Therapy For Ascites Research Articles

Therapy of ascites in patients with hepatitis C liver cirrhosis: Systemic meta-analysis cohort study

The 12th leading cause of death in the United States is cirrhosis. Recent studies have shown that liver fibrosis is an ever-evolving process and that early cirrhosis may be reversible. One in three people with cirrhosis is unaware of their condition. The most well-known reasons for cirrhosis are viral hepatitis C, alcoholic liver sickness, and nonalcoholic steatohepatitis. The aim of the study is to compare the different therapeutic approaches to patients with liver cirrhosis due to the hepatitis C and ascites systemic meta‐analysis study. In this study, we looked through Embase, MEDLINE, Science Reference Record Extended, and preliminary registers until December 2022 to distinguish randomized clinical preliminaries in patients with cirrhosis because of hepatitis C and ascites. The study comprised 2344 revised articles. Roughly 30.3% of members got paracentesis in addition to liquid substitution. A transjugular intrahepatic portosystemic shunt was associated with a higher rate of ascites resolution at maximal follow-up (HR 5.22; 95% CrI 1.97 to 76.67) and adding aldosterone adversaries to paracentesis in addition to liquid substitution (HR 20.22; 95% CrI 4.03 to 434.91) contrasted with paracentesis in addition to liquid substitution (extremely low-sureness proof). In conclusion, in light of extremely low-assurance proof, transjugular intrahepatic portosystemic shunt and adding aldosterone adversaries to paracentesis in addition to liquid substitution might expand the goal of ascites contrasted with paracentesis in addition to liquid substitution.

Abstract 1105: A chemotherapeutic approach to kill cancer stem cell rich ovarian ascites

Abstract Purpose: More than one third of ovarian cancer patients present with cancer cells in the abdomen (also known as ascites) at diagnosis, and almost all have ascites at recurrence (Ahmed and Stenvers 2013). It is well-documented that subpopulations of the ascites show cancer stem cell-like characteristics which possess enhanced resistance to chemotherapies and the capacity for distal metastatic spread and recurrent disease. Therefore, ascites are a major source of morbidity and mortality for ovarian cancer patients. The major deficiency that currently exists is that there is no effective and safe therapy for ascites since they are rich in cancer stem cells (CSCs) and resistant to chemotherapy. To overcome this deficiency, it is our objective to develop an effective chemotherapy approach that can destroy the CSC-rich ascites and inhibit recurrence. Methods: Several established human ovarian cancer cells as well as ascites obtained from the abdomen of an ovarian cancer patient (ASCITES) were cultured. Cells were sorted by FACS Cell Sorter to determine the percentage of cancer stem cells (CSCs) in each cell line. Dose response curves of different chemotherapeutic drugs such as Cisplatin (CDDP), 6-Methylpurine (6-MP), 5-Flurouracil (5-FU), SN-38, Monomethyl auristatin E (MMAE) and Etoposide were studied in suspension culture enriched with cancer stem cells. The relative change in total CSC-rich spheroid mass which considers both number and volume of spheroids was used to determine Killing Index for each chemotherapeutic drug. To investigate inhibition of recurrence, the spheroids were monitored for 30 days post treatment and the viability of CSC-rich spheroids were studied by fluorescent microscopy. Results: Primary human ovarian A2780 and ASCITES (derived from ovarian cancer patient Ascitic fluid) were found to have CSCs with unlimited renewal capacity in suspension culture. While Cisplatin, 5-FU, 6-MP and Etoposide showed efficacy in killing CSC spheroids at effective doses around 1-10 μM, but MMAE and SN-38 showed the ability to either significantly diminish or completely eradicate CSC spheroids with effective doses as low as 10 nM. Importantly, no evidence of recurrence (repopulation of spheroids) was observed in MMAE and SN-38 treated group even after 30 days of post treatment. Conclusion: These promising results with the two chemotherapeutic drugs that show their ability to kill highly drug-resistant CSC-rich ovarian spheroids open the door to further investigate their use in the clinic. Currently, we are investigating the potential use of these two drugs in combination but at very low concentrations for the treatment of abdominal ovarian metastasis. Citation Format: Siddik Sarkar, Obeid M. Malekshah, Arash Hatefi. A chemotherapeutic approach to kill cancer stem cell rich ovarian ascites [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1105. doi:10.1158/1538-7445.AM2017-1105

Results of the CARMA study to investigate catumaxomab therapy for ascites related to peritoneal carcinomatosis in clinical practice.

TPS3119^ Background: The trifunctional antibody CATU (catumaxomab) is approved in the EU for intraperitoneal (IP) treatment of malignant ascites (MA) in patients (pts) with EpCAM-positive carcinomas. Clinical data for CATU are based on 2 phase III and several phase I/II trials. However, the routine use of CATU has not been evaluated systematically. Therefore, a prospective observational study (CARMA) was started in 2010 investigating the administration of CATU in a total of 160 pts with MA under routine conditions. Participating centers were hospitals and oncologic practices in Germany and Austria. Hereby, we report on the results of the 2nd interim CARMA analysis. Methods: This analysis included 103 pts with MA due to EpCAM-positive carcinomas: ovarian, n=37; gastric, n=13; pancreatic, n=10; colorectal, n=6, miscellaneous, n=37. Pts were treated with CATU at a routine setting at 4 increasing dosages over a 2-week interval. The primary endpoint was puncture-free interval (PFI), secondary endpoints included safety and overall survival (OS). Results: The study population mainly comprised pts with advanced-stage disease. In 65% distant metastases were present. Therapy was given in 24 hospitals (73 %) and 9 outpatient facilities (27 %). Pts suffered from typical MA related symptoms such as abdominal swelling (77%), pain (56%), dyspnea (27%), anorexia (31%), constipation (13%). In 67 pts (65%), CATU was given as planned, 36 pts (35%) received <4 infusions. Most frequent adverse events (AE) were fever (20%), nausea (14%) and diarrhea (6%).The median PFI was 57 days (d), the median OS was 100 d. For the subgroups ovar/non-ovar, a median PFI of 93/41 d and a median OS of 115/72 d was observed. Conclusion: CARMA represents the first systematic evaluation of CATU therapy given for MA under routine conditions. In accordance to previous prospective trials, the presented 2nd interim-analysis was able to demonstrate a clinically meaningful benefit of CATU, particularly impressive in ovarian cancer pts. CATU showed an acceptable safety profile, thus allowing for treatment at an outpatient setting in an adequately selected group of pts. The final CARMA analysis after including 160 pts is thus eagerly awaited. Clinical trial information: DRKS00000458.

Diagnosis and therapy of ascites in liver cirrhosis

Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm(3) and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.

The Efficacy of Low Dose Captopril Adjuvant for Natriuresis in Patient with Liver Cirrhosis with Ascites Who Have Received Furosemide and Spironolacton

B ackg r ou nd : The ideal therapy for ascites in liver cirrhosis is a low sodium diet and a combination of furosemide and spironolacton. However, this still sometimes does not produce satisfactory Results, even after increasing the dose of the diuretic. Such failure occurs due to the influence of the Renin Angiotensin Aldosterone (RAA) system. Low doses of ACE inhibitors (captopril) should improve renal blood flow and increase filtration at the glomeruli, thus increasing natriuresis without causing haemodynamic imbalance. Study aim: To discover the natriuretic and diuretic effects of low dose captopril adjuvant in patients with liver cirrhosis who have received furosemide and spironolacton by measuring urinary sodium and 24-hour urine output. Materials and method: This study was conducted on in- and out- patients with liver cirrhosis and Ascites at the Dr. Kariadi Central Public Hospital, Semarang, who met the inclusion and exclusion criteria. The study took place from June 1st, 1997 to March 31st, 1998, and included 40 cases of liver cirrhosis with ascites. Study design: Open comparative randomized clinical trial with permuted blocks. All of the patients received a low fat diet, 40 mg of furosemide, 3x50 mg of spironolacton for 2 weeks, and patients with a urinary sodium level was below 80 mEq/L were randomized into two groups: group A receiving 3 x 6.25 mg of captopril, and group B receiving standard therapy. Results : V a r i a b l e Pre- treatment Post – treatment p Group A : Urinary sodium level (meq/L) 65.450 ± 16.577 109.950 ± 49.109 0.001 24-hour urine output (cc) 1138.750 ± 480.438 1381.250 ± 394.441 0.004 Group B: Urinary sodium level (meq/L) 68.30 ± 12.85 91.750 ± 64.04 0.103 24-hour urine output (cc) 1390 ± 448.27 1392.50 ± 713.46 0.988 The pre- and post- treatment Results for Group A were significantly different. The pre- and post- treatment Results for Group B were not significantly different. Conclusion: Low dose (3 x 6.25 mg) captopril adjuvant in patients with liver cirrhosis and ascites who have received standard doses of furosemide and spironolacton could increase natriuresis and diuresis without causing haemodynamic imbalance. Key w o r d s : Captopril, liver cirrhosis, ascites

Effects of Recombinant Human Serum Albumin on Ascites in Rats with Puromycin Aminonucleoside-Induced Nephropathy

1. Recombinant human serum albumin (rHSA) (1 g/kg) significantly decreased the weight of ascites in rats with puromycin aminonucleoside-induced nephropathy. 2. Furosemide (1–30 mg/kg) did not significantly reduce the weight of ascites in this model. 3. A combination of rHSA (1 g/kg) with furosemide (5 mg/kg) significantly decreased the weight of ascites in this model compared with furosemide alone. 4. In consideration of these results, rHSA can be a substitute for human serum albumin products prepared from human plasma in therapy for ascites or edema in furosemide-resistant nephrotic syndrome.

肝硬変腹水の新しい治療 身体圧迫療法の試み

肝硬変腹水の新しい治療 身体圧迫療法の試み

A Rational Approach to the Therapy of Ascites

A Rational Approach to the Therapy of Ascites

The pathogenesis of renal sodium retention and ascites formation in Laennec's cirrhosis.

This chapter critically reviews our current understanding of the pathogenesis, clinical syndrome, and therapy of the disturbances of renal sodium handling, renal perfusion, and glomerular filtration rate that occur in patients with Laennec's cirrhosis. Avid renal sodium reabsorption, a characteristic feature of cirrhosis, occurs independent of moderate changes in renal function and precedes the onset of ascites. The initiation of sodium retention may be a direct consequence of the hepatic disease process and may also result from defective intravascular filling. In the presence of ascites the most important sodium retaining signal is a defective intravascular volume. The principal effectors of renal sodium retention and vasoconstriction are stimulation of the renin-angiotensin-aldosterone axis and augmentation of renal sympathetic nerve activity. Deficient production of natriuretic hormone(s) and endogenous renal vasodilators, such as prostaglandins and kinins, also contributes to the sodium retention and renal hypoperfusion seen in cirrhosis. The hepatorenal syndrome is an extreme imbalance in these renal vasoconstrictor and vasodilator forces. In the therapy of ascites in Laennec's cirrhosis, abstention from alcohol, sodium restriction, and cautious diuresis are the principal therapeutic measures. A grave prognosis accompanies the diagnosis of the hepatorenal syndrome although recoveries have been reported.

Physiologic Considerations in the Medical Management of Ascites

Therapy of ascites is important due to the significant morbidity and mortality to which this condition predisposes the cirrhotic patient. After briefly reviewing the pathogenesis of ascites to highlight the central role of sodium retention, the normal and altered physiology of salt and water balance are reviewed to provide a background for formulating a physiologic approach to medical management. Finally, a medical regimen for the management of ascites is suggested, one that employs salt and water restriction and a rational progressive program of diuretics to reverse the pathological sodium retention. Using such an approach, a high frequency of success with minimal complications can be achieved.

Some notes on clinical feature of cirrhosis of the liver with ascites and diuretic therapy for ascites

It can be said that intractable ascites is a sign in the terminal stage of cirrhosis of the livr. So, the duration of survival period mainly depends upon the ability of skillfulness.

Surgical Treatment of Ascites

ASCITES is a problem frequently encountered and often unsatisfactorily treated. An adjunct in the therapy of ascites has been tried in a limited number of cases and has seemed sufficiently helpful to warrant reporting. Attempts to obtain more lasting relief from ascites have been many and varied. In 1896 Drummond and Morison1 reported the first surgical treatment of ascites. Talma,2 in 1898, is usually credited with the original suggestion for the surgical relief of ascites, and the operation — omentopexy — has come to be known as the Talma-Morison operation. Morison's patient lived two years after the operation. Monprofit3 reported . . .