancy-related ascites (27 peritoneal carcinomatosis, 9 miscellaneous malignant causes without peritoneal carcinomatosis) and 69 patients with nonmalignant ascites (55 with liver cirrhosis, 14 with miscellaneous nonmalignant causes) were investigated. hCG-beta concentrations were elevated in malignant samples and with a cut-off value of 10 mIU/ml hCG-beta yielded a sensitivity of 61%, specificity of 94% and efficiency of 83%. Ascitic fluid protein (cut-off value 3.0 g/100 ml) and cholesterol (cut-off value 45 mg/100 ml) concentrations showed a sensitivity of 64%/83%, specificity of 77%/81% and efficiency of 72%/82%. The combination of hCG-beta and cytological examination yielded 89.5% differential diagnostic efficiency, superior to the combinations of protein and cytology or protein and hCG-beta. hCG-beta tended to be superior to protein/cholesterol determination regarding sensitivity (44% vs. 11%/33%) and specificity (79% vs. 50%/57%) in the subgroups of patients with miscellaneous causes of ascites. In conclusion, hCG-beta is frequently elevated in malignancy-related ascites and seems to be as useful a parameter as total protein for the differentiation of malignancy-related from nonmalignant ascites.

The Analysis of Ascitic Fluid for the Differentiation of Malignant and Nonmalignant Ascites

We investigated the efficacy of protein and other laboratory tests in the differential diagnosis of malignant and nonmalignant ascites. The mean total protein, albumin, cholesterol and Lactic Dehydrogenase (LDH) in malignant ascites was found to be greater than in nonmalignant ascites (p On the basis of the data presented, we concluded that the ascitic cholesterol level and albumin gradient are important diagnostic criteria, and we suggest that these two parameters be used to fine-tune diagnostic accuracy in the differential diagnosis of ascitic fluid.

Free fatty acid analysis in ascitic fluid improves diagnosis in malignant abdominal tumors

The fasting concentration of free fatty acids (FFA) in the ascitic fluid was determined in 14 patients with malignant ascites and in 19 patients with liver cirrhosis. In malignant ascites FFA levels were increased more than three times when compared with the levels in cirrhotic ascites (5.241 ± 0.493 vs. 1.558 ± 0.170 μmol/ml; P < 0.0001). Palmitic acid was the most representative saturated FFA (which together accounted for 2.499 ± 0.323 vs. 0.833 ± 0.064 μmol/ml; P < 0.0001), while unsaturated FFA (2.741 ± 0.298 vs. 0.725 ± 0.111 μmol/ml; P < 0.001) were represented, in decreasing order, by oleic, linoleic and arachidonic acids. The ratio of unsaturated to saturated FFA was higher in neoplastic patients (1.35 ± 0.29 vs. 0.826 ± 0.065 P < 0.05). Albumin concentration in ascitic fluid of neoplastic patients was 22.44 ± 1.35 g/l, while that of cirrhotic patients was 8.19 ± 0.32 g/l, P < 0.0001. A close relationship ( R 2 = 95.14%) between albumin concentration in ascitic fluid and levels of total FFA was found. These data support the hypothesis that the elevation of FFA in ascitic fluid allows discrimination between malignant and non-malignant ascites.

High-dose localized radiation therapy for treatment of hepatic malignant tumors: CT findings and their relation to radiation hepatitis.

High-dose radiation therapy of the liver performed using overlapping portals defined by a three-dimensional treatment-planning system (conformal radiation therapy) is a new method of treating hepatic tumors. This study was performed to delineate the differences in the CT appearances of the liver after therapy compared with other methods of radiotherapy and to correlate imaging findings to clinical findings of radiation hepatitis. Contrast-enhanced CT scans were obtained at 8- to 12-week intervals on 31 consecutive patients with primary or metastatic hepatic malignant tumors. All had undergone high-dose conformal radiation therapy and injection of fluorodeoxyuridine into the hepatic artery as part of the treatment for unresectable hepatic neoplasms. Tumor size, location, presence of changes within the target volume after therapy, presence of atrophy of the treated segments or hypertrophy of the untreated segments, ascites, and any changes in adjacent organs seen on serial CT scans obtained before and after treatment were recorded. Clinical records were reviewed for evidence of radiation hepatitis (nonmalignant ascites evident on physical examination and a twofold elevation of alkaline phosphatase in the anicteric patient). In 23 (74%) of the 31 patients, follow-up CT studies after treatment showed a low-attenuation area adjacent to the hepatic tumor in the target volume. In two patients with fatty infiltration of the liver, CT showed relative increased density in the treatment portal. A sharp, straight interface was rarely seen at the treatment margin. Maximal effect was seen 2-3 months after completion of therapy and persisted for up to 3 months. Atrophy in the treated segment or lobe was seen in four patients, hypertrophy of the untreated liver was seen in four patients, and both effects were seen in seven patients. Extrahepatic effects included segmental right renal atrophy in three patients and duodenal wall thickening in two patients. Only two patients (6%) in this series had clinical evidence of radiation hepatitis. High-dose localized radiotherapy of the liver results in reversible hypodense regions in the liver parenchyma within the target volume that do not have a sharp interface delineating the radiation portal. This appearance should not be confused with tumor progression or irreversible liver injury. The changes evident on CT scans after therapy are not predictive of radiation hepatitis.

The fibrinolytic system in human ascites.

We recently reported that the contact and kallikrein-kinin systems are activated in malignancy-related ascites. We have now studied the fibrinolytic system in ascites and plasma from patients with gastrointestinal cancer(n = 14) and non-malignant liver disease (n = 18). Enzyme immunoassays (EIAs) showed that urokinase and tissue plasminogen activators (uPA, tPA) and PA inhibitors (PAI-1, PAI-2) were present in ascites from both patient groups and that tPA was the predominant PA. uPA, tPA, and PAI-1, were detected in plasma from patients and controls. These EIA findings were supported by zymography studies. Functional assays showed considerable generation of plasmin-like activity and low plasminogen and antiplasmin values in malignancy-related ascites. The plasmin/antiplasmin and tPA/PAI-1 ratios were particularly high in malignancy-related ascites as compared with non-malignant ascites. Plasma from the liver disease patients showed a higher tPA/PAI-1 ratio and, thus a higher potential for plasminogen activation than plasma from cancer patients and controls. Patient plasma showed low values of plasmin-like activity, antiplasmin, and plasminogen. Our findings show that the fibrinolytic system is activated in malignancy-related ascites.

Serum CA-125 Level in End-Stage Renal Disease Patients Maintained on Chronic Peritoneal Dialysis or Hemodialysis: The Effect of Continuous Presence of Peritoneal Fluid, Peritonitis, and Peritoneal Catheter Implantation

Serum Ca-125, an ovarian tumor marker, is used to screen and follow up patients with overian cancer. Normal values (< 35 U/ml) have been reported in patients with end-stage renal disease and patients maintained on chronic hemodialysis (HD). Non-malignant ascites has been associated with high serum levels of CA-125, suggesting that the presence of fluid in the peritoneal cavity may stimulate its release. We studied 38 HD and 43 chronic ambulatory peritoneal dialysis (CAPD) patients with regard to serum CA-125 levels. In the HD patients, the mean +/- SE serum CA-125 level was 10.1 +/- 1.7 U/ml (range < 5-39) with 8% of the patients having serum levels of > 35 U/ml. In the CAPD patients, the mean serum CA-125 level in all samples collected (n = 68) was 17.7 +/- 2.7 U/ml (range < 5-101, p < 0.01 vs. HD) with 16% of the sera showing levels of > 35 U/ml. The high serum CA-125 levels in the CAPD patients were from sera obtained within 2 months of diagnosis of peritonitis, peritoneal dialysis (PD) catheter implantation, or intra-abdominal surgery. When serum samples from this 2-month period were excluded, the mean serum CA-125 level was 8.9 +/- 1.5 U/ml (p = NS vs. HD) and only 1 patient had an abnormal level. Peritoneal dialysate CA-125 levels during an episode of peritonitis were significantly higher than at the baseline (69.1 +/- 14.2 vs. 21 +/- 2.5, p = 0.004) and both were significantly higher than the serum levels (p < 0.0001). Serum CA-125 levels were also the same in both sexes and races. In conclusion, it was found that while the serum CA-125 level is within normal limits in the majority of HD and stable CAPD patients, it is not uncommon that it is elevated in CAPD patients within 2 months of peritonitis, PD catheter placement, or intra-abdominal surgery, particularly when peritoneal exchanges are temporarily on hold in the latter two. The serum CA-125 level should be interpreted with caution in the CAPD patients as it may be a non-specific marker of peritoneal irritation. It was also found that there was a significant removal of CA-125 by the peritoneal fluid which markedly increased during episodes of peritonitis.

Preoperative chemoradiation for adenocarcinoma of the pancreas and duodenum

Purpose : This study was designed to evaluate the effects of preoperative chemoradiation on resectability, response, local control, and survival in patients with local or local-regional involvement from carcinoma of the pancreas or cancer of the duodenum and to assess the associated toxicity of such treatment. Methods and Materials : This prospective pilot study of preoperative chemoradiation was initiated in 1986 for patients with clinical evidence of adenocarcinoma of the pancreas or duodenum without evidence of distant metastases. Radiation was given at 1.8 Gy per day to a total dose of 50.4 Gy. Two cycles of chemotherapy were given concurrent with radiation. On days 2–5 and 29–32, 5-fluorouracil (1 gm/m 2/24 h X 4 days) was given, while mitomycin-C (10 mg/m 2) was given on day 2 only. Surgical resection was 4–6 weeks following completion of chemoradiation. Thirty-one patients (17 male and 14 female) were entered on the protocol with a median potential follow-up of 4.5 years (range 6 months to 7.5 years). The median age was 64 years (range 32–73 years). Twenty-seven patients had pancreatic cancer (25 head, two body), while four patients had carcinoma arising from the duodenum. Twenty-one patients were initially judged to be unresectable and ten potentially resectable prior to chemoradiation. Results : Twenty-nine of 31 patients completed the entire course of radiation and both cycles of chemotherapy. Acute toxicity from chemoradiation consisted of nausea, vomiting, diarrhea, stomatitis, or hematologic suppression which was moderate to severe (Grade 3 or 4) in seven patients (23%). One patient died of sepsis following the first week of therapy. Seventeen patients (55%) underwent curative resection with subtotal or total pancreatectomy or Whipple resection (four duodenum, 13 pancreas) and two ( 2 17 ) had pathologic nodal involvement, while ( 0 17 ) none had involved margins. A complete pathologic response was seen in all four ( 4 4 ) patients with duodenal cancer and in none ( 0 13 ) with pancreatic cancer who underwent resection. The median postoperative hospitalization stay was 22 days (range 4–144 days). Of 17 patients who underwent curative resection, there were two postoperative mortalities (12%). Late complications have included abscess, one; and nonmalignant ascites, five. Ten of the 31 patients are alive. For patients with pancreatic cancer the median survival is 9 months, while survival at 1 year and 3 years are 36%, and 19% overall and 60% and 43% at 1 and 3 years for those undergoing resection. Six of the 27 patients (22%) with pancreatic cancer are alive without recurrence. All four patients with duodenal cancer are alive without recurrence (12 months, 23 months, 35 months, 90 months). Conclusion : Preoperative chemoradiation for cancer of the pancreas and duodenal region was relatively well-tolerated and enhanced resectability and downstaging of nodal metastases were suggested. The 3-year survival, particularly in patients who underwent resection, was high. For these reasons the applicability of this treatment regimen for pancreatic cancer is presently being studied in a group-wide multi-institutional Phase 11 trial. Chemoradiation for duodenal cancer has produced a complete pathologic response in all patients and survival has been excellent, suggesting efficacy of this regimen for duodenal cancer.

Differential diagnosis of human ascites: inhibitors of the contact system and total proteins.

To assess their accuracies as markers for malignancy, we assayed alpha 2-macroglobulin, C1-inhibitor, alpha 1-protease inhibitor, and total proteins in ascites and plasma from patients with gastrointestinal cancer (n = 15) and non-malignant liver disease (n = 13), using functional and immunologic assays. For all inhibitors and total proteins determined in ascites, the values in the cancer group were significantly higher than the corresponding values in the group with non-malignant liver disease. The diagnostic accuracy for differentiating malignancy-related from non-malignant ascites was 93% for a alpha 1-protease inhibitor value > or = 50% of the pool plasma value and 90% for alpha 2-macroglobulin > or = 16%, C1-inhibitor > or = 40% (all functional assays), and total proteins > or = 20 g/l (biuret). In conclusion, functional assays for alpha 2-macroglobulin, C1-inhibitor, and alpha 1-protease inhibitor and determination of total proteins in ascites appeared to be very informative tests for the differential diagnosis of ascites. The test for alpha 1-protease inhibitor gave higher specificity (92% versus 77%) and likelihood ratio for a positive test (12 versus 4) compared with the other tests.

Evaluation of fibronectin as a marker of malignant ascites.

The aim of the study was to assess the accuracy of fibronectin, a glycoprotein, for the diagnosis of malignant ascites and to compare it with conventional parameters. Ascitic fluid samples from 50 patients, 25 with intra-abdominal malignancy and 25 without it were analysed for total protein concentration, fluid/serum protein ratio, glucose concentration, leucocyte count, pH, fibronectin concentration (by ELISA) and for malignant cell cytology. Twenty-two of the 25 patients with ascites and intra-abdominal malignancy had documented peritoneal metastases in group A. The 25 patients with non-malignant ascites constituted group B. Mean values of ascitic fluid fibronectin, for groups A and B were 538 +/- 46 micrograms/mL and 60 +/- 4.92 micrograms/mL, respectively (P less than 0.001). Within the group with malignant ascites, patients who had positive malignant cytology (n = 12) exhibited a significantly higher ascitic fluid fibronectin concentration than patients with negative cytology (P less than 0.05). While mean ascitic fluid protein concentration showed a significant difference (P less than 0.01) between the two groups, there was no difference in respect to ascitic fluid pH, glucose concentration and leucocyte count. Malignant cell cytology was positive in 54.5% of group A patients with no false positive report in group B. The diagnostic accuracy for differentiating malignant from non-malignant ascites was 100% for a fibronectin value of greater than or equal to 110 micrograms/mL as compared with 78.7% for ascitic fluid protein concentration greater than or equal to 0.5 g/dL, 57.4% for leucocyte count greater than or equal to 1000/mm3, 59.6% for pH less than 7.45 and 78.7% for malignant cell cytology.

Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites. Proposal of a diagnostic sequence

The authors tried to differentiate malignancy-related from nonmalignant ascites with a sequence of sensitive followed by specific ascitic-fluid parameters. There were four results of this study. First, of nine parameters investigated in a first series of 48 patients, 28 with nonmalignant and 20 with malignancy-related ascites, ascitic-fluid cholesterol and fibronectin yielded the best negative predictive value of 92% each. Carcinoembryonic antigen (CEA) and cytologic examination both showed a positive predictive value of 100%. Second, combining cytologic examination (sensitivity, 70%) and CEA determination (sensitivity, 45%) increased the sensitivity to 80%. Third, cytologic findings were negative in all ascitic-fluid samples with a cholesterol concentration below the cutoff value of 45 mg/100 ml. Fourth, based on the results of the first series of 48 patients, the diagnostic sequence with cholesterol as a sensitive parameter, followed by the combination of cytologic examination and CEA determination as specific parameters, was tested in a second series of 71 patients, 37 with nonmalignant and 34 with malignancy-related ascites. Again cytologic examination was negative in all samples with cholesterol levels below 45 mg/100 ml. In the total of 119 patients, this diagnostic sequence did not identify 9% of patients with malignancy-related ascites, and 82% of samples classified as malignancy related by cholesterol levels above 45 mg/100 ml were confirmed by positive cytologic examination and/or CEA level above 2.5 ng/ml. Thus, a diagnostic sequence with ascitic-fluid cholesterol determination, followed by cytologic examination and CEA determination, in samples with cholesterol levels above 45 mg/100 ml should permit a cost-efficient routine differentiation of malignancy-related from nonmalignant ascites.

Diagnostic accuracy of sialic acid in the diagnosis of malignant ascites.

The authors evaluated the diagnostic accuracy of sialic acid and its lipid-bound fraction in ascites and compared these tests with others (fibronectin, cholesterol) recently claimed as valuable in the differential diagnosis of ascites. Fibronectin yielded the best diagnostic accuracy (85%) with no false-positive and 37% of false-negative (10/27). The authors also found higher concentration of sialic acid in malignant ascites than in nonmalignant ascites (P less than 0.001) and, taking 300 mg/l as the cutoff value, the false-positive rate was 10% (four of 40), the false-negative rate 30% (eight of 27), and the overall diagnostic accuracy 82%, comparable to that of the fibronectin. The authors conclude that both fibronectin and sialic acid determinations in ascites may be regarded as accurate markers of neoplastic involvement of the peritoneum, although no test is useful in the ascites with hepatocellular carcinoma and cirrhosis of the liver.

Unusual Anodic Migrating Isoamylase Differentiates Selected Malignant from Nonmalignant Ascites

Ascitic fluid from nine patients with nonmalignant ascites and nine patients with malignant ascites was subjected to isoamylase analysis. Unusual isoamylase bands that migrate to the anode were demonstrated in seven of eight patients with ovarian carcinoma and in one patient with gastric carcinoma. In no case of nonmalignant ascites was anodic isoamylase found, despite the presence of normal amylase in all samples. This is the first report of anodic isoamylase from ascitic fluid in gastric carcinoma and the first series comparing isoamylase patterns in malignant and nonmalignant ascites. Anodic isoamylase on electrophoresis of ascitic fluid may prove to be useful as a tumor marker in differentiating selected malignancies from nonmalignant ascites.

Proteases and antiproteases in ascites--differentiation of malignant and nonmalignant ascites and prediction of coagulopathy in ascites retransfusion.

Ascites is a symptom of a severe disease. In most cases prognosis is poor. However, the differentiation of malignant and nonmalignant ascites is of clinical significance since it leads to different treatment. Thus far, most attempts using laboratory parameters (protein, pH, LDH, lactate, WBC) did not reveal sufficient separating potential to be useful in clinical routine. Recently fibronectin1 and cholesterol2 have been introduced having a sensitivity and specifity between 90 and 100%. However, it is not clear if these parameters can differentiate all forms of ascites.

Proteases and antiproteases related to the coagulation system in plasma and ascites — An approach to differentiate between malignant and cirrhotic ascites

The concentrations of several proteases and antiproteases known to be present in ascites were tested in plasma and ascitic fluid with regard to their ability to separate ascites according to malignant or nonmalignant disease. Seventeen patients with proven malignant ascites and 37 with ascites due to liver cirrhosis were included. Activities of plasminogen, alpha 2-antiplasmin, antithrombin-III, and factor V, and the concentration of alpha 1-protease inhibitor were significantly higher in the plasma of patients with malignant ascites than in cirrhotic patients. Fibronectin, plasminogen, alpha 2-macroglobulin, alpha 1-protease inhibitor, antithrombin-III, and albumin revealed higher concentrations or activities in malignant ascites than in cirrhotic ascites. Due to a wide variation of most parameters, only fibronectin, antithrombin III, and alpha 1-protease inhibitor in ascites had a sensitivity and specificity higher than 90% for malignant ascites. When the specific protein/albumin ratio was used, only the accuracy of fibronectin was increased reaching a sensitivity and specificity of 100%. The plasma/ascites gradients of the proteins assessed differed significantly, that of fibronectin being much higher (22 +/- 7) than that of all other proteins. In malignant ascites fibronectin concentration was only correlated with alpha 1-protease inhibitor concentration but not with the concentration or activity of all other proteins, while in cirrhotic ascites most proteins revealed a positive correlation. The determination of the fibronectin concentration or the fibronectin/albumin ratio in ascites can differentiate malignant and nonmalignant ascites. All other proteases and antiproteases assessed are of lesser value for this purpose, although most are significantly increased in ascites and plasma of patients with malignant disorders.

The concentration of laminin in malignant and non-malignant ascites

The concentration of laminin in malignant and non-malignant ascites