Spontaneous Ascites Research Articles

Bacterial profile, drug resistance pattern, clinical and laboratory predictors of ascites infection in cirrhosis patients

Ascites is a pathological collection of free fluid in the peritoneal cavity, which is a common complication in patients with cirrhosis, an advanced liver disease. Bacterial infection increases the mortality rate of hospitalized patients with cirrhosis, irrespective of the severity of the liver disease. Around 60% of patients with compensated cirrhosis developed ascites within 10 years during the course of their disease. The in-hospital mortality rate due to spontaneous bacterial peritonitis (SBP) could exceed 90%, but with early diagnosis and prompt antibiotic therapy, this rate has been shown to decrease to 20%. Here, we enrolled adult (age ≥ 18) patients with liver disease with evidence of cirrhosis who developed ascites and assessed the presence of spontaneous ascites fluid infection (SAFI) in these patients. Of the total 218 patients, 22.9% (50/218) develop ascites infection. The liver organ function tests like alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin were found to be significantly (P < 0.05) higher in patients with ascites fluid infection compared to patients with non-ascites fluid infection. Of the gram-negative bacteria, K. pneumonia and E. coli were isolated and found to be 100% resistant to amoxicillin and clavulanate. From the gram-positive bacterial isolates, S. aureus was only resistant to penicillin, whereas Str. viridans was resistant to ceftriaxone, cefotaxime, cefepime, and penicillin. On the other hand, clinical features such as a history of jaundice, low arterial blood pressure, and ultrasound results such as a shrunken liver and enlarged spleen were also independent predictors of spontaneous bacterial peritonitis. In conclusion, given the high probability of death following SAFI, early detection, and treatment, as well as knowledge of the microbial agent, resistance profile, and predictive markers in various contexts, are essential for the timely diagnosis and management of SAFI in these patients.

Mycobacteria avium-related peritonitis in a patient undergoing peritoneal dialysis: case report and review of the literature

BackgroundMycobacteria avium (M. avium) is a species of ubiquitous slowly growing nontuberculous mycobacteria. It causes opportunistic infections. However, M. avium-related peritonitis in peritoneal dialysis (PD) patients is rare.Case presentationA 51-year-old female end-stage kidney disease patient undergoing PD was admitted for a noninfectious complication. She presented catheter exit site drainage and slightly increased PD effluent white cell count (WCC) with polymorphonuclear predominance on admission. Exit site infection and PD-related peritonitis were diagnosed. Repeated cultures of effluent and drainage were negative. Initial empirical antibiotics and further adjustment were not rewarding. PD was terminated 2 weeks later, however, shortly the patient developed stupor, high fever, peritoneal irritation, and spontaneous chylous ascites, and showed elevated ascitic adenosine deaminase (ADA). The manifestations persisted and the patient’s general condition deteriorated despite intensified antibiotic therapy. Massive parallel sequencing identified M. avium in ascites on hospital day 25, and 4-drug treatment with azithromycin, amikacin, rifampin, and ethambutol was initiated. Nevertheless, the patient died from sepsis on hospital day 30.ConclusionsWe report a case of PD-related M. avium peritonitis. Prolonged culture-negative peritonitis, chylous ascites, and elevated ascitic ADA may hint the possibility of mycobacterial infections. Diagnostic method allowing prompt identification of the pathogen is warranted. The prognosis can be extremely poor, and the prophylaxis and treatment should be better defined.

The relationship between the mean platelet volume and the development of spontaneous ascites fluid infection in patients with decompensated cirrhosis

The relationship between the mean platelet volume and the development of spontaneous ascites fluid infection in patients with decompensated cirrhosis

Hematological, Biochemical and Etiological factors of Chronic Liver Disease in a tertiary care Hospital of Lahore

Chronic Liver Disease (CLD) progresses from hepatocyte inammation to brosis, regeneration, cirrhosis and in some cases to Hepatocellular Carcinoma (HCC). In general, the main etiologies of Liver Cirrhosis (LC) are viral infections (hepatitis C and B viruses), chronic alcohol abuse and Non-Alcoholic Fatty Liver Disease (NAFLD), including Non-Alcoholic Steato Hepatitis (NASH). Major complications of CLD are ascites, upper gastrointestinal bleeding, jaundice (acute or chronic) and hepatic encephalopathy. Abstract:Study Design: Cross-sectional.Conclusions: This study assesses the etiological factors and complications of CLD in a tertiary care hospital of Lahore, Pakistan. Objectives: Methods: Study was carried out in indoor and Accident &amp; Emergency Departments of Mayo Hospital Lahore. 100 clinically diagnosed CLD cases were chosen through “Convenient Sampling” technique during 3 months. Observations: Most common complications of CLD were upper GI variceal Bleeding (48%) &amp; hepatic encephalopathy (34%) and acute or chronic hepatitis (AVH) (33%). Other less common complications observed were hepatorenal syndrome (10%), Spontaneous bacterial peritonitis (15%), Ascites (5%) and HCC (10%). Hepatitis C was found as main etiological factor of CLD. Bleeding and hepatic encephalopathy are the common complications. Awareness programmes regarding CLD and its complications are mandatory in our society to improve human health.

Comparison of clinical characteristics and outcomes of spontaneous bacterial peritonitis and culture negative neutrocytic ascites

Objective: Ascitic fluid infections (AFI) in cirrhotic patients can be classified into two groups: spontaneous bacterial peritonitis (SBP) and culture-negative neutrocytic ascites (CNNA). The aim of this study was to compare the clinical characteristics and outcomes of the two groups of patients with AFI.Methods: We retrospectively reviewed the medical records of cirrhotic patients with AFI. We evaluated demographic data, clinical presentations of AFI, laboratory findings, liver function, and mortality rates.Results: Between January 2005 and December 2014, 533 patients with AFI were evaluated; 259 (48.6%) had SBP and 274 (51.4%) CNNA. Ascites neutrophil count (4410/mm3 versus 1046/mm3, p < .001) and the blood culture positive rate (38.1% versus 20.1%, p < .001) were higher in the SBP group, which also had a higher MELD score (24.29 versus 22.05, p = .004). Seven-day mortality was higher in the SBP group (9.4% versus 4.5%, p = .027) but there was no significant difference in 30-day (22.1% versus 17.5%) or 90-day mortality rate (36.1% versus 36.4%).Conclusions: Patients in the SBP group had a higher MELD score, ascites neutrophil count, and positive blood culture rate. Although seven-day mortality rate was higher in the SBP group, the 30-day and 90-day mortality rates were similar in the two groups.

Influence of Beta Blockers on Complications of Cirrhosis

INTRODUCTION: Histologically cirrhosis, a chronic liver disease is characterized by fibrosis and the alteration of normal liver architecture into abnormal nodules. In the west, it is the leading cause of mortality, particularly affecting the productive age population. In our country, an estimated 188,575 cirrhosis related death in 2010 which is 18.3% of the universal burden of the disease. And the deaths due to cirrhosis increased globally from 2005 to 2015, whereas age-standardized cirrhosis mortality rates fell during the same period. The economic burden, the disease poses on the family of the patient and the patient’s loss of productive life has been overseen largely. The complications of cirrhosis are protean including portal hypertension, ascites, hepatorenal syndrome, hepatic encephalopathy, portal vein thrombosis, hepatocellular carcinoma and eventually death. Besides the complications that are disease driven, certain complications are worsened by the therapies instituted for the management of cirrhosis, of which beta blockers which have been used for managing portal hypertension since the 1980s when Lebrec et al. first demontsrated the usefulness of non selective beta blockers in a randomized controlled trial involving 74 patients with variceal bleeding, has recently drawn the interest of researchers and hepatologists worldwide, when concerns of its safety in advanced cirrhosis was raised by Serste. AIM OF THE STUDY: Aimed to analyze the impact of beta blockers on the following complications in cirrhosis: 1. Spontaneous bacterial peritonitis (SBP), 2. Refractory ascites, 3. Hepatorenal syndrome (HRS) and 4. Hepatic encephalopathy (HE). In patients who did or did not take non-selective beta blockers and thereby to test the null hypothesis that beta blockers cause worsening of the above mentioned complications. MATERIALS AND METHODS: Study Design: Single centre, case control retrospective study. Study centre: Department Of Digestive Health and Diseases, Kilpauk Medical College and Hospital, Kilpauk Medical College, Chennai. Period of Study: 2 years (January 2015 to January 2017). Study population: In Patients and Outpatients having cirrhosis and portal hypertension who were registered with the Department of Digestive Health and Disease between the period January 2009 to January 2016. Inclusion criteria: Patients having cirrhosis with portal hypertension. Exclusion criteria : Patients who had significant cardiovascular disease, extrahepatic malignancy, intrinsic renal disease and those not willing to provide consent were excluded from this study. METHODOLOGY Patients were identified from a prospectively collected data base. The following parameters were recorded at the time of enrollment to study: age, sex, duration of disease, number of hospital admissions for cirrhosis related illnesses, history of diabetes, history of upper gastrointestinal bleeding, presence of cirrhotic cardiomyopathy, portal vein thrombosis. Biochemical parameters such as complete blood count, renal function test, and liver function test were done. The MELD[5] and CTP[6,7] score were calculated based on the bilirubin, creatinine, PT/INR, albumin, presence of ascites and Hepatic Encephalopathy. RESULTS: A total of 82 patients were included in this study. The mean age of the entire cohort was 47.91 years. Predominantly our cohort had male patients (n=65, 79.3%). The overall mean duration of disease was 1.5 years. The common etiology for liver cirrhosis was ethanol (n = 61, 74.39%), followed by Chronic viral Hepatitis B (n = 9, 10.97%) cryptogenic, non alcoholic steatohepatitis and Hepatitis C. Four patients had both Hepatitis B and significant alcohol consumption. CONCLUSIONS: In this study , no significant statistical association was found between the NSBB group versus the non NSBB group in terms of the following 4 complications of cirrhois: 1. Spontaneous Bacterial peritonitis, 2. Refractory Ascites, 3. Hepatorenal syndrome, 4. Hepatic encephalopathy, To conclude, in this study non selective beta blockers are neither protective nor a risk factor for spontaneous bacterial peritonitis, refractory ascites, hepatorenal and hepatic encephalopathy. And therefore, we suggest that beta blockers can be continued safely in cirrhotics.

Culture and characterization of spontaneous ascites cells isolated from Microtus fortis

To isolate and culture the spontaneous ascites cells from Microtus fortis under artificial conditions, so as to investigate the molecular mechanism at the cell level. The cells were isolated from spontaneous ascites of M. fortis artificially bred for 90 d, and were cultured and observed under a microscope. The differences of ascites cells among normal, spontaneous ascites and schistosomiasis infected samples of M. fortis were compared. The lesion of tissue was observed simultaneously. There were no obvious organ tissue lesions in M. fortis with spontaneous ascites, and the number and types of cells in peritoneal fluid were irregular and significantly changed. With the extension of culture time, the colonies appeared and there were a large number of vacuole-like cells in the cultured medium and sequentially presenting proliferation, deformation, disintegration and the fiber-like changes and could be passaged 3-4 d only. The cells from M. fortis with spontaneous ascites are similar to its abdominal cavity cells after infection of Schistosoma japonica.

Prognostic Factors for Cirrhosis Hospital in Abidjan (C&amp;#244;te d’Ivoire)

Cirrhosis is the cause of a high rate of death in hospitals. The aim of this research was to estimate the incidence of mortality and identify the risk factors associated with cirrhosis patients in hospital in Cote d’Ivoire. Methodology: It is a retrospective study covering from January 1st, 2002 to December 31st, 2011 at Centre Hospitalier et Universitaire de Yopougon in Abidjan. We concerned the cirrhosis patients that have been followed at the hepatology and gastroenterology department. Survival was estimated by the Kaplan-Meier curve and comparison of survival curves by the log-rank test. The multi-varied analysis of the survivals has been achieved with the Cox proportional Hazard regression. A p value < 0.05 was taken as significant. Results: We recruited, 221 patients (135 men) of whom the medium age was 59 ± 15.12 years. Among those patients, 34.5% were classified as Child Pugh C and 52.94% Child Pugh B, 19.45% suffered from digestive hemorrhage, 26.5% suffered from renal deficiency, 47% suffered from hepatic encephalopathy and 10.7% from hyponatremia. The median overall survival of patients was 0.50 person-months. The variables that were significantly associated to a reduction of survival were hepatic encephalopathy (p = 0.0029), spontaneous ascitesfluid infection (p = 0.0208), hyponatremia (p = 0.0434) and stage Cof Child- Pugh score (p = 0.046). Conclusion: The incidence of mortality in cirrhotic patients hospitalized in Abidjan is high. Pejorative prognostic factors were essentially hepatic encephalopathy, spontaneous ascites fluid infection, hyponatremia and stage C of Child-Pugh score.

CAUDAL VENA CAVA KINKING IN DOGS WITH ASCITES

A 9-year-old dog with spontaneous ascites was found to have hepatic vein distension and a tortuous vena cava on abdominal ultrasound. In right lateral recumbency, the caudal vena cava crossed the diaphragm and became kinked before entering into the right atrium. Following this observation, we performed an experimental study in a normal dog to determine whether kinking of the caudal vena cava could be the result and not the cause of ascites. Ascites was induced using warm saline injected through a needle inserted into the abdominal cavity. Venograms were collected from different body positions, under four conditions: before and after a total of one, two and 3 liters of saline had been injected. Caudal vena cava kinking was observed in the experimental dog after 2 liters of fluid had been injected. Vena cava obstruction may cause ascites, but we found that sometimes caudal vena cava kinking can be the result and not the cause of the peritoneal effusion.

A Recent Evaluation of Empirical Cephalosporin Treatment and Antibiotic Resistance of Changing Bacterial Profiles in Spontaneous Bacterial Peritonitis

The aim of this research is to evaluate the recent changes in microorganisms causing spontaneous bacterial peritonitis in cirrhotic patients, antibiotic resistance, and response to empirical cephalosporin therapy. A total of 218 patients with ascites secondary to cirrhosis were enrolled. Parenteral cefotaxime or cefepime was given to patients who had a neutrophil count of 250/mm(3) or more or a positive bacterial culture of ascitic fluid. Antibiotic failure was defined by an absence of clinical improvement and an insufficient decrease in neutrophil count of ascites (<25% of initial value) by the third day of therapy. Of all the patients, 44.6% had culture-negative neutrocytic ascites, 24.8% had spontaneous bacterial peritonitis, and 10.1% had monomicrobial nonneutrocytic bacterascites. Growth in culture was observed in 76 patients (34.9%). The two most common isolated bacteria were Escherichia coli (33.8%) and coagulase-negative Staphylococcus (CoNS; 19.7%). The two cephalosporins were effective against E. coli (82%) and but not against CoNS (44%), while levofloxacin showed reasonable activity against both E. coli (71%) and CoNS (90%) in vitro. We confirmed a recent increased incidence of spontaneous bacterial peritonitis caused by Gram-positive bacteria. Levofloxacin seems to be a good alternative treatment for patients with uncomplicated spontaneous ascites infections.

Echocardiographic characteristics of chickens with ascites syndrome

1. B- and M-mode echocardiography was used to compare cardiac function in broilers with spontaneous ascites syndrome with that of normal chickens. 2. Thirty ascitic chickens and 15 normal chickens aged three, 4, 5 and 6 weeks from the same flock (180 birds in total) were examined. They were restrained gently in a natural standing position, and echocardiographs were obtained with a 7·0-MHz linear transducer placed on the left pectoral apterium. Indices of cardiac structure and functioning were calculated from the echocardiographs, and some were normalised to body weight. Heart rate was also measured. 3. All cardiac structural indices in both ascitic and normal chickens increased with age. Compared with normal chickens, right ventricular diameter at both the end of systole and of diastole was greater in ascitic chickens at all ages. Left ventricular diameter at the end of systole in ascitic chickens was greater at 4, 5 and 6 weeks of age. Ventricular septal thickness at the end of both systole and diastole was greater in ascitic chickens at 5 and 6 weeks. Left ventricular free wall thickness at the end of diastole was less in ascitic chickens at 3 weeks. However, all the structural indices decreased with age after normalisation with body weight. 4. The heart rate of ascitic chickens was lower at 4, 5 and 6 weeks. Normalised left ventricular fractional shortening was lower in ascitic chickens at 4, 5 and 6 weeks, as was normalised right ventricular fractional shortening. Incrassation of the ventricular septum (ΔT), which changed little in normal chickens, was less at 4, 5 and 6 weeks in ascitic chickens. Left ventricular fractional shortening, right ventricular fractional shortening and ΔT were all negatively correlated with ascites heart index at all ages. 5. Taken together the results suggest heart failure of both ventricles, but that right ventricular dysfunction is more extensive than left ventricular dysfunction. We suggest that secondary pulmonary hypertension would result in these ascitic chickens due to volume overload.

Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection

Spontaneous ascites infection is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients; however, there is a lack of knowledge about this issue in ascitic infections. The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous ascites infection. The study population consisted of 45 decompensated cirrhotic patients (32 men, 13 women) with different etiologies. Patients with ascitic polymorphonuclear leukocyte count > or =250/mm(3) and/or positive ascitic bacterial cultures were classified as the "infected group". Comparison was made between the infected and non-infected group for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of cell surface markers for ascitic T, B and natural killer lymphocytes; intracytoplasmic interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma; levels of ascitic IL-8, IL-10, IL-12 and TNF-alpha; and soluble Fas antigen and soluble Fas ligand. The CD4/CD8 ratio was significantly decreased and expression of T cell receptor-gammadelta was increased in the infected group. Furthermore, ascites TNF-alpha levels were also elevated in this group. Ascitic IL-8, IL-10, IL-12 and TNF-alpha levels were significantly higher in patients with positive ascitic bacterial culture. These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might be involved in the pathogenesis of ascites infections.

Nitric oxide complexes in the interaction between primary and secondary tumor of L5178Y lymphoma

Heme and non-heme Fe-NO complexes were observed in regard to the growth of primary and secondary solid tumors and ascites of murine L5178Y lymphoma. The complexes were detected by electron paramagnetic resonance spectroscopy at liquid nitrogen temperature. Primary solid tumors and secondary solid tumors or ascites were inoculated on the same day, or with a delay. The primary tumor inhibited growth of the secondary solid tumor only if the latter was inoculated with a delay, which did not correlate with the change of the types, nor with the increase in the level of Fe-NO complexes detected in the tissue, suggesting a "non-immunological" character of this inhibition. In some animals with solid tumors, spontaneous ascites developed. This process resulted in a marked decrease in the level of Fe-NO complexes in the solid tumor tissue. The primary solid tumor, however, did not influence the growth of secondary ascites, but intensified NO generation in the ascites of animals with partial removal of ascitic fluid. This experimental group survived 2.2 days longer than the control group without primary solid tumor. Our research revealed that the presence of Fe-NO complexes in the interaction between primary and secondary tumor strongly depends on the form of the tumor: solid or ascitic, and that murine L5178Y lymphoma may serve as a convenient model for the research on "concomitant immunity" against in vivo growing tumors. This is the first EPR study on "concomitant immunity" in regard to tumor-tumor and tumor-ascites interactions in vivo.

Clinical and laboratory features of spontaneous bacterial peritonitis

Spontaneous Bacterial Peritonitis (SBP) is a complication of cirrhosis. The mortality rate is approximately 30-50%. SBP is defined as an ascitic fluid infection in the absence of any obvious intraabdominal infectious foci. While earlier reports of SBP emphasized high mortality rates, recently lower mortality rates have been reported. To evaluate the clinical and laboratory features and prognostic indicators of SBP. Retrospective study. Hacettepe University Hospitals. A total of 281 SBP episodes of 214 patients between 3rd march 1981 and 3rd August 1999, in Hacettepe University Hospital were evaluated. Statistical analysis was performed in the group of patients having chronic liver diseases. One hundred and forty nine of the patients 214 (69.6%) were males and 65(30.4%) were females. The mean age of all patients were 49.91+/-15.01 years (17 to 90 years). All spontaneous ascites infection episodes were symptomatic. In all of the episodes, most common clinical features were as follows: icterus (54.5%), abdominal tenderness (54.5%), hepatic encephalopathy (50.7%), fatigue (46.7%), abdominal pain (44.4%) and fever (38.8%). The culture of the ascitic fluid resulted in isolation of a bacteria in 25.4% of all episodes. The most frequently isolated microorganisms turned out to be gram negative enteric bacterias (76.2%). Sixty seven patients in 179 cases with liver disease passed away (37.4%). The use of cefotaxime and newer cephalosporins seemed to have less mortality (31.7%) as compared with that (42.2%) observed in patients treated with other antibiotic regimens. Of all the factors analysed in patients with chronic liver diseases, being Child-Pugh class C, having fatigue, hepatic encephalopathy, hypotension, higher peripheral blood leukocyte count (> or =12000/mm3), renal dysfunction (serum creatinine level > or = 2mg/dl), longer prothrombin time (INR > or = 2.5), lower ascites protein level (<Igr/ dl) and, liver disease for longer time, developing superinfection (an infection other than SBP starting during SBP treatment) were statistically correlated with a higher death rate (p<0.05).

Spontaneous Bacterial Peritonitis

Infected ascites is one of the complication happened in liver cirrhotic patient in ascites. There are 5 infected ascites classifications i.e. Spontaneous Ascites Infection Consist of Spontaneous Bacterial Peritonitis, Monomicrobial Non Neurocytic Bacteriascites, Culture Negative Neurocytic Ascites, Secondary Bacterial Peritonitis and Iantrogenic Polimicrobial Bacterascites. Spontaneous Bacterial Peritonitis (SBP) is the infection in ascites without unrecognized intra abdominal infection source.The normal floras in the gastrointestinal, respiratory or urinal tract are the important infection source in SBP. As we know that normal ascites has ability to kill micro organism through phagocitosis function, opsonization, but when infected occurs ; phagocitosis function, opsonization, and MPS could be worst so that the possibility of being SBP increased. The common frequently sign and symptom of SBP are fever, abdominal pain, consciousness assault, tenderness, diarrhea, paralytic ileus, hypotension and hypothermia. Some of the invasive actions like endoscopy, variceal sclerotherapy and ligation may cause intestine flora translocation to mesenteric gland, bacterimia and infected ascites also made transmural passage intestine micro organism to ascites may cause infected ascites. Cefotaxime is the antibiotic that more frequently studied to SBP patient. The dose of cefotaxime to SBP patient show that 2 gram/6 hours and 2 gram/12 hours injected produce SBP resolution and the same survival, besides that 2 gram/8 hours injected for 5 and 10 days also show the same effectively. The antibiotic prophylaxis such as quinolon group show the effective result in liver cirrhotic with the gastroentestinal tract bleeding and low total protein (<1 gram/dl ) or has the SBP experience patients.

Complement and Immunoglobulin Levels in Serum and Ascitic Fluid of Patients With Spontaneous Bacterial Peritonitis, Malignant Ascites, and Tuberculous Peritonitis

We determined complement and immunoglobulin levels in ascitic fluid and serum of 47 patients with spontaneous bacterial peritonitis, malignant ascites, or tuberculous ascites. Paracentesis was done to confirm the underlying cause of ascites. Biochemical, hematologic, and microbiologic investigations were also done. The highest serum and ascitic fluid C3 and C4 levels and ascitic fluid IgM, IgA, and IgG levels were found in patients with tuberculosis. Ascitic fluid C3 level was found to be higher in the tuberculous group than in the patients with spontaneous bacterial peritonitis or malignant ascites. Ascitic fluid C4 levels were higher in patients with tuberculosis than in those with spontaneous bacterial peritonitis. We believe that further studies of the in vivo kinetics of immunoglobulins and complement in ascitic fluid of various causes are necessary for a better understanding of the host defense mechanisms of these fluids.

Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites

Abstract Background/Aims : Norfloxacin is useful to prevent infections in hospitalized cirrhotic patients with low ascitic fluid protein concentrations. It is also effective in preventing the recurrence of spontaneous bacterial peritonitis. The aim of our study was to determine the efficacy of norfloxacin in the primary prophylaxis of gram-negative bacilli infections in cirrhotic patients with low ascitic fluid protien levels ( Methods: One hundred ans even patients were randomized to receive norfloxacin (400 mg/day; n =53) or placebo ( n =54) for 6 months. The patients had no history of infection since cirrhosis diagnosis and no active infection. Results: The probability of gram-negative infection was significantly lower among patients treated with norfloxacin than among those treated with placebo. Six gram-negative bacilli infections occurred in the placebo group and none in the treatment group. Severe infections (spontaneous bacterial peritonitis, neutrocytic ascites and bacteremia) developed in nine patients in the placebo group (17%) and in one patient in the norfloxacin group (2%; p Conclusions: These data show that primary prophylaxis with norfloxacin for 6 months is effective in the prevention of infections caused by gram-negative bacilli in cirrhotic patients with low ascitic fluid total protein levels.

Ascites in Growing Broilers: A Research Model

A method was developed to experimentally produce ascites in broiler chickens. High-altitude simulation (treatment group) was conducted to study the development of ascites in broiler chickens. In each of three experiments, 15 male broiler chicks (1 wk old) were placed in a hypobaric chamber (principal groups) for 5 wk and 15 other chicks were reared in batteries (control groups). Ascites occurred among chicks in the principal groups recorded at 13, 27, and 80% at simulated altitudes of 1,980, 2,438, and 2,896 m, respectively. No ascites were observed in the controls at 100 m (the altitude at College Station, Texas). Body weight was significantly (P<.05) reduced for broilers in the principal groups versus the controls-especially at 2,896 m, where the principals weighed 500 g less than the controls. The counts for hematocrit, hemoglobin, and red blood cells were significantly (P<.05) increased in all treatment groups; while at 2,438 and 2,896 m, corticosterone was significantly reduced. Histopathology indicated consistent, mild, cardiopulmonary lesions similar to those observed in the spontaneous ascites of broiler chickens. The high-altitude simulation model will be useful in studying the etiological factors and interactions causing ascites.