Reinfusion Of Ascitic Fluid Research Articles

Extracorporal modified ascitic fluid reinfusion in treatment of resistant ascites in liver cirrhosis

OBJECTIVE. The aim of the study was to estimate the efficacy of new method of reinfusion of extracorporeal modified ascitic fluid in therapy of diuretic resistance ascites in patients with liver cirrhosis and portal hypertension syndrome. MATERIAL AND METHODS. An analysis of treatment was made in 83 patients, who underwent laparocentesis and ascitic fluid evacuation. The patients were divided into two groups. Laparocentesis and fractional evacuation of ascitic fluid were carried out for the patients of the first group (n=40). This procedure was followed by intravenous infusion of 25 % albumin (10 g of albumin on each 2 litres of removed fluid) in order to make up losses of protein. Laparocentesis and ascitic fluid evacuation with following extracorporal processing and reinfusion were performed for the second group of patients (n=43). RESULTS. There was noted an increase of day diuresis from (620,0 ± 110,0) ml to (2,2 ± 0,4) l compared with the first group from (780 ± 80) ml to (1,2 ± 0,5) l and rise of sodium excretion (132 ± 7) mmol/l compared with the first group - (120 ± 6) mmol/l. An average molecular peptide concentration was decreased in blood plasma to (0,254 ± 0,098) units in the second group and it counted (0,298 ± 0,045) units in the first group. CONCLUSIONS. Reinfusion of extracorporeal modified ascitic fluid was more effective than conventional correction of albumin level and electrolytes disturbances against a background of ascitic fluid evacuation.

Reinfusion of ascites during hemodialysis as a treatment of massive refractory ascites and acute renal failure

Refractory ascites can occur in patients with various conditions. Although several procedures based on the reinfusion of ascitic fluid have been reported after the failure of bed rest, salt and water restriction, diuretics, intravenous administration of albumin, and repeated paracentesis, these procedures are performed for ascitic fluid removal without dialytic effect. In this study, a flow control reinfusion of ascites during hemodialysis (HD) was performed to demonstrate the efficacy of this method in a lupus patient with massive refractory ascites and respiratory and acute renal failure (ARF). The alleviation of ascites and ARF attests to the success of the flow control reinfusion of ascites during HD. This procedure can control the rate of ascites and body fluid removal simultaneously during HD using the roller pump. In conclusion, with a normal coagulation profile, the procedure of flow control reinfusion of ascites during HD is an effective alternative treatment for the alleviation of refractory ascites with renal failure.

Resolution of primary amyloidosis by melphalan and prednisolone: a case report

We here report a case of a 50-year-old man who showed histologically evident resolution of primary amyloidosis by melphalan and prednisolone. The patient was admitted to our hospital for further evaluation of nephrotic syndrome and remarkable hepatomegaly with refractory ascites, on September 11, 1998. Laboratory tests at presentation showed nephrotic syndrome with slight renal impairment and elevation of the enzymes of the biliary system. Monoclonal light chains were not detected in the serum or urine by immunoelectrophoresis. A renal biopsy revealed global deposition of amyloid in all glomeruli, interstitium and blood vessels. Immunofluorescence staining was positive for kappa light chains. Liver biopsy specimens showed extensive deposition of amyloid along sinusoid walls. Bone marrow aspiration contained 7% plasma cells but no clusters or abnormal cells. Based on these findings, systemic AL- (amyloid light chain) amyloidosis was diagnosed, and the treatment with combinations of melphalan and prednisolone was started from October 1998 at intervals of 4-6 weeks. Renal impairment progressed, resulting in the initiation of maintenance hemodialysis in February 1999. Reinfusion of ascitic fluid into the hemodialysis circuit had been performed from March 1999 for refractory ascites, and ascites disappeared in July 1999. Furthermore, urinary output increased after 14 courses of chemotherapy. Renal function gradually ameliorated with a concomitant reduction in the enzymes of biliary system, and finally hemodialysis was discontinued in April 2001. Sixteen courses of chemotherapy were administered by April 2001. Proteinuria was negative in August 2001. A second renal biopsy was performed on November 20, 2001, which showed markedly decreased amyloid deposition and a proliferation of mesangial cells and increase in matrix in various degrees. We report a case of a patient with primary amyloidosis who was successfully treated by melphalan and prednisolone, resulting in marked resolution of renal amyloidosis.

Concentrated ascitic fluid reinfusion in cirrhotic patients: A simplified method

A new method for ascites filtration and reinfusion, which uses a single Cuprophan filter and is performed in the dialysis unit, is reported. Thirty-one procedures were performed in 17 patients with cirrhosis and massive ascites. A mean volume of 8.6 L of ascitic fluid was removed; from this volume, 5 L were ultrafiltered and a concentrated ascitic fluid was reinfused (x̄ = 359.8 mL). The whole procedure was completed in a mean time of 248 minutes. No relevant method-related complications were detected. Moreover, no significant changes in blood urea nitrogen (BUN), creatinine, plasma and urinary electrolytes, or platelet count were found, even in the case of repeated procedures (two to nine times). The reinfused fluid contained a mean value of albumin of 4.7 g/dL and significant amounts of globulins and complement. The overall cost of the materials used in the procedure ($49.46) offered competitive advantages with respect to other types of frequently used methods. In conclusion, we present a safe, effective, and time- and cost-saving technique for ascites reinfusion that represents an advantageous alternative to more complicated and expensive methods or to the currently used medical therapy.

Hyperfibrinolysis but not hypercoagulability after a new ascites-apheresis procedure in liver cirrhosis patients with refractory ascites

Summary Given the frequent occurrence of disseminated intravascular coagulation after reinfusion of ascitic fluid in cirrhotic patients, a study involving a new ascites-apheresis apparatus was undertaken in 11 patients with decompensated liver cirrhosis and massive refractory ascites, with the aim of investigating activation of coagulation and fibrinolysis after the procedure. A large series of assays were performed in ascitic fluid and plasma before and after the apheresis sessions, and the measured values were compared with those expected and calculated on the basis of fluid and protein changes bound to the filtration and reinfusion procedures. In ascitic fluid, the measured values reflecting activation of blood clotting as prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complexes (TAT) although increased after filtration were much lower than expected. In plasma after reinfusion, F1+2 and TAT were also significantly less increased than calculated, presumably also because of their short half-life, while values reflecting activation of fibrinolysis as total, fibrin and fibrinogen degradation products were significantly increased above those calculated. Thus, the filtration-reinfusion system employed in this study appeared to efficiently remove most of the procoagulant materials from the ascitic fluid and did not significantly activate blood clotting in plasma. The observed activation of fibrinolysis was of limited extent as no relevant changes were observed in the basic clotting tests (PT and aPTT) and fibrinogen.

Non-Machinery-Based System for Cell-Free, Concentrated Autogenous Ascitic Fluid Reinfusion

A non-machinery-based system for the reinfusion of ascitic fluid was developed and assessed. In fundamental studies utilizing bovine serum, this procedure proved economical, quick and useful. The most suitable filter was PS-R (#405-2). Bovine serum with a protein concentration below 3.0 g/dl was treated using this system. Samples containing blood (prepared to 0.5% hematocrit) were also treated, but the treatment time required was double that of serum with the same protein concentration. In both cases the protein recovery ratios were about 90%. We conducted clinical studies on 62 occasions (machinery-based system; 31 times, non-machinery-based system; 31 times) on 19 cases of ascites refractory to treatment with various drugs including diuretics. Clarification of the differences between the non-machinery-based system, indicated the former to be superior. This new procedure is easier because of its use of no machinery, and the high protein recovery ratio proved its usefulness.

Treatment of severe ovarian hyperstimulation syndrome by ultrafiltration and reinfusion of ascitic fluid

Two severe OHSS patients were treated by ultrafiltration and reinfusion of their ascitic fluid. Improvement of symptoms was marked after this treatment with no complications, and termination of pregnancy was avoided. Treatment of OHSS with this ultrafiltration and reinfusion method may help to resolve serious cases of OHSS and become a useful treatment for severe OHSS.

Extracorporeal ultrafiltration and intravenous reinfusion of ascitic fluid vs. Large-volume paracentesis: A randomized controlled trial

Extracorporeal ultrafiltration and intravenous reinfusion of ascitic fluid vs. Large-volume paracentesis: A randomized controlled trial

Atrial Natnuretic Peptide and Hemodynamic Changes after Concentrated Ascitic Fluid Reinfusion in Cirrhotic Patients

In order to assess the role, if any, of atrial natriuretic peptide (ANP) and hemodynamic changes in diuretic response to concentrated ascitic fluid reinfusion (CAFR) in cirrhotic patients, we studied 10 patients with liver cirrhosis before and after aspiration, concentration and intravenous reinfusion of their ascitic fluid. Basal ANP levels were higher than in normal subjects, but not related to the degree of water and sodium excretion. CAFR induced a variable degree of ANP changes and diuretic response, and these two parameters were strictly correlated to each other. No major changes of cardiac output and systemic vascular resistances were observed after CAFR. In conclusion, the apparent resistance to ANP diuretic action observed in basal condition in cirrhotic patients seems to revert after expanding blood volume by CAFR.

A DIC-like picture on plasma and ascitic fluid of cirrhotic patients.

Ascitic fluid reinfusion in severe cirrhosis has frequently been associated with intravascular coagulation (DIC). A low-grade DIC has been postulated to be present in liver cirrhosis. PT, APTT, fibrinogen, plasminogen, antiplasmin, fibrin degradation producers (FDP), euglobulin lysis time, tissue plasminogen activator, and fibrinopeptide A were investigated both in the plasma and ascitic fluid of cirrhotic patients before and after the concentration-reinfusion technique. Our results indicate that increased thrombin formation associated with hyperfibrinolysis is present in the plasma of cirrhotic patients. In ascitic fluid very high levels of thrombin and fibrinolysis activation were found. We conclude that (1) a DIC-like picture exists in ascites and (2) after ascites reinfusion procedures, ascitic fluid is the principal factor in the pathogenesis of DIC. During ascitic fluid reinfusion heparin treatment could be used successfully.

Morbidity and mortality after peritoneovenous shunt surgery for refractory ascites.

A prospective analysis of the morbidity and mortality after peritoneovenous shunting was carried out in 25 patients who had a total of 27 shunts for refractory ascites. Major complications were limited to the patients in whom ascites was secondary to hepatic rather than peritoneal disease. Immediate postoperative complications followed 17 out of the 23 shunts carried out in patients with liver disease and included septicaemia (two), profound hypotension (two), pulmonary oedema (one), and clinically evident disseminated intravascular coagulation (14). Long term morbidity was again limited to the patients with liver disease and included chronic shunt infection (two) and major venous thrombosis (two). Shunt associated mortality was only seen in the patients with liver disease. Despite late shunt blockage in five long term survivors with alcoholic liver disease fluid retention was easily controlled by simple medical means probably because of improved liver function associated with abstinence from alcohol. It is concluded that: (1) patients with hepatic and malignant ascites respond differently to the insertion of a peritoneovenous shunt; (2) Shunt patency should be monitored regularly in patients with liver disease and, because of the potential for septic and thrombotic complications, if blocked the shunt should be removed and; (3) because of the morbidity and mortality of peritoneovenous shunt surgery in patients with liver disease and refractory ascites, an alternative mode of therapy, such as repeated ultrafiltration and reinfusion of ascitic fluid, may be a more effective initial therapeutic approach especially in patients in whom there is a reversible element to their underlying liver disease.

Budd-Chiari syndrome following pregnancy: Report of 16 cases, with roentgenologic, hemodynamic and histologic studies of the hepatic outflow tract

Budd-Chiari syndrome following pregnancy is an extremely rare disease as reported in the literature. Reported here are 16 such cases in a total of 105 patients with Budd-Chiari syndrome seen at Postgraduate Institute of Medical Education and Research, Chandigarh, from 1963 to 1978. The clinical pointer to the diagnosis was sudden occurrence of abdominal pain and ascites following childbirth. Eleven patients had diuretic-resistant ascites. Percutaneous hepatography was valuable in detecting the site and the nature of the outflow block. The prognosis was uniformly bad, and eight patients died within one year from the onset of their illness. The various treatment schedules, including anticoagulant therapy, Rhodiascit ascitic fluid re-infusion and portasystemic shunt surgery, had no beneficial effect on the survival of these patients.

Functional renal failure and haemorrhagic gastritis associated with endotoxaemia in cirrhosis.

Forty-three patients with cirrhosis and ascites, 21 with normal renal function, 10 with a progressive functional renal failure (FRF), and 12 with a steady FRF, were investigated for the presence of endotoxaemia by the Limulus lysate test. Endotoxaemia was found in nine patients with FRF and in none of the 21 with normal renal function (P less than 0-01). A positive Limulus test was almost exclusively associated with a progressive FRF (eight of 10 patients) and all but one of them died. Renal function improved as endotoxaemia disappeared in the survivor. Endotoxaemia was also associated with haemorrhage due to acute erosions of the gastric mucosa, being present in six of the seven patients who had this complication. Intravascular coagulation was not found in any patient. The Limulus test was positive in the ascitic fluid in 18 of 21 patients tested, although only two of them had peritonitis. These results suggest that endotoxaemia may play a critical role in the development of progressive renal failure and haemorrhagic gastritis in cirrhosis, and emphasise the potential risk of procedures involving reinfusion of ascitic fluid.

Evaluation of reinfusion of ascitic fluid in patients with liver cirrhosis

Evaluation of reinfusion of ascitic fluid in patients with liver cirrhosis

Combined Ascitic Fluid and Furosemide Infusion in the Management of Ascites.

Meeting Abstracts1 May 1970Combined Ascitic Fluid and Furosemide Infusion in the Management of Ascites.G. Eknoyan, M.D., M. Martinez-Maldonado, M.D., J. J. Yium, M.D., W. N. Suki, M.D., F.A.C.P.G. Eknoyan, M.D.Search for more papers by this author, M. Martinez-Maldonado, M.D.Search for more papers by this author, J. J. Yium, M.D.Search for more papers by this author, W. N. Suki, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-72-5-793_5 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptParacentesis and the administration of diuretics to reduce the ascites of patients with cirrhosis of the liver may lead to impaired renal function. To obviate the difficulties inherent in the use of each alone, reinfusion of ascitic fluid with the simultaneous administration of mercurial or thiazide diuretics has been used. However, this results in only modest diuresis. We evaluated the use of more potent diuretics in combination with ascitic fluid infusion in the management of massive ascites.The effect of ascitic fluid infusion and furosemide administration alone and in combination was studied in eight patients with massive ascites. Ascitic fluid... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Houston, Tex. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1970Volume 72, Issue 5Page: 793-794KeywordsAscitesCirrhosisDiureticsLiver Issue Published: 1 May 1970 PDF DownloadLoading ...

Systemic and renal hemodynamics in oliguric hepatic failure: effect of volume expansion.

Systemic and renal hemodynamics were studied by indicator dilution techniques before and after infusion of 500 ml of dextran 40 in 21 patients with renal failure developing in the course of decompensated cirrhosis. Cardiac index was directly correlated with total blood volumes. Renal blood flow was low and renal vascular resistance elevated in 13 of 15 patients. Renal vascular resistance was directly related to total systemic nonrenal vascular resistance. Two patients with the highest cardiac outputs in the group were oliguric with high renal blood flow. Plasma volume expansion increased cardiac output in 19 of 21 patients and increased renal blood flow in 12 of 14. The patients were divided into two groups on the basis of control cardiac index. Those with lower cardiac index had lower blood volumes and responded to dextran with a 73% increase in cardiac output, a 148% increase in renal blood flow, and a rise in renal fraction. Those with high control cardiac index had significantly higher blood volumes and responded to dextran with only a small average rise in cardiac output and renal blood flow. Systolic arterial pressure was less than 100 mm Hg in 12 patients. When compared to the normotensive subjects, this hypotension was characterized by a lower vascular resistance, a tendency for a lesser rise in renal blood flow after volume expansion, and a more rapid demise. The prompt circulatory improvement after volume expansion in many of these patients indicates that functional plasma volume depletion may be an important factor in the renal vasoconstriction of oliguric hepatic failure. In an attempt to sustain volume expansion, reinfusion of ascitic fluid was accomplished in four patients. Normal renal blood flow was maintained during reinfusion and a diuresis always occurred, but the response usually was not maintained after the infusion was terminated.

Treatment of Intractable Ascites by Peritoneal A trial Shunt

THE DEVELOPMENT of intractability in controlling ascites in patients with cirrhosis of the liver is often an ominous sign in the terminal phase of this disease. Despite programs for mobilizing ascitic fluid by using newer diuretics, aldosterone antagonists, and steroids, there still remains a group of patients resistant to all forms of medical therapy. Removal of ascitic fluid by repeated paracenteses gives only short-term relief at best, while compounding protein and electrolyte wasting in patients who can ill afford it. Many methods have been devised for the treatment of intractable ascites, but all have certain basic shortcomings which have limited their usefulness. Recently, the demonstration that ascitic fluid can be given intravenously suscessfully, with improvement to the patient without side effects or difficulties, has reawakened interest in this approach to treatment.1,2However, most techniques for reinfusion of ascitic fluid, at best, are bulky and awkward. Smith (1962) reported the