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Lipi L, Choudhary NS, Dhampalwar S, Kathuria A, Saraf N, Soin AS. Cytomegalovirus Duodenitis Causing Persistent Hypoalbuminemia and Ascites After Liver Transplantation. J Clin Exp Hepatol 2024; 14:101387. [PMID: 38495464 PMCID: PMC10943483 DOI: 10.1016/j.jceh.2024.101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
A 44-year-old male had persistent hypoalbuminemia and ascites after liver transplantation. Imaging of the liver and gastrointestinal system was normal. Urine examination was negative for proteinuria. A diagnosis of protein-losing enteropathy was suspected, and a duodenal biopsy was done. Duodenal biopsy was positive for cytomegalovirus (CMV). The patient improved with CMV treatment.
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Affiliation(s)
- Lipika Lipi
- Department of Pathology, Institute of Liver Transplantation and Regenerative Medicine, India
| | | | - Swapnil Dhampalwar
- Department of Pathology, Institute of Digestive and Hepatobiliary Sciences, India
| | - Abhishek Kathuria
- Department of Pathology, Medanta The Medicity, Gurugram, Haryana, India
| | - Neeraj Saraf
- Department of Pathology, Institute of Digestive and Hepatobiliary Sciences, India
| | - Arvinder S. Soin
- Department of Pathology, Institute of Digestive and Hepatobiliary Sciences, India
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2
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Gutmann EJ, Marotti JD. Guar beans in a peritoneal fluid sample. Cytopathology 2024; 35:425-426. [PMID: 38126698 DOI: 10.1111/cyt.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
We report a case of guar beans in a peritoneal fluid sample and describe the thought process that enabled us to make sense of this previously unreported finding.
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Affiliation(s)
- Edward J Gutmann
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Dartmouth (Geisel) Medical School, Hanover, New Hampshire, USA
| | - Jonathan D Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Dartmouth (Geisel) Medical School, Hanover, New Hampshire, USA
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3
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Tsiakalos A, Schinas G, Karatzaferis A, Rigopoulos EA, Pappas C, Polyzou E, Dimopoulou E, Dimopoulos G, Akinosoglou K. Acalculous Cholecystitis as a Complication of Primary Epstein-Barr Virus Infection: A Case-Based Scoping Review of the Literature. Viruses 2024; 16:463. [PMID: 38543828 PMCID: PMC10974004 DOI: 10.3390/v16030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024] Open
Abstract
Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively.
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Affiliation(s)
| | - Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
| | | | | | | | - Eleni Polyzou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
| | | | - George Dimopoulos
- 3rd Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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Küçükyurt S, Eşkazan T, Ayer M, Kılıçkıran Avcı B, Hatemi İ, Eşkazan AE. Ascites does not accompany pleural effusion developing under dasatinib therapy in patients with CML-CP. Pleura Peritoneum 2024; 9:39-43. [PMID: 38558869 PMCID: PMC10980979 DOI: 10.1515/pp-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 01/23/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Pleural effusion (PE) is the most frequent pulmonary complication of dasatinib, a tyrosine kinase inhibitor (TKI). Concurrent pericardial effusions have been reported in about one-third of the cases. In this study, we aimed to investigate ascites generation in chronic-phase chronic myeloid leukemia (CML-CP) patients developing PE under dasatinib. Methods We conducted a cross-sectional study to evaluate whether pericardial effusion and ascites accompany PE in CML-CP patients treated with dasatinib. For this purpose, consecutive patients with CML-CP who developed PE under dasatinib therapy have been evaluated with chest X-ray, transthoracic echocardiography, and abdominal ultrasonography. Results There were seven patients, and the median age was 50 years (range, 31-73 years). Most of patients were male (n=5). All patients received imatinib as first-line TKI. Six patients received dasatinib following imatinib failure in second line. The median duration from dasatinib initiation to PE generation was 58 months (range, 8-135 months). Consequently, four patients had grade 1 pericardial effusion, and no patient had ascites. Conclusions In our small study, dasatinib-related PE was associated with low-grade pericardial effusion but no ascites. There are hypothetical explanations of this phenomenon including the simultaneous activation/inhibition of kinases; however, more research needs to be performed on this topic.
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Affiliation(s)
- Selin Küçükyurt
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Tuğçe Eşkazan
- Division of Gastroenterology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Mesut Ayer
- Department of Hematology, Başakşehir Çam and Sakura City Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Burçak Kılıçkıran Avcı
- Department of Cardiology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - İbrahim Hatemi
- Division of Gastroenterology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
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Lu CH, Liu CY, Jhuang JY, Chen CC. Comprehensive evaluation of benign and malignant etiologies of different serous effusions with the International System for Reporting Serous Fluid Cytopathology: A multi-institutional study in Taiwan. Cancer Cytopathol 2024; 132:169-178. [PMID: 38062987 DOI: 10.1002/cncy.22783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND The International System for Reporting Serous Fluid Cytopathology (ISRSFC) was introduced globally in 2019 in response to the absence of a standardized reporting system for serous fluid cytology. This study presents experiences implementing this system across three distinct hospitals in Taiwan. METHODS A total of 6177 serous fluid specimens in three hospitals in Taiwan between 2018 and 2020 were retrospectively reviewed and reclassified according to the ISRSFC. Cytohistological correlation and chart review were further performed to investigate etiologies and risks of malignancy (ROMs). RESULTS Reclassification showed that 34 (0.7%) of 4838 pleural effusions were nondiagnostic (ND), 4086 (84.5%) were negative for malignancy (NFM), 201 (4.2%) were atypia of undetermined significance (AUS), 92 (1.9%) were suspicious for malignancy (SFM), and 425 (8.8%) were malignant (MAL). The 1231 ascites cases contained 13 (1.1%) ND, 1004 (81.6%) NFM, 53 (4.3%) AUS, 31 (2.5%) SFM, and 130 (10.6%) MAL specimens. In pleural effusions, the ROM was 2.9% for ND, 14.0% for NFM, 52.2% for AUS, 85.9% for SFM, and 95.1% for MAL. In ascites, it was 15.4% for ND, 19.1% for NFM, 52.8% for AUS, 83.9% for SFM, and 92.3% for MAL. In pericardial effusions, it was 0.0% for ND, 11.6% for NFM, 30.8% for AUS, 100.0% for SFM, and 95.2% for MAL. Different effusions' most common benign and malignant etiologies were also disclosed. CONCLUSIONS These multi-institutional data have determined the diagnostic usefulness of the ISRSFC, which provides pathologists and physicians with invaluable assistance in correctly classifying effusions for further management.
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Affiliation(s)
- Chun-Han Lu
- Department of Medical Education, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Jie-Yang Jhuang
- Department of Pathology, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- PhD Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung City, Taiwan
- Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan City, Taiwan
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
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Stolzberg N, Paramanandam G, Myers SR, Abreu S, Volk-Craft BE. A Tunneled Catheter Placement Program for Community Hospices. J Pain Symptom Manage 2024; 67:e163-e168. [PMID: 37992847 DOI: 10.1016/j.jpainsymman.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
CONTEXT The symptoms associated with the excessive fluid accumulation of ascites or pleural effusions can be intractable to medical management and can have a significant negative impact on quality of life of hospice patients. Hospice of the Valley, a community-based, nonprofit hospice agency has historically referred patients to outpatient providers for paracentesis, thoracentesis, and placement of tunneled drainage catheters. OBJECTIVES To describe an in-house pilot program of tunneled catheter placement to provide immediate and longer-term symptom relief for selected hospice patients. METHODS The logistics and cost of the pilot program are described. Key data elements, including select demographics, patient eligibility screening, and incidence of procedure-related or late complications are reported. RESULTS A total of 135 drainage procedures completed on 127 unique hospice patients over 27 months (2020-2023) were reviewed. The rate of procedure-related complications (<4%) and late complications (<3%) are low. The average cost per procedure ($1030) compares favorably with outpatient providers' fees. The program was well-accepted by the interdisciplinary hospice team, patients, and families. CONCLUSIONS An in-house program of tunneled catheter placement is a feasible option for hospice providers with low-cost exposure and high potential for improved quality of life and symptom relief for selected patients.
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Affiliation(s)
- Ned Stolzberg
- Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
| | | | - Shelly R Myers
- Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
| | - Shawn Abreu
- Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
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Giles B, Fancey K, Gamble K, Riaz Z, Dowman JK, Fowell AJ, Aspinall RJ. Novel, nurse-led early postdischarge clinic is associated with fewer readmissions and lower mortality following hospitalisation with decompensated cirrhosis. Frontline Gastroenterol 2024; 15:124-129. [PMID: 38486673 PMCID: PMC10935524 DOI: 10.1136/flgastro-2023-102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/20/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Patients hospitalised with decompensated cirrhosis have high rates of early unplanned readmission. Many readmissions are avoidable with secondary preventative strategies, but patients are often readmitted prior to outpatient review. To address this, we established a novel, nurse-led early postdischarge (EPD) clinic delivering goal-directed care for cirrhosis complications and evaluated the impact. Methods Retrospective cohort study comparing outcomes in 78 patients seen in the EPD clinic with 91 phenotypically matched controls receiving standard, consultant hepatologist care. Follow-up for 12 months from index admission with endpoints including survival, time to readmission, number of readmissions and healthcare burden. Results Median time to readmission was 51 days in controls and 98 days in the intervention group (p<0.01). The intervention cohort had significantly fewer readmissions at 30 days (12% vs 30%, p<0.01) and 90 days (27% vs 49%, p<0.01) but not significantly at 12 months (58% vs 68%, p=0.16) with an overall reduction in bed day usage of 29%. Mortality for the control group was 4% at 30 days with no deaths in the intervention group. There were significantly fewer deaths in the intervention group at 90 days (5% vs 15%, p<0.05) and 12 months (22% vs 41%, p<0.01). Conclusions Following an index hospitalisation with decompensated cirrhosis, goal-directed postdischarge care can be effectively delivered by specialist nurses, prior to outpatient review by hepatologists. This model was associated with significantly fewer readmissions, lower bed day usage and a reduced mortality. Our data suggest such models of care deserve wider implementation and further evaluation.
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Affiliation(s)
- Benjamin Giles
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Kirsty Fancey
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Karen Gamble
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Zeshan Riaz
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Joanna K Dowman
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Andrew J Fowell
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Richard J Aspinall
- Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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Vyhlídalová Kotrbová A, Gömöryová K, Mikulová A, Plešingerová H, Sladeček S, Kravec M, Hrachovinová Š, Potěšil D, Dunsmore G, Blériot C, Bied M, Kotouček J, Bednaříková M, Hausnerová J, Minář L, Crha I, Felsinger M, Zdráhal Z, Ginhoux F, Weinberger V, Bryja V, Pospíchalová V. Proteomic analysis of ascitic extracellular vesicles describes tumour microenvironment and predicts patient survival in ovarian cancer. J Extracell Vesicles 2024; 13:e12420. [PMID: 38490958 PMCID: PMC10942866 DOI: 10.1002/jev2.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
High-grade serous carcinoma of the ovary, fallopian tube and peritoneum (HGSC), the most common type of ovarian cancer, ranks among the deadliest malignancies. Many HGSC patients have excess fluid in the peritoneum called ascites. Ascites is a tumour microenvironment (TME) containing various cells, proteins and extracellular vesicles (EVs). We isolated EVs from patients' ascites by orthogonal methods and analyzed them by mass spectrometry. We identified not only a set of 'core ascitic EV-associated proteins' but also defined their subset unique to HGSC ascites. Using single-cell RNA sequencing data, we mapped the origin of HGSC-specific EVs to different types of cells present in ascites. Surprisingly, EVs did not come predominantly from tumour cells but from non-malignant cell types such as macrophages and fibroblasts. Flow cytometry of ascitic cells in combination with analysis of EV protein composition in matched samples showed that analysis of cell type-specific EV markers in HGSC has more substantial prognostic potential than analysis of ascitic cells. To conclude, we provide evidence that proteomic analysis of EVs can define the cellular composition of HGSC TME. This finding opens numerous avenues both for a better understanding of EV's role in tumour promotion/prevention and for improved HGSC diagnostics.
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Affiliation(s)
| | - Kristína Gömöryová
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - Antónia Mikulová
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - Hana Plešingerová
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - Stanislava Sladeček
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - Marek Kravec
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - Šárka Hrachovinová
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - David Potěšil
- Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | | | - Camille Blériot
- Institut Gustave Roussy, INSERM U1015VillejuifFrance
- Institut Necker Enfants Malades, IMMEDIABParisFrance
| | - Mathilde Bied
- Institut Gustave Roussy, INSERM U1015VillejuifFrance
| | - Jan Kotouček
- Department of Pharmacology and ToxicologyVeterinary Research InstituteBrnoCzech Republic
| | - Markéta Bednaříková
- Department of Internal Medicine ‐ Hematology & Oncology, University Hospital Brno and Medical FacultyMasaryk UniversityBrnoCzech Republic
| | - Jitka Hausnerová
- Department of Pathology, University Hospital Brno and Medical FacultyMasaryk UniversityBrnoCzech Republic
| | - Luboš Minář
- Department of Obstetrics and Gynecology, University Hospital Brno and Medical FacultyMasaryk UniversityBrnoCzech Republic
| | - Igor Crha
- Department of Health Sciences, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Michal Felsinger
- Department of Obstetrics and Gynecology, University Hospital Brno and Medical FacultyMasaryk UniversityBrnoCzech Republic
| | - Zbyněk Zdráhal
- Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | | | - Vít Weinberger
- Department of Obstetrics and Gynecology, University Hospital Brno and Medical FacultyMasaryk UniversityBrnoCzech Republic
| | - Vitězslav Bryja
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
| | - Vendula Pospíchalová
- Department of Experimental Biology, Faculty of ScienceMasaryk UniversityBrnoCzech Republic
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Iwai N, Ohara T, Okuda T, Oka K, Sakai H, Kajiwara-Kubota M, Tsuji T, Sakagami J, Kagawa K, Doi T, Inoue K, Dohi O, Yoshida N, Uchiyama K, Ishikawa T, Takagi T, Konishi H, Itoh Y. Prognostic value of moderate or massive ascites in patients with advanced gastric cancer. Oncol Lett 2024; 27:116. [PMID: 38312910 PMCID: PMC10835336 DOI: 10.3892/ol.2024.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/12/2023] [Indexed: 02/06/2024] Open
Abstract
Advanced gastric cancer is a highly aggressive malignancy. The available literature does not provide the prognostic value of ascites based on their degree, because most clinical trials exclude patients who present with massive ascites. Therefore, this study examined whether the presence or degree of ascites has a prognostic value in 124 patients with advanced gastric cancer. The degree of ascites was assessed using computed tomography and classified as none, small, moderate or massive. The overall survival (OS) was compared based on the presence or degree of ascites. Furthermore, a Cox proportional hazards analysis was performed to ascertain the predictors of OS. The cumulative 1-year and 2-year OS rates in patients without ascites were 43.5 and 20.2%, respectively, whereas those in patients with ascites were 29.1 and 13.6%, respectively (P=0.116). The cumulative 1-year and 2-year OS rates in patients without moderate or massive ascites were 39.5 and 20.9%, respectively; however, those in patients with moderate or massive ascites were 28.0 and 4.0%, respectively (P=0.027). Multivariate analysis showed that diffuse-type [hazard ratio (HR), 1.532; 95% confidence interval (CI), 1.002-2.343; P=0.049], moderate or massive ascites (HR, 2.153; 95% CI, 1.301-3.564; P=0.003) and chemotherapy (HR, 0.189; 95% CI, 0.101-0.352; P<0.001) were significant predictive factors of OS. In conclusion, the present study indicated that moderate or massive ascites may influence the OS of patients with advanced gastric cancer.
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Affiliation(s)
- Naoto Iwai
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Tomoya Ohara
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
| | - Takashi Okuda
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Kohei Oka
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hiroaki Sakai
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
| | - Mariko Kajiwara-Kubota
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
| | - Toshifumi Tsuji
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
| | - Junichi Sakagami
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
| | - Keizo Kagawa
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto 620-8505, Japan
| | - Toshifumi Doi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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Hardwick JJ, Ioannides-Hoey CSFK, Finch N, Black V. Bicavitary effusion in cats: retrospective analysis of signalment, clinical investigations, diagnosis and outcome. J Feline Med Surg 2024; 26:1098612X241227122. [PMID: 38506622 DOI: 10.1177/1098612x241227122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES The aim of this study was to describe the clinical and diagnostic findings and outcome of cats with bicavitary effusion presenting to a referral centre. METHODS Medical records of cats presenting with bicavitary effusion were identified and their history, physical examination findings, clinicopathological data, diagnostic imaging findings, aetiology of bicavitary effusions (cardiac disease, neoplasia, infectious disease, sterile inflammatory disease, severe hypoalbuminaemia, trauma, coagulopathy or 'open' if no definitive diagnosis was reached) and outcome were recorded. Cox regression analysis was performed to identify independent predictors of death in cats with bicavitary effusion. Kaplan-Meier curves were generated for survival analysis. RESULTS In total, 103 cats with bicavitary effusion were included. Neoplasia and cardiac disease were the most common aetiologies of bicavitary effusion, in 21 (20.4%) and 20 (19.4%) cats, respectively, followed by infectious disease (n = 11, 10.7%), trauma (n = 13, 12.6%), hypoalbuminaemia (n = 6, 5.8%), sterile inflammatory disease (n = 4, 3.9%) and coagulopathy (n = 1, 1.0%). The median survival time for all cats with bicavitary effusion was 3 days. Cats with a neoplastic aetiology had a 2.03 times greater risk of death compared with cats in which no diagnosis was achieved. Neoplasia (P = 0.030) and pedigree breed status (P = 0.016) were independent predictors of death in the multivariable Cox regression model. CONCLUSIONS AND RELEVANCE This study highlights that bicavitary effusions in cats generally carry a guarded to poor prognosis, particularly if neoplasia is the underlying aetiology or if the cat is a pedigree breed. Cardiac disease appeared to be associated with a better prognosis, suggesting that assessment for congestive heart failure should be considered early when evaluating cats with bicavitary effusion. The prognosis for cats with feline infectious peritonitis is likely to be markedly improved by the advent of novel antiviral drugs, compared with the historical cohort of cats presented here.
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Affiliation(s)
- Joshua J Hardwick
- Cave Veterinary Specialists (part of Linnaeus Veterinary), Wellington, UK
| | | | - Natalie Finch
- Langford Vets Small Animal Referral Hospital, Langford, UK
| | - Victoria Black
- Langford Vets Small Animal Referral Hospital, Langford, UK
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11
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Lan T, Chen M, Tang C, Deltenre P. Recent developments in the management of ascites in cirrhosis. United European Gastroenterol J 2024; 12:261-272. [PMID: 38340308 PMCID: PMC10954428 DOI: 10.1002/ueg2.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/05/2023] [Indexed: 02/12/2024] Open
Abstract
In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long-term albumin infusion may improve survival in patients with cirrhosis and ascites while beta-blockers may reduce ascites occurrence. Transjugular intrahepatic porto-systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low-flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long-term therapy, the place of beta-blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt-related side-effects. These issued should be addressed in future studies.
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Affiliation(s)
- Tian Lan
- Lab of Gastroenterology and Hepatology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Chen
- Lab of Gastroenterology and Hepatology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Chengwei Tang
- Lab of Gastroenterology and Hepatology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Pierre Deltenre
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
- Department of Gastroenterology and Hepatology, Clinique St Luc, Bouge, Belgium
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12
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Shah AA, Priyatha V, Ali Y, Wahab A, Salarzai MA, Ahmad J, Salih N. A Rare Case of Portal Hypertension and Ascites Following Intrauterine Fetal Death: A Case Report. Cureus 2024; 16:e55364. [PMID: 38562337 PMCID: PMC10982831 DOI: 10.7759/cureus.55364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
We present a rare case of a 25-year-old woman who developed idiopathic portal hypertension and ascites four days after delivering a stillborn child at term. She had no previous liver illness or risk factors for portal vein thrombosis. Investigations revealed a dilated portal vein, esophageal varices, and high serum-albumin gradient ascites, all of which point to a presinusoidal etiology of portal hypertension. There was no indication of cirrhosis, hepatic or portal vein thrombosis, metabolic or autoimmune liver diseases, or persistent infections. She was treated with antibiotics, diuretics, and beta-blockers, and she underwent a therapeutic paracentesis. The etiology of her portal hypertension remains undetermined. Idiopathic portal hypertension is a rare condition of unknown etiology, characterized by portal hypertension without cirrhosis or thrombosis. It is linked to several risk factors and histological abnormalities, and it can be accompanied by portal hypertension consequences, such as variceal hemorrhage and ascites. The diagnosis is made using clinical criteria and the elimination of alternative causes of portal hypertension. Management is mostly symptomatic, intending to avoid and treat portal hypertension consequences. The prognosis varies according to the underlying etiology and presence of complications.
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Affiliation(s)
- Aizaz A Shah
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Vemparala Priyatha
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Yamna Ali
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Abdul Wahab
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | - Junaid Ahmad
- Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Noman Salih
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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13
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Iannone G, Pompili E, De Venuto C, Pratelli D, Tedesco G, Baldassarre M, Caraceni P, Zaccherini G. The Role of Transjugular Intrahepatic Portosystemic Shunt for the Management of Ascites in Patients with Decompensated Cirrhosis. J Clin Med 2024; 13:1349. [PMID: 38592162 PMCID: PMC10932158 DOI: 10.3390/jcm13051349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
The development and progression of ascites represent a crucial event in the natural history of patients with cirrhosis, predisposing them to other complications and carrying a heavy impact on prognosis. The current standard of care for the management of ascites relies on various combinations of diuretics and large-volume paracenteses. Periodic long-term albumin infusions on top of diuretics have been recently shown to greatly facilitate the management of ascites. The insertion of a transjugular intrahepatic portosystemic shunt (TIPS), an artificial connection between the portal and caval systems, is indicated to treat patients with refractory ascites. TIPS acts to decrease portal hypertension, thus targeting an upstream event in the pathophysiological cascade of cirrhosis decompensation. Available evidence shows a significant benefit on ascites control/resolution, with less clear results on patient survival. Patient selection plays a crucial role in obtaining better clinical responses and avoiding TIPS-related adverse events, the most important of which are hepatic encephalopathy, cardiac overload and failure, and liver failure. At the same time, some recent technical evolutions of available stents appear promising but deserve further investigations. Future challenges and perspectives include (i) identifying the features for selecting the ideal candidate to TIPS; (ii) recognizing the better timing for TIPS placement; and (iii) understanding the most appropriate role of TIPS within the framework of all other available treatments for the management of patients with decompensated cirrhosis.
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Affiliation(s)
- Giulia Iannone
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Pompili
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Clara De Venuto
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Dario Pratelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Greta Tedesco
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
| | - Maurizio Baldassarre
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (G.I.); (E.P.); (C.D.V.); (D.P.); (G.T.); (P.C.)
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Vacaru A, Won MM, Raymond SL, Chamberlin JD, Radulescu A. Cloacal Dysgenesis Sequence in a Preterm Neonate. Am J Case Rep 2024; 25:e942203. [PMID: 38412145 PMCID: PMC10910718 DOI: 10.12659/ajcr.942203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/23/2024] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cloaca malformations result from a disproportion of apoptosis, cell growth, and maturation. The range of cloacal malformations is extensive and diverse, with a lack of a straightforward classification system. Cloacal dysgenesis sequence (CDS), also known as urorectal septum malformation sequence, is a rare cloaca variant described as the absence of a perineal orifice. Prenatal magnetic resonance imaging and antenatal ultrasounds may reveal a cloacal malformation; however, many patients are not diagnosed with cloacal malformation until birth. CASE REPORT We present a case of a female neonate delivered by a 23-year-old G2P1T1A0L0 mother who had received comprehensive prenatal care. During pregnancy, bilateral multicystic dysplastic kidneys were identified prenatally, leading to the in utero placement of a vesicoamniotic shunt. The physical exam revealed a distended abdomen with reduced abdominal musculature and laxity, ascites, a vesicoamniotic shunt in place, absent urethra, ambiguous genitalia with no vaginal opening, no perineal opening, and clubfoot. Abdominal radiograph showed findings consistent with significant abdominal ascites. An exploratory laparotomy was performed that included diverting colostomy, mucous fistula creation, tube vaginostomy, removal of the vesicoamniotic shunt, and suprapubic tube placement. The patient recovered well from this operation with no complications. CONCLUSIONS CDS is an uncommon condition in pediatric patients, and although sonographic findings can reveal urinary tract abnormalities, prenatal imaging might not always identify CDS. Our case underscores the uniqueness of the case and the significance of early detection and immediate medical and surgical intervention.
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Affiliation(s)
| | - Mitchell M. Won
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Steven L. Raymond
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Joshua D. Chamberlin
- Division of Pediatric Urology, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Andrei Radulescu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
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15
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Yang CJ, Song JS, Yoo JJ, Park KW, Yun J, Kim SG, Kim YS. 16S rRNA Next-Generation Sequencing May Not Be Useful for Examining Suspected Cases of Spontaneous Bacterial Peritonitis. Medicina (Kaunas) 2024; 60:289. [PMID: 38399576 PMCID: PMC10890036 DOI: 10.3390/medicina60020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/28/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Ascites, often associated with liver cirrhosis, poses diagnostic challenges, particularly in detecting bacterial infections. Traditional methods have limitations, prompting the exploration of advanced techniques such as 16S rDNA next-generation sequencing (NGS) for improved diagnostics in such low-biomass fluids. The aim of this study was to investigate whether the NGS method enhances detection sensitivity compared to a conventional ascites culture. Additionally, we aimed to explore the presence of a microbiome in the abdominal cavity and determine whether it has a sterile condition. Materials and Methods: Ten patients with clinically suspected spontaneous bacterial peritonitis (SBP) were included in this study. A traditional ascites culture was performed, and all ascites samples were subjected to 16S ribosomal RNA gene amplification and sequencing. 16S rRNA gene sequencing results were interpreted by comparing them to positive and negative controls for each sample. Results: Differential centrifugation was applied to all ascites samples, resulting in very small or no bacterial pellets being harvested. The examination of the 16S amplicon sequencing libraries indicated that the target amplicon products were either minimally visible or exhibited lower intensity than their corresponding negative controls. Contaminants present in the reagents were also identified in the ascites samples. Sequence analysis of the 16S rRNA gene of all samples showed microbial compositions that were akin to those found in the negative controls, without any bacteria isolated that were unique to the samples. Conclusions: The peritoneal cavity and ascites exhibit low bacterial biomass even in the presence of SBP, resulting in a very low positivity rate in 16S rRNA gene sequencing. Hence, the 16S RNA sequencing method does little to enhance the rate of positive samples compared to traditional culture methods, including in SBP cases.
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Affiliation(s)
- Chan Jin Yang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Ju Sun Song
- GC Genome, Department of Laboratory Medicine, Green Cross Laboratories, Youngin 16924, Republic of Korea;
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Keun Woo Park
- Preclinical Stroke Modeling Laboratory Weill Cornell Medicine, Burke Medical Research Institute, White Plains, NY 10605, USA;
| | - Jina Yun
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
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Hjortebjerg R, Høgdall C, Hansen KH, Høgdall E, Frystyk J. The IGF-PAPP-A-Stanniocalcin Axis in Serum and Ascites Associates with Prognosis in Patients with Ovarian Cancer. Int J Mol Sci 2024; 25:2014. [PMID: 38396692 PMCID: PMC10888379 DOI: 10.3390/ijms25042014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Pregnancy-associated plasma protein-A (PAPP-A) and PAPP-A2 modulate insulin-like growth factor (IGF) action and are inhibited by the stanniocalcins (STC1 and STC2). We previously demonstrated increased PAPP-A and IGF activity in ascites from women with ovarian carcinomas. In this prospective, longitudinal study of 107 women with ovarian cancer and ascites accumulation, we determined corresponding serum and ascites levels of IGF-1, IGF-2, PAPP-A, PAPP-A2, STC1, and STC2 and assessed their relationship with mortality. As compared to serum, we found highly increased ascites levels of PAPP-A (51-fold) and PAPP-A2 (4-fold). Elevated levels were also observed for IGF-1 (12%), STC1 (90%) and STC2 (68%). In contrast, IGF-2 was reduced by 29% in ascites. Patients were followed for a median of 38.4 months (range: 45 days to 8.9 years), during which 73 patients (68.2%) died. Overall survival was longer for patients with high serum IGF-1 (hazard ratio (HR) per doubling in protein concentration: 0.60, 95% CI: 0.40-0.90). However, patients with high ascites levels of IGF-1 showed a poorer prognosis (HR: 2.00 (1.26-3.27)). High serum and ascites IGF-2 levels were associated with increased risk of mortality (HR: 2.01 (1.22-3.30) and HR: 1.78 (1.24-2.54), respectively). Similarly, serum PAPP-A2 was associated with mortality (HR: 1.26 (1.08-1.48)). Our findings demonstrate the presence and activity of the IGF system in the local tumor ecosystem, which is likely a characteristic feature of malignant disease and plays a role in its peritoneal dissemination. The potential clinical implications are supported by our finding that serum levels of the proteins are associated with patient prognosis.
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Affiliation(s)
- Rikke Hjortebjerg
- Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark;
| | - Claus Høgdall
- Department of Gynecology, Juliane Marie Center, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Kristian Horsman Hansen
- Endocrine Research Unit, Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark;
- OPEN Lab, Odense University Hospital, 5000 Odense, Denmark
| | - Estrid Høgdall
- Department of Pathology, Herlev University Hospital, 2730 Herlev, Denmark;
| | - Jan Frystyk
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark;
- Endocrine Research Unit, Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark;
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Nakamura K, Sugeno M, Watahiki Y, Kanemitsu K. Peritoneal and Ovarian Tuberculosis with Massive Ascites. Intern Med 2024; 63:469-470. [PMID: 37344427 PMCID: PMC10901710 DOI: 10.2169/internalmedicine.2013-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Affiliation(s)
- Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, Japan
| | - Misa Sugeno
- Department of Gynecology and Obstetrics, Ohta-Nishinouchi Hospital, Japan
- Department of Gynecology and Obstetrics, Fukushima Medical University, Japan
| | - Yu Watahiki
- Department of Gastroenterology, Ohta-Nishinouchi Hospital, Japan
- Department of Gastroenterology, Fukushima Medical University, Japan
| | - Keiji Kanemitsu
- Department of Infection Control, Fukushima Medical University, Japan
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18
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Verma R, Sonier C, Rizvi N, Kashyap R. Multi-Drug-Resistant Tuberculosis Peritonitis: A Case Report. Cureus 2024; 16:e53975. [PMID: 38469015 PMCID: PMC10927249 DOI: 10.7759/cureus.53975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
The increasing incidence of tuberculosis raises concerns globally, impacting both developing and developed nations. Abdominal tuberculosis stands out as the most prevalent form of extrapulmonary tuberculosis. This case report details the diagnostic journey of a young male with abdominal TB complicated by concurrent HIV infection. The patient presented with night sweats and substantial weight loss, concurrently receiving a naive human immunodeficiency virus (HIV) diagnosis with an undetectable CD4 count. Imaging revealed abdominal lymphadenopathy concealing the pancreatic head while bronchoscopy unveiled TB in the lung. The patient faced septic shock and bilateral pulmonary embolism, possibly due to immune reconstitution inflammatory syndrome (IRIS). The patient then developed ascites, and a diagnosis of TB peritonitis was made based on low serum ascites albumin gradient (SAAG) and a positive acid-fast bacillus (AFB) result in the para-aortic lymph node. Treatment complexity arose from drug resistance to isoniazid and ethambutol.
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Affiliation(s)
- Rhea Verma
- Medicine, Drexel University College of Medicine, Philadelphia, USA
| | | | - Nida Rizvi
- Internal Medicine, WellSpan Health, York, USA
| | - Rahul Kashyap
- Medicine, Drexel University College of Medicine, Philadelphia, USA
- Research, Global Remote Research Program, St Paul, USA
- Critical Care Medicine, Mayo Clinic, Rochester, USA
- Research, WellSpan Health, York, USA
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Myers J, Howe M, Jia Z, Quinn K, Meaney C, Lokuge B, Parry N, Vaz D, Zeng J, Berman H. The Impact of a Point-of-Care Ultrasound (POCUS) Program to Diagnose and Manage Ascites in Home-based Palliative Care. J Am Med Dir Assoc 2024; 25:375-380. [PMID: 38000441 DOI: 10.1016/j.jamda.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE The objective of this study was to examine the impact of a point-of-care ultrasound (POCUS) program among people with ascites receiving home-based palliative care by measuring the association of POCUS with ascites-related days spent out of the home, compared with outcomes before POCUS implementation. DESIGN Open cohort study. SETTING AND PARTICIPANTS Adults who had an ascites-related procedure (ARP) between January 1, 2014, and December 31, 2015 (ie, pre-POCUS) and January 1, 2019, and December 31, 2020 (ie, POCUS). An ARP was defined as using ultrasound to diagnose suspected ascites or a paracentesis with or without ultrasound guidance to manage ascites. METHODS The main outcome was the rate of ascites-related days spent out of the home, defined as days out of the home for either ARPs or because of ascites-related hospital admissions, relative to the time patients were at risk for spending ascites-related days out of the home. RESULTS Among the 103 pre-POCUS patients (mean age 68.0; 50.4% female), there were 161 ARPs with 12.4% occurring at home. Among the 127 POCUS patients (mean age 74.0; 52.0% female) there were 193 ARPs with 82.4% occurring at home. POCUS was associated with a significantly lower rate of ascites-related days spent outside the home (pre-POCUS rate of 33 days per 1000 patient days vs POCUS rate of 9 days; unadjusted incidence rate ratio (IRR), 3.86; 95% CI, 2.95-5.12; P < .001; adjusted IRR, 3.83; 95% CI, 1.27-11.54; P = .02). POCUS was also associated with a higher likelihood of ARPs occurring in the home [unadjusted odds ratio (OR), 32.44; 95% CI, 18.15-59.90; P < .001; adjusted OR, 48.99; 95% CI, 21.04-114.10; P < .001]. CONCLUSIONS AND IMPLICATIONS The use of POCUS may contribute to maximizing time spent at home for palliative care patients with ascites. These findings support the use of POCUS for home-based palliative care programs.
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Affiliation(s)
- Jeff Myers
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.
| | - Marnie Howe
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Zhimeng Jia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Kieran Quinn
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Natalie Parry
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Desiree Vaz
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Joy Zeng
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Hershl Berman
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Yao J, Zhang S, Zhou F, Zhuang M, Fei S. The relationship between inflammatory cytokines and in-hospital complications of acute pancreatitis. Immun Inflamm Dis 2024; 12:e1203. [PMID: 38411379 PMCID: PMC10898203 DOI: 10.1002/iid3.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE Acute necrotic collection (ANC), acute peripancreatic fluid collection (APFC), pleural effusion, and ascites are common early complications of acute pancreatitis. This study aimed to investigate the relationship between 12 serum cytokines and the early complications and severity of acute pancreatitis (AP). METHODS We retrospectively analyzed the clinical data of 307 patients with AP, and divided them into severe group and mild-to-moderate group according to the revised Atlanta classification. Propensity score matching was used to control for confounding factors. Binary logistic regression analysis was used to explore the relationship between cytokine levels and early complications of AP. RESULTS Serum levels of interleukin (IL)-1β, IL-5, IL-6, IL-8, IL-10, IL-17, and tumor necrosis factor-α were significantly higher in the severe acute pancreatitis (SAP) group than in the non-SAP group (p < .05). After adjusting for confounding factors, the upper quartiles of IL-6, IL-8, and IL-10 were associated with an increased risk of ANC compared with those in the lowest quartile (IL-6: quartile 3, odds ratio [OR] = 3.99, 95% confidence interval [CI] = 1.95-8.16; IL-8: quartile 4, OR = 2.47, 95% CI = 1.27-4.84; IL-10: quartile 2, OR = 2.22, 95% CI = 1.09-4.56). APFC was associated with high serum levels of IL-6 (quartile 3, OR = 1.32, 95% CI = 1.02-1.72), pleural effusions were associated with high serum levels of IL-1β, IL-6, IL-8, and IL-10 (IL-1β: quartile 4, OR = 2.36, 95% CI = 1.21-4.58; IL-6: quartile 3, OR = 4.67, 95% CI = 2.27-9.61; IL-8: quartile 3, OR = 2.95, 95% CI = 1.51-5.79; IL-10: quartile 4, OR = 3.20, 95% CI = 1.61-6.36), and high serum levels of IL-6 and IL-10 were associated with an increased risk of ascites (IL-6: quartile 3, OR = 3.01, 95% CI = 1.42-6.37; IL-10: quartile 3, OR = 2.57, 95% CI = 1.23-5.37). CONCLUSION Serum cytokine levels, including IL-1β, IL-6, IL-8, and IL-10 may be associated with the occurrence of early complications of AP. In daily clinical practice, IL-6 may be the most worthwhile cytokine to be detected.
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Affiliation(s)
- Jiaxin Yao
- Department of Gastroenterology, Xuzhou Medical University, Xuzhou, China
| | - Shuangshuang Zhang
- Department of Gastroenterology, Xuzhou Medical University, Xuzhou, China
| | - Fei Zhou
- Department of Gastroenterology, Xuzhou Medical University, Xuzhou, China
| | - Mengting Zhuang
- Department of Gastroenterology, Xuzhou Medical University, Xuzhou, China
| | - Sujuan Fei
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Gastrointestinal Endoscopy, Xuzhou Medical University, Xuzhou, China
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Maehara K, Hijioka S, Takeshita K, Kanno A, Okusaka T. Viscosity and Characteristics of Malignant Ascites. Anticancer Res 2024; 44:533-542. [PMID: 38307583 DOI: 10.21873/anticanres.16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM Malignant ascites is a common condition in patients with terminal cancer. Treatments, such as diuretics, percutaneous drainage of ascites, and abdominal vein shunting have been advocated. However, these treatments have not achieved sufficient palliative effects. Therefore, the development of innovative therapies is mandated, especially for new therapies that require the creation of a fluid simulation of malignant ascites. However, there have been no previous studies on the physical properties of malignant ascites, including viscosity, which are necessary for the development of such a fluid. Therefore, we prospectively investigated the physical properties of malignant ascites. PATIENTS AND METHODS This single-center, prospective, observational study included 30 patients between November 2021 and January 2023. The primary endpoint was the viscosity of the malignant ascites, and the secondary endpoints included other viscosity studies, biochemical tests, and the presence of malignant cells in the ascites. RESULTS The median viscosity was 1.105 mPa*S. The viscosity of malignant ascites tended to decrease with increasing temperature, which is common for liquids. Malignant ascites fluid containing malignant cells tended to be more viscous than ascites fluid without malignant cells; furthermore, albumin levels tended to be higher in the former than in the latter. CONCLUSION Malignant ascites' median viscosity was 1.105 mPa*S. Correlation between viscosity and temperature showed a decreasing trend. These findings contribute valuable insights for future malignant ascites management and device development.
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Affiliation(s)
- Kosuke Maehara
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
- Division of Gastroenterology, Department of, Medicine, Jichi Medical University, Tochigi, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan;
| | - Kotaro Takeshita
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Atsushi Kanno
- Division of Gastroenterology, Department of, Medicine, Jichi Medical University, Tochigi, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
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22
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Miller A, Carney B, Shah S, Chen HW, Gougol A, Borhani A, Bataller R, Malik S, Rachakonda V. Liver surface nodularity and ascites are associated with mortality risk in acute alcohol-associated hepatitis. Alcohol Clin Exp Res (Hoboken) 2024; 48:273-282. [PMID: 38123167 DOI: 10.1111/acer.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Acute alcohol-associated hepatitis (AH) is associated with high mortality. CT-derived liver surface nodularity (LSN) is a robust prognostic biomarker in other chronic liver diseases. The aim of this study was to determine relationships between LSN, disease severity, and mortality in AH. METHODS Adults hospitalized with AH from January 2016 to March 2020 were included if an abdominal CT was performed between 8 weeks prior to 72 h after hospitalization. LSN was measured using quantitative methods (Liver Surface Nodularity Software version 0.88, Birmingham, AL, USA). Cox proportional hazards models, logistic regression and AUROC analysis were used to examine relationships between LSN and 180-day transplant-free survival. RESULTS Of 386 patients hospitalized with AH during the study period, 230 had CT scans performed, and 205 met inclusion criteria. Mean transplant-free survival was 127 days (95% CI 118-137). Within each cohort, patients were grouped into low [LSN-LOW, N = 109 (53.2%)] and high [LSN-HIGH, N = 96 (46.8%)] LSN strata based on an optimal cutoff of 2.86 derived from unadjusted ROC curves. Patients with high LSN had features of portal hypertension, which included encephalopathy [53 (55.2%) vs. 43 (39.4%), p = 0.017], ascites on CT [81 (84.4%) vs. 69 (63.3%), p = 0.001] and portosystemic shunts [78 (81.2%) vs. 69 (63.3%), p = 0.003]. High LSN, ascites and MELD were independently associated with lower likelihood of 180-day transplant-free survival, and inclusion of a score assigning 1 point each for high LSN or ascites on CT (AHRADS score) to MELD enhanced diagnostic accuracy of AUROC for 180-day survival compared to MELD alone [AUROC 0.782 (95% CI 0.719-0.845) vs. 0.735 (0.667-0.802), p = 0.023]. CONCLUSIONS CT-derived factors that include LSN and ascites are radiographic biomarkers associated with 180-day transplant-free survival in alcohol-associated hepatitis.
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Affiliation(s)
- Alex Miller
- Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Benjamin Carney
- Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Shivani Shah
- Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Hui-Wei Chen
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Amir Gougol
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Amir Borhani
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ramon Bataller
- Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Shahid Malik
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Vikrant Rachakonda
- Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, USA
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Ashritha A, Lal BB, Khanna R, Sood V, Sood AK, Alam S. Midodrine reduces new-onset acute kidney injury and hyponatremia in children with cirrhosis and ascites awaiting liver transplantation: Results from an open-label RCT. J Pediatr Gastroenterol Nutr 2024; 78:350-359. [PMID: 38374552 DOI: 10.1002/jpn3.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Midodrine, an oral α-1-adrenergic receptor agonist, counters arterial hypovolemia and reduces complications in adult patients with cirrhosis. This randomized controlled trial (RCT) aimed to assess the efficacy and safety of midodrine in preventing complications and improving survival in children with cirrhosis and ascites who are awaiting liver transplantation (LT). METHODS This open-label RCT conducted from January 2022 to May 2023 included children under 18 years with cirrhosis and ascites. Patients were randomized to receive either midodrine plus standard medical therapies (SMTs) or SMT alone. The primary outcome measure was the incidence of cirrhosis-related complications within 6 months. RESULTS Thirty-five subjects were enrolled and randomized. Patients in the midodrine arm had a lower incidence of new-onset acute kidney injury (AKI) compared with the SMT arm (11.1% vs. 41.2%). Patients in the midodrine arm showed a decline in serum creatinine and improvement in glomerular filtration rate, whereas no changes were observed in the SMT arm. There was a lower incidence of new-onset hyponatremia in the midodrine arm (20% vs. 56%). Midodrine led to reduction in plasma rennin activity (PRA) and improvement in systemic hemodynamics. There was no difference in the rate of resolution of ascites, recurrence of ascites, requirement of therapeutic paracentesis, cumulative albumin infusion requirement, episodes of spontaneous bacterial peritonitis, and hepatic encephalopathy between the two arms. CONCLUSION Midodrine, when added to SMT, was effective in reducing the incidence of new-onset AKI and hyponatremia in pediatric cirrhotics awaiting LT. It also improved systemic hemodynamics and showed a trend towards reducing PRA.
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Affiliation(s)
- A Ashritha
- Department of Pediatric Hepatology and Cardiology Section, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Bikrant B Lal
- Department of Pediatric Hepatology and Cardiology Section, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology and Cardiology Section, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikrant Sood
- Department of Pediatric Hepatology and Cardiology Section, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Arun K Sood
- Department of Pediatric Hepatology and Cardiology Section, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Seema Alam
- Department of Pediatric Hepatology and Cardiology Section, Institute of Liver and Biliary Sciences, New Delhi, India
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24
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Barron-Cervantes NM, Martinez-Esteban A, Nuccio-Giordano FM, Faes-Petersen R, D G Gidi A, Villegas-Tovar E. Anaplastic Carcinoma Arising From a Mural Nodule in Benign Mucinous Cystadenoma. Cureus 2024; 16:e53603. [PMID: 38449961 PMCID: PMC10915789 DOI: 10.7759/cureus.53603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Giant abdominopelvic tumors continue to present a diagnostic and therapeutic challenge for all surgeons despite all the advances in the world of imaging. Particularly, one of the most important challenges is to determine its probable origin for adequate surgical planning. Even though mostly all of these tumors are benign ovarian tumors, extraordinarily, malignant mural nodules may develop from the wall of these benign tumors, carrying an invariable unfavorable prognosis for the patient. This case highlights the importance of a correct diagnostic approach using ultrasound and abdominal computed tomography scans and confirming the diagnosis through a histopathologic examination. The treatment for these cases is surgical resection and posterior oncological treatment if needed. This case shows how timely treatment is one of the principal determinators of morbidity and mortality.
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Affiliation(s)
| | | | | | | | - Alejandro D G Gidi
- General and Gastrointestinal Surgery, Angeles Health System, Mexico City, MEX
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25
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Yonemura A, Semba T, Zhang J, Fan Y, Yasuda-Yoshihara N, Wang H, Uchihara T, Yasuda T, Nishimura A, Fu L, Hu X, Wei F, Kitamura F, Akiyama T, Yamashita K, Eto K, Iwagami S, Iwatsuki M, Miyamoto Y, Matsusaki K, Yamasaki J, Nagano O, Saya H, Song S, Tan P, Baba H, Ajani JA, Ishimoto T. Mesothelial cells with mesenchymal features enhance peritoneal dissemination by forming a protumorigenic microenvironment. Cell Rep 2024; 43:113613. [PMID: 38232734 DOI: 10.1016/j.celrep.2023.113613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/13/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
Malignant ascites accompanied by peritoneal dissemination contain various factors and cell populations as well as cancer cells; however, how the tumor microenvironment is shaped in ascites remains unclear. Single-cell proteomic profiling and a comprehensive proteomic analysis are conducted to comprehensively characterize malignant ascites. Here, we find defects in immune effectors along with immunosuppressive cell accumulation in ascites of patients with gastric cancer (GC) and identify five distinct subpopulations of CD45(-)/EpCAM(-) cells. Mesothelial cells with mesenchymal features in CD45(-)/EpCAM(-) cells are the predominant source of chemokines involved in immunosuppressive myeloid cell (IMC) recruitment. Moreover, mesothelial-mesenchymal transition (MMT)-induced mesothelial cells strongly express extracellular matrix (ECM)-related genes, including tenascin-C (TNC), enhancing metastatic colonization. These findings highlight the definite roles of the mesenchymal cell population in the development of a protumorigenic microenvironment to promote peritoneal dissemination.
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Affiliation(s)
- Atsuko Yonemura
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Takashi Semba
- Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Jun Zhang
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Yibo Fan
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Noriko Yasuda-Yoshihara
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
| | - Huaitao Wang
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Tomoyuki Uchihara
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
| | - Tadahito Yasuda
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
| | - Akiho Nishimura
- Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Lingfeng Fu
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Xichen Hu
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Feng Wei
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
| | - Fumimasa Kitamura
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
| | - Kohei Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | | | - Juntaro Yamasaki
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University, Tokyo 160-8582, Japan; Division of Gene Regulation, Cancer Center, Fujita Health University, Toyoake 470-1192, Japan
| | - Osamu Nagano
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University, Tokyo 160-8582, Japan; Division of Gene Regulation, Cancer Center, Fujita Health University, Toyoake 470-1192, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University, Tokyo 160-8582, Japan; Division of Gene Regulation, Cancer Center, Fujita Health University, Toyoake 470-1192, Japan
| | - Shumei Song
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patrick Tan
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Takatsugu Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; Gastrointestinal Cancer Biology, International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan; Division of Carcinogenesis, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
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Gonzalez-Garay AG, Serralde-Zúñiga AE, Velasco Hidalgo L, Flores García NC, Aguirre-Salgado MI. Transjugular intrahepatic portosystemic shunts for adults with hepatorenal syndrome. Cochrane Database Syst Rev 2024; 1:CD011039. [PMID: 38235907 PMCID: PMC10795102 DOI: 10.1002/14651858.cd011039.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Hepatorenal syndrome is a condition that occurs in people with chronic liver disease (such as alcoholic hepatitis, advanced cirrhosis, or fulminant liver failure) and portal hypertension. The prognosis is dismal, often with a survival of weeks to months. Hepatorenal syndrome is characterised by the development of intense splanchnic vasodilation favouring ascites and hypotension leading to renal vasoconstriction and acute renal failure. Therefore, treatment attempts focus on improving arterial pressure through the use of vasopressors, paracentesis, and increasing renal perfusion pressure. Several authors have reported that the placement of transjugular intrahepatic portosystemic shunts (TIPS) may be a therapeutic option because it decreases portal pressure and improves arterial and renal pressures. However, the evidence is not clearly documented and TIPS may cause adverse events. Accordingly, it is necessary to evaluate the evidence of the benefits and harms of TIPS to assess its value in people with hepatorenal syndrome. OBJECTIVES To evaluate the benefits and harms of transjugular intrahepatic portosystemic shunts (TIPS) in adults with hepatorenal syndrome compared with sham, no intervention, conventional treatment, or other treatments. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 2 June 2023. SELECTION CRITERIA We included only randomised clinical trials with a parallel-group design, which compared the TIPS placement with sham, no intervention, conventional therapy, or other therapies, in adults aged 18 years or older, regardless of sex or ethnicity, diagnosed with chronic liver disease and hepatorenal syndrome. We excluded trials of adults with kidney failure due to causes not related to hepatorenal syndrome, and we also excluded data from quasi-randomised, cross-over, and observational study designs as we did not design a separate search for such studies. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause mortality, 2. morbidity due to any cause, and 3. serious adverse events. Our secondary outcomes were 1. health-related quality of life, 2. non-serious adverse events, 3. participants who did not receive a liver transplant, 4. participants without improvement in kidney function, and 5. length of hospitalisation. We performed fixed-effect and random-effects meta-analyses using risk ratio (RR) or Peto odds ratio (Peto OR), with 95% confidence intervals (CI) for the dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for the continuous outcomes. We used GRADE to assess certainty of evidence. MAIN RESULTS We included two randomised clinical trials comparing TIPS placement (64 participants) versus conventional treatment (paracentesis plus albumin 8 g/L of removed ascites) (66 participants). The co-interventions used in the trials were dietary treatment (sodium less than 60 mmoL/day), spironolactone (300 mg/day to 400 mg/day), and furosemide (120 mg/day). Follow-up was up to 24 months. Both were multicentre trials from Spain and the USA, and Germany, conducted between 1993 and 2002. Most participants were men (aged 18 to 75 years). We are uncertain about the effect of TIPS placement compared with conventional treatment, during the first 24 months of follow-up, on all-cause mortality (RR 0.88, 95% CI 0.55 to 1.38; 2 trials, 130 participants; I2 = 58%; very low-certainty evidence) and on the development of any serious adverse event (RR 1.60, 95% CI 0.10 to 24.59; 2 trials, 130 participants; I2 = 78%; very low-certainty evidence). The use of TIPS may or may not result in a decrease in overall morbidity such as bacterial peritonitis, encephalopathy, or refractory ascites, during the first 24 months of follow-up, compared with the conventional treatment (RR 0.95, 95% CI 0.77 to 1.18; 2 trials, 130 participants; I2 = 0%; low-certainty evidence). We are uncertain about the effect of TIPS placement versus conventional treatment on the number of people who did not receive a liver transplant (RR 1.03, 95% CI 0.93 to 1.14; 2 trials, 130 participants; I2 = 0%; very low-certainty evidence) or on the length of hospitalisation (MD -20.0 days, 95% CI -39.92 to -0.08; 1 trial, 60 participants; very low-certainty evidence). Kidney function may improve in participants with TIPS placement (RR 0.53, 95% CI 0.27 to 1.02; 1 trial, 70 participants; low-certainty evidence). No trials reported health-related quality of life, non-serious adverse events, or number of participants with improvement in liver function associated with the TIPS placement. Funding No trials reported sources of commercial funding or conflicts of interest between researchers. Ongoing studies We found one ongoing trial comparing TIPS with conventional therapy (terlipressin plus albumin) and listed one study as awaiting classification as no full-text article could be found. AUTHORS' CONCLUSIONS TIPS placement was compared with conventional treatment, with a follow-up of 24 months, in adults with hepatorenal syndrome type 2. Based on two trials with insufficient sample size and trial limitations, we assessed the overall certainty of evidence as low or very low. We are unsure if TIPS may decrease all-cause mortality, serious adverse events, the number of people who did not receive a liver transplant, and the days of hospitalisation because of the very low-certainty evidence. We are unsure if TIPS, compared with conventional treatment, has better effects on overall morbidity (bacterial peritonitis, encephalopathy, or refractory ascites). TIPS may improve kidney function, but the certainty of evidence is low. The trials included no data on health-related quality of life, non-serious adverse events, and liver function associated with the TIPS placement. We identified one ongoing trial and one study awaiting classification which may contribute to the review when information becomes available.
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Affiliation(s)
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Nayelli Cointa Flores García
- Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ma Isabel Aguirre-Salgado
- Medical Library, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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27
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Yan L, Chu Z, Yang J, Zhang Y, Liu G, Lei Z, Chen Q, Li J, Yang J, Zhao M, Zhang S, Wu X, Peng X, Zhang H. Multiple cystic echinococcosis in abdominal and pelvic cavity treated by surgery with a 4-year follow-up: a case report. Front Med (Lausanne) 2024; 11:1276850. [PMID: 38304097 PMCID: PMC10830638 DOI: 10.3389/fmed.2024.1276850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
We report a case of a male patient who presented with multiple abdominal and pelvic echinococcosis. The patient had been diagnosed with hepatic echinococcosis for 7 years and developed intermittent distension and discomfort in the upper abdomen after an accidental fall. In recent years, the patient's abdominal distention increased gradually. Computed tomography revealed multiple hydatid cysts in the liver, spleen, abdominal cavity, and pelvic cavity. Abdominal organs were severely compressed, such that he could not eat normally except for a liquid diet. The patient underwent radical surgical resection based on the multi-disciplinary treatment (MDT) and the operation lasted 10 h, nearly 100 hydatid cysts were excised, about 18 liters of cyst fluid and cyst contents were removed, and the patient lost 20 kg of weight after surgery. The operation was successful, but there were still some postoperative complications such as hypovolemic shock, postoperative ascites, postoperative bile leakage. Treatment measures for the patient were anti-infection, antishock, clamping the abdominal drainage tube, and negative pressure abdominal puncture drainage. At follow up the patient's quality of life had been significantly improved with 15 kg weight gain compared to before.
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Affiliation(s)
- Lerong Yan
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
- School of Medicine of Shihezi University, Shihezi, China
| | - Zhiqiang Chu
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Jian Yang
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Yongguo Zhang
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Guisheng Liu
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Zhen Lei
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Qian Chen
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Jiang Li
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Jing Yang
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Meifeng Zhao
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Shijie Zhang
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Shihezi, China
- Xinjiang Production and Construction Corps Infectious Diseases Clinical Medical Research Center, Shihezi, China
| | - Xiangwei Wu
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Shihezi, China
- Xinjiang Production and Construction Corps Infectious Diseases Clinical Medical Research Center, Shihezi, China
| | - Xinyu Peng
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Shihezi, China
- Xinjiang Production and Construction Corps Infectious Diseases Clinical Medical Research Center, Shihezi, China
| | - Hongwei Zhang
- Department of Heaptobiliary Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Shihezi, China
- Xinjiang Production and Construction Corps Infectious Diseases Clinical Medical Research Center, Shihezi, China
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Vivarelli M, Mocchegiani F, Wakabayashi T, Gaudenzi F, Nicolini D, Al-Omari MA, Conte G, Borgheresi A, Agostini A, Rossi R, Fujiyama Y, Giovagnoni A, Wakabayashi G, Benedetti Cacciaguerra A. Prevention of Post-Hepatectomy Liver Failure in Cirrhotic Patients Undergoing Minimally Invasive Liver Surgery for HCC: Has the Round Ligament to Be Preserved? Cancers (Basel) 2024; 16:364. [PMID: 38254855 PMCID: PMC10814940 DOI: 10.3390/cancers16020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Post-hepatectomy liver failure (PHLF) represents a major cause of morbidity and mortality after liver resection. The factors related to PHLF are represented not only by the volume and function of the future liver remnant but also by the severity of portal hypertension. The aim of this study was to assess whether the preservation of the round ligament (RL) may mitigate portal hypertension, thus decreasing the risk of PHLF and ascites in cirrhotic patients while undergoing minimally invasive liver surgery (MILS). All the cirrhotic patients who underwent MILS for HCC from 2016 to 2021 in two international tertiary referral centers were retrospectively analyzed, comparing cases with the RL preserved vs. those with the RL divided. Only patients with cirrhosis ≥ Child A6, portal hypertension, and ICG-R15 > 10% were included. Main postoperative outcomes were compared, and the risk factors for postoperative ascites (severe PHLF, grade B/C) were investigated through a logistic regression. After the application of the selection criteria, a total of 130 MILS patients were identified, with 86 patients with the RL preserved and 44 with the RL divided. The RL-preserved group showed lower incidences of severe PHLF (7.0% vs. 20.5%, p = 0.023) and ascites (5.8% vs. 18.2%, p = 0.026) in comparison with the RL-divided group. After uni/multivariate analysis, the risk factors related to postoperative ascites were RL division and platelets < 92 × 103/µL, calculated with ROC analysis. The preservation of the round ligament during MILS may mitigate portal hypertension, preventing PHLF and ascites in cirrhotic patients with borderline liver function.
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Affiliation(s)
- Marco Vivarelli
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
| | - Federico Mocchegiani
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
| | - Taiga Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan; (T.W.); (M.A.A.-O.)
| | - Federico Gaudenzi
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
| | - Daniele Nicolini
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
| | - Malek A. Al-Omari
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan; (T.W.); (M.A.A.-O.)
| | - Grazia Conte
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Andrea Agostini
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Roberta Rossi
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
| | - Yoshiki Fujiyama
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan; (T.W.); (M.A.A.-O.)
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan; (T.W.); (M.A.A.-O.)
| | - Andrea Benedetti Cacciaguerra
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (M.V.); (F.G.); (D.N.); (A.B.C.)
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Shea AA, Heffron CL, Grieco JP, Roberts PC, Schmelz EM. Obesity modulates the cellular and molecular microenvironment in the peritoneal cavity: implication for ovarian cancer risk. Front Immunol 2024; 14:1323399. [PMID: 38264656 PMCID: PMC10803595 DOI: 10.3389/fimmu.2023.1323399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Abdominal obesity increases the risk of developing ovarian cancer but the molecular mechanisms of how obesity supports ovarian cancer development remain unknown. Here we investigated the impact of obesity on the immune cell and gene expression profiles of distinct abdominal tissues, focusing on the peritoneal serous fluid (PSF) and the omental fat band (OFB) as critical determinants for the dissemination of ovarian metastases and early metastatic events within the peritoneal cavity. Methods Female C57BL/6 mice were fed a low-fat (LFD) or a high-fat diet (HFD) for 12 weeks until the body weights in the HFD group were significantly higher and the mice displayed an impaired glucose tolerance. Then the mice were injected with the murine ovarian cancer cells (MOSE-LTICv) while remaining on their diets. After 21 days, the mice were sacrificed, tumor burden was evaluated and tissues were harvested. The immune cell composition of abdominal tissues and changes in gene expression in the PSF and OFB were evaluated by flow cytometry and qPCR RT2-profiler PCR arrays and confirmed by qRT-PCR, respectively. Other peritoneal adipose tissues including parametrial and retroperitoneal white adipose tissues as well as blood were also investigated. Results While limited effects were observed in the other peritoneal adipose tissues, feeding mice the HFD led to distinct changes in the immune cell composition in the PSF and the OFB: a depletion of B cells but an increase in myeloid-derived suppressor cells (MDSC) and mono/granulocytes, generating pro-inflammatory environments with increased expression of cyto- and chemokines, and genes supporting adhesion, survival, and growth, as well as suppression of apoptosis. This was associated with a higher peritoneal tumor burden compared to mice fed a LFD. Changes in cellular and genetic profiles were often exacerbated by the HFD. There was a large overlap in genes that were modulated by both the HFD and the cancer cells, suggesting that this 'genetic fingerprint' is important for ovarian metastases to the OFB. Discussion In accordance with the 'seed and soil' theory, our studies show that obesity contributes to the generation of a pro-inflammatory peritoneal environment that supports the survival of disseminating ovarian cancer cells in the PSF and the OFB and enhances the early metastatic adhesion events in the OFB through an increase in extracellular matrix proteins and modulators such as fibronectin 1 and collagen I expression as well as in genes supporting growth and invasion such as Tenacin C. The identified genes could potentially be used as targets for prevention strategies to lower the ovarian cancer risk in women with obesity.
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Affiliation(s)
- Amanda A. Shea
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Connie Lynn Heffron
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, VA, United States
| | - Joseph P. Grieco
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, United States
| | - Paul C. Roberts
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, VA, United States
| | - Eva M. Schmelz
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
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Oh SY, Woo HY, Lim L, Im H, Lee H, Lee JM, Hong SK, Choi Y, Yi NJ, Lee KW, Suh KS, Ryu HG. Comparison of postoperative ascites replacement strategies on time to first flatus after living donor liver transplantation: Albumin vs. lactated Ringer's solution. Clin Transplant 2024; 38:e15231. [PMID: 38289882 DOI: 10.1111/ctr.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION There is insufficient evidence regarding the optimal regimen for ascites replacement after living donor liver transplantation (LT) and its effectiveness. The aim of this study is to evaluate the impact of replacing postoperative ascites after LT with albumin on time to first flatus during recovery with early ambulation and incidence of acute kidney injury (AKI). METHODS Adult patients who underwent elective living donor LT at Seoul National University Hospital from 2019 to 2021 were randomly assigned to either the albumin group or lactated Ringer's group, based on the ascites replacement regimen. Replacement of postoperative ascites was performed for all patients every 4 h after LT until the patient was transferred to the general ward. Seventy percent of ascites drained during the previous 4 h was replaced over the next 4 h with continuous infusion of fluids with a prescribed regimen according to the assigned group. In the albumin group, 30% of a total of 70% of drained ascites was replaced with 5% albumin solution, and remnant 40% was replaced with lactated Ringer's solution. In the lactated Ringer's group, 70% of drained ascites was replaced with only lactated Ringer's solution. The primary outcome was the time to first flatus from the end of the LT and the secondary outcome was the incidence of AKI for up to postoperative day 7. RESULTS Among the 157 patients who were screened for eligibility, 72 patients were enrolled. The mean age was 63 ± 8.2 years, and 73.0 % (46/63) were male. Time to first flatus was similar between the two groups (66.7 ± 24.1 h vs. 68.5 ± 25.6 h, p = .778). The albumin group showed a higher glomerular filtration rate and lower incidence of AKI until postoperative day 7, compared to the lactated Ringer's group. CONCLUSIONS Using lactated Ringer's solution alone for replacement of ascites after living donor LT did not reduce the time to first flatus and was associated with an increased risk of AKI. Further research on the optimal ascites replacement regimen and the target serum albumin level which should be corrected after LT is required.
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Affiliation(s)
- Seung-Young Oh
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Young Woo
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Leerang Lim
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunjae Im
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hannah Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Geol Ryu
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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31
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Yu S, Yuan H, Cao Y. Caroli disease combined with Banti syndrome in a woman: a case report. J Int Med Res 2024; 52:3000605231221088. [PMID: 38190840 PMCID: PMC10775735 DOI: 10.1177/03000605231221086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024] Open
Abstract
Caroli disease is a rare congenital malformation that predisposes to segmental cystic dilatation of the intrahepatic bile ducts. Banti syndrome is characterized by persistent splenomegaly due to chronic congestion, resulting in a low hematocrit and ultimately leading to pancytopenia. In this report, we describe a 29-year-old woman who presented with a >20-year history of hepatitis B surface antigen positivity and a >1-year history of recurrent fatigue and malaise. On examination, the patient had abdominal distension with marked splenomegaly (7 cm below the ribs) and ascites with tenderness of the abdominal muscles to palpation. A complete blood count showed a low white blood cell count, red blood cell count, and hemoglobin concentration. During the course of treatment, the patient developed multiple symptoms of pancytopenia and concomitant splenomegaly, and she was discharged after total splenectomy with good recovery. The combination of Banti syndrome and Caroli disease results in severe symptoms of portal hypertension.
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Affiliation(s)
- Shian Yu
- Department of General Surgery, Nanchang University Affiliated Infectious Diseases Hospital, Nanchang, China
| | - Hang Yuan
- Department of General Surgery, Nanchang University Affiliated Infectious Diseases Hospital, Nanchang, China
| | - Yong Cao
- Department of General Surgery, Nanchang University Affiliated Infectious Diseases Hospital, Nanchang, China
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Li X, Li W, Wu Y, Liu Y. Varicose vein embolization and portal vein stenting in a patient with sinistral portal hypertension-induced gastrointestinal hemorrhage: a case report. Ann Med Surg (Lond) 2024; 86:485-488. [PMID: 38222742 PMCID: PMC10783337 DOI: 10.1097/ms9.0000000000001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/20/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Massive gastrointestinal hemorrhage is a severe hemorrhage that occurs in the gastrointestinal tract and is a life-threatening condition. Sinistral portal hypertension is a common etiology for massive gastrointestinal hemorrhage, whose occurrence might be derived from pathological changes induced by obstruction and/or increased blood flow to the portal vein system. However, there is a rare study reporting pancreatic disease-induced sinistral portal hypertension. Case presentation An 80-year-old female pancreatic cancer patient was admitted to our hospital on 22 January 2022 due to a massive gastrointestinal hemorrhage with shock after receiving radio-chemotherapy. Abdominal enhanced computerized tomography showed that the patient presented with pancreatic cancer-causing sinistral portal hypertension with massive collateral circulation, intrahepatic bile duct dilation, and the formation of massive ascites. Subsequent portography interventional procedure revealed the esophageal and gastric varix. Then, the varicose vein was embolized, and the stent was implanted at the lumen of the superior mesenteric vein accessing the portal vein. The patient recovered from pancreatic cancer-causing sinistral portal hypertension, and a normal direction of blood flow was observed in the superior mesenteric vein with a decreasing amount of ascites. In addition, a transfusion was also carried out, and the massive gastrointestinal hemorrhage was alleviated. Clinical discussion and conclusion This study emphasizes the successful treatment of massive gastrointestinal hemorrhage induced by pancreatic cancer-causing sinistral portal hypertension by varicose vein embolization and portal vein stenting, which could be considered an alternative opinion for these patients.
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Affiliation(s)
| | | | | | - Yuan Liu
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
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Pompili E, Baldassarre M, Bedogni G, Zaccherini G, Iannone G, De Venuto C, Pratelli D, Palmese F, Domenicali M, Caraceni P. Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study. Liver Int 2024; 44:72-82. [PMID: 37718730 DOI: 10.1111/liv.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/31/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND AND AIMS The PREDICT study recently showed that acutely decompensated (AD) patients with cirrhosis can present three different clinical phenotypes in the 90 days after admission: (1) pre-ACLF, developing acute-on-chronic liver failure (ACLF); (2) unstable decompensated cirrhosis (UDC), being re-admitted for AD without ACLF and (3) stable decompensated cirrhosis (SDC), not presenting readmission or ACLF. This study aimed to externally validate the existence of these three distinct trajectories and to identify predictors for the occurrence of each trajectory. METHODS Baseline data, 3-month ACLF and readmission incidence and 1-year survival were analysed in a prospective cohort of patients admitted for AD. A multinomial multivariable model was used to evaluate the association between baseline features and clinical trajectories. RESULTS Of the 311 patients enrolled, 55% met the criteria for SDC, 18% for UDC and 27% for pre-ACLF, presenting a significantly different 1-year mortality: pre-ACLF 65%, UDC 46%, SDC 21% (p < .001). The presence of hepatic encephalopathy (HE) was associated with UDC (p = .043), while the absence of ascites to SDC (p = .017). Among laboratory parameters, an increase in MELD-Na (p = .001) and C-reactive protein (p = .009) and a decrease in haemoglobin (p = .004) and albumin (p = .008) levels were associated with pre-ACLF. CONCLUSION The present study confirms that AD patients have three different clinical trajectories with different mortality rates. Besides the severity of cirrhosis, the association with C-reactive protein supports the predominant role of systemic inflammation in ACLF pathophysiology. Finally, HE is associated with the UDC phenotype highlighting the need for better management of this complication after discharge.
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Affiliation(s)
- Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Iannone
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Clara De Venuto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dario Pratelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Gianchandani Gyani SG, Yeola M, Keshwani RO, Gianchandani SG, Katariya P. Atypical Psuedo-Demons-Meigs Syndrome Presenting As Acute Dyspnoea With Pseudomembranous Colitis. Cureus 2024; 16:e52689. [PMID: 38384615 PMCID: PMC10879644 DOI: 10.7759/cureus.52689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/20/2024] [Indexed: 02/23/2024] Open
Abstract
Demons-Meigs syndrome is a rare clinical presentation of benign ovarian mass with hydrothorax and ascites. As ascites can be present in any ovarian mass, hydrothorax is a salient feature of the syndrome. The syndrome is subtyped as atypical in the absence of ascites from the triad. Nevertheless, it is labeled as pseudo-Demons-Meigs syndrome if the ovarian tumor is neoplastic rather than benign. The management of Demons-Meigs syndrome is complex and could be misleading due to pleural effusion and ascites, so an understanding of the syndrome is important. This case report is unique as it has two rare findings of neoplastic tumor and absence of ascites. Furthermore, this case is distinct as both ovaries are involved in malignant granulosa theca cell tumor with right-sided pleural effusion without ascites.
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Affiliation(s)
- Sanjeev G Gianchandani Gyani
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Minimal Access and Robotic Surgery, Anglia Ruskin University, Chelmsford, ARE
| | - Meenakshi Yeola
- General Surgery, All India Institute of Medical Sciences, Mangalgiri, Mangalgiri, IND
| | - Resha O Keshwani
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin G Gianchandani
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Katariya
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Perdigão S, Cunha R, Costa C, Sousa C, Teira A. Peritoneal Carcinomatosis: When Everything Is Not What It Seems. Cureus 2024; 16:e52924. [PMID: 38406146 PMCID: PMC10893882 DOI: 10.7759/cureus.52924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Malignant peritoneal mesothelioma (MPM) is a rare neoplasm with a low incidence rate worldwide but high morbidity and mortality rates. Due to its rarity, the studies are scarce. We present a case of a 73-year-old woman admitted to the internal medicine unit with constitutional syndrome, abdominal pain, and ascites. Throughout the investigation, aspects suggestive of peritoneal carcinomatosis were identified. An extensive study was then carried out in an attempt to identify the primary tumor, which proved to be unsuccessful. During the two weeks of hospitalization, the patient's clinical condition worsened, with an increase in ascites and a deterioration in her general health. This case was then discussed with an oncology consultant, and it was decided to biopsy a peritoneal implant with the support of interventional radiology. MPM was then diagnosed through histopathology. With this case, the authors intend to highlight that, although rare, this diagnosis should be considered when appropriate and that even in the suspicion of secondary disease, the primary tumor should always be identified, as localized MPM may be curable.
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Affiliation(s)
- Sofia Perdigão
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Rita Cunha
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Catarina Costa
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, PRT
| | - Cristiana Sousa
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Antonio Teira
- Oncology, Centro Hospitalar de Tras-os-Montes e Alto Douro, Chaves, PRT
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Singh B, Gupta P, Chatterjee D, Gupta N, Singh T, Dahiya D. Bugs' eyes and black monsters: Ascitic fluid cytology in an elderly male with hematochezia. Cytopathology 2024; 35:173-176. [PMID: 37828808 DOI: 10.1111/cyt.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
Anorectal malignant melanomas are rare, accounting for less than 2% of all melanomas. Malignant effusions developing secondary to malignant melanoma are highly uncommon. Herein, we present the cytomorphological features of a metastatic anorectal malignant melanoma presenting with ascites at the initial clinical presentation.
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Affiliation(s)
- Brijdeep Singh
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Dahiya
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jiang D, Liu X, Tan R, Zhu Y, Zhang L. Euphorbia factor L2 suppresses the generation of liver metastatic ascites in breast cancer via inhibiting NLRP3 inflammasome activation. Int J Mol Med 2024; 53:8. [PMID: 38063231 PMCID: PMC10712698 DOI: 10.3892/ijmm.2023.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
Metastasis is the leading cause of death in patients with breast cancer, in part due to the lack of effective treatments. Euphorbia factor L2 (EFL2) is a diterpenoid extracted from Euphorbia lathyris L. seeds, which has attracted increasing attention in recent years due to its anticancer effect. However, the role and molecular mechanism of EFL2 in breast cancer liver metastasis remain unclear. In the present study, a breast cancer liver metastasis model was constructed and the effect of EFL2 on ascites generation in mice was examined. H&E staining detected inflammatory cells and tumor cells in the liver, small intestine and tumor tissues. Western blotting and reverse transcription‑quantitative PCR were used to detect the protein and mRNA expression of NLR family pyrin domain containing‑3 (NLRP3) and related molecules in tumor tissues. Immunohistochemistry was used to detect the levels of CD4 and CD8 T cells in tumor tissue and immunofluorescence was used to further detect the expression level of NLRP3. Finally, the aforementioned experiments were further verified by overexpressing NLPR3. It was found that EFL2 inhibited generation of ascites in the model in a dose‑dependent manner. Furthermore, EFL2 inhibited tumor cell metastasis and enhanced immune cell infiltration. Meanwhile, EFL2 dose‑dependently downregulated the mRNA and protein expression of NLRP3 and related molecules in the model, and overexpression of NLRP3 abolished these beneficial effects of EFL2. Taken together, the present experimental data suggested that EFL2 has a significant inhibitory effect on ascites of breast cancer liver metastasis in vivo, which may inhibit tumor cell metastasis by downregulating NLRP3 expression, providing an experimental basis for treating breast cancer metastasis.
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Affiliation(s)
- Dongjing Jiang
- Traditional Chinese Medicine and Research Office, Suzhou Vocational Health College, Suzhou, Jiangsu 215000, P.R. China
| | - Xun Liu
- Traditional Chinese Medicine and Research Office, Suzhou Vocational Health College, Suzhou, Jiangsu 215000, P.R. China
| | - Rulan Tan
- Traditional Chinese Medicine and Research Office, Suzhou Vocational Health College, Suzhou, Jiangsu 215000, P.R. China
| | - Ye Zhu
- Traditional Chinese Medicine and Research Office, Suzhou Vocational Health College, Suzhou, Jiangsu 215000, P.R. China
| | - Li Zhang
- Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine and Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
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38
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Rodrigues Barbosa B, Pereira L, Campante F, Pona AP. Chronic Liver Disease, Not Everything Is What It Seems: Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome. Cureus 2024; 16:e51630. [PMID: 38313999 PMCID: PMC10837645 DOI: 10.7759/cureus.51630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Overlap syndrome (OS) is a rare condition that shares characteristics of at least two other recognized diseases, whose early diagnosis impacts treatment decisions and prognosis since the unfavorable course of the OS seems to be worse than that of the diseases alone. OS in autoimmune liver diseases combines characteristic features of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis. AIH is a chronic, inflammatory disease of the liver that occurs predominantly in females. The disease may start as acute hepatitis and progress to chronic liver disease and cirrhosis. PBC is characterized by a T-lymphocyte-mediated attack on small intralobular bile ducts. A continuous assault on the bile duct epithelial cells leads to their gradual destruction and eventual disappearance. The sustained loss of intralobular bile ducts causes the signs and symptoms of cholestasis and eventually may result in cirrhosis and liver failure. With treatment with ursodeoxycholic acid, the majority of patients now have normal life expectancies. The authors report a subtype of OS, i.e., AIH-PBC overlap, characterized by elevated serum transaminases, cholestasis markers, antimitochondrial antibodies (AMAs), and histological findings compatible with AIH, including moderate-to-severe interface hepatitis. The authors present a clinical case referred for internal medicine consultation regarding a 73-year-old woman presenting pancytopenia and increased transaminases, along with weight loss, decreased appetite, and tiredness. Laboratory tests were positive for the following parameters: antinuclear antibody, anti-double-stranded DNA antibody, AMA, anti-glycoprotein-210, and anti-smooth muscle antibody (anti-actin). Computed tomography of the abdomen displayed chronic liver disease and evidence of small perihepatic ascites. The diagnosis was established with a liver biopsy revealing architectural alteration with severe advanced fibrosis, with bridges and parenchymal nodularity, and histological parenchymal changes of progressive chronic liver disease (chronic biliary disease/PBC) in the stage of cirrhosis. With proper treatment, the condition of the patient significantly improved.
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Affiliation(s)
| | - Laurinda Pereira
- Department of Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Fátima Campante
- Department of Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Ana Paula Pona
- Department of Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
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Tapper EB, Zhao Z, Parikh ND. An Emulated Clinical Trial of Deprescribing Proton Pump Inhibitors in Patients With Cirrhosis. Am J Gastroenterol 2024; 119:203-205. [PMID: 37561055 PMCID: PMC10840882 DOI: 10.14309/ajg.0000000000002462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Proton pump inhibitors (PPI) are overused and carry harms in cirrhosis. Deprescribing is advocated but has not been trialed. METHODS AND FINDINGS We emulated a clinical trial using Medicare data. All patients were receiving chronic PPI therapy before a compensated cirrhosis diagnosis. We compared the risk death/decompensation over 3 years between continuous users and deprescribers. We find that PPI deprescription is associated with less ascites and that cumulative PPI use is associated with more ascites and encephalopathy. Ultimately, 71% of deprescribers restart PPIs. DISCUSSION PPI deprescribing has benefits but requires ongoing support and alternative therapies for gastrointestinal symptoms.
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Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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Liu C, Li Y, Li Y, Hu M, Wang H, Lu S, Li Z, Dilimulati D, Jiao S, Lu S, Zhao W. Sufficiently activated mature natural killer cells derived from peripheral blood mononuclear cells substantially enhance antitumor activity. Immun Inflamm Dis 2024; 12:e1143. [PMID: 38270321 PMCID: PMC10777885 DOI: 10.1002/iid3.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Peripheral blood-derived natural killer (NK) cells spontaneously lyse tumor cells without prior sensitization. However, NK cells in peripheral blood (PBNK cells) are in a resting state and exhibit inhibitory phenotypes and impaired cytotoxicity. Thus, strengthening the cytotoxic effector function of PBNK cells and improving NK cell expansion in vitro for a convenient allogeneic therapy are essential. MATERIALS AND METHODS Pure cytokine activation and expansion of NK cells (super NK [SNK]) from peripheral blood mononuclear cells were studied. Markers of activated and inhibited NK cells and cytokine secretion by NK cells were examined using flow cytometry. NK cell antitumor activity in vitro was assessed using lactate dehydrogenase (LDH) cytotoxicity assay and an Incucyte real-time imaging system. Additionally, the function of SNK cells against ascites caused by ovarian cancer in NOD-Prkdc(em26Cd52)il2rg(em26Cd22)/Nju (NCG) mice was determined. In a further investigation of the differences between PBNK and SNK, the mRNA of both cells was sequenced and analyzed. RESULTS Human peripheral blood mononuclear cells showed selective NK cell expansion upon cytokine activation and culture. Both SNK and PBNK cells expressed activation markers, but at different levels, and SNK cells secreted more cytokines related to cytotoxicity than PBNK cells did. Accordingly, SNK cells exhibited strong antitumor activity ex vivo and improved NCG mice survival after intraperitoneal ovarian cancer transplantation. Mechanistically, SNK cells expressed more genes associated with nucleotide metabolism, fatty acid, and ATP metabolism than PBNK cells. CONCLUSION SNK cells derived from peripheral blood mononuclear cells have sufficiently activated mature characteristics and high antitumor activity, rendering them a highly promising and essential therapeutic approach for cancer treatment.
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Affiliation(s)
- Chuanling Liu
- Department of OncologyChinese PLA General HospitalBeijingChina
| | - Yingying Li
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Yanrong Li
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Meng Hu
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Haiyan Wang
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Shasha Lu
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Zhao Li
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Dilinuer Dilimulati
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Shunchang Jiao
- Department of OncologyChinese PLA General HospitalBeijingChina
| | - Shelian Lu
- Research and Development DepartmentBeijing DCTY® Biotech Co., LtdBeijingChina
| | - Weihong Zhao
- Department of OncologyChinese PLA General HospitalBeijingChina
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41
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Li N, Xu M, Liu SY, Yu MQ, Ruan CF. Risk factors for hospital readmission among patients with cirrhosis and ascites in China: a retrospective observational study. J Int Med Res 2024; 52:3000605231223087. [PMID: 38258740 PMCID: PMC10807325 DOI: 10.1177/03000605231223087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE In this investigation, we aimed to explore risk factors for 90-day hospital readmission among patients with cirrhosis and ascites in an Asian population. METHODS In this retrospective study, we included consecutive patients diagnosed with cirrhosis and ascites hospitalized in Renji Hospital between 2018 and 2022 to elucidate risk factors for 90-day readmission. We conducted multivariate logistic regression analysis to identify readmission risk factors. RESULTS We included 265 patients with cirrhosis and ascites. A 43% readmission rate was observed within 90 days. After adjustment for multiple covariates, we found that readmission within 90 days was independently linked to reduced levels of hemoglobin (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.97) and serum albumin (OR 0.88, 95% CI 0.83-0.93), and higher Model for End-Stage Liver Disease and sodium (MELD-Na) scores (OR 1.04, 95% CI 1.01-1.07) at discharge. CONCLUSIONS Patients with cirrhosis who have ascites are frequently rehospitalized within 90 days after discharge. Lower hemoglobin or albumin and higher MELD-Na scores at discharge may be the main risk factors for hospital readmission.
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Affiliation(s)
- Na Li
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei Xu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shi-Ying Liu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Qin Yu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chun-Feng Ruan
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Rebordão-Pires M, Estrada MF, Gomes A, Silva F, Baptista C, Ramos MJ, Fortuna A, Simões P, Sousa G, Marreiros A, Fior R. Relapsed Ovarian Cancer Patients with Ascites and/or Pleural Effusion Still Benefit from Treatment: A Real-Life Study. Cancers (Basel) 2023; 16:162. [PMID: 38201589 PMCID: PMC10778384 DOI: 10.3390/cancers16010162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Relapsed HGSOC with ascites and/or pleural effusion is a poor-prognostic population and poorly represented in clinical studies. We questioned if these patients are worth treating. In other words, if these patients received the most effective treatment, would it change the course of this disease? To our knowledge this is the first real-life study to evaluate this question in this low-survival population. (2) Methods: To tackle this question we performed a retrospective, multi-centric, real-life study, that reviewed relapsed HGSOC patients with ascites and/or pleural effusion. Our rationale was to compare the OS of two groups of patients: responders, i.e., patients who had an imagological response to treatment (complete/partial response/stable disease, RECIST criteria) versus non-responders (no response/progression upon treatment). We evaluated the predictive value of clinical variables that are available in a real-life setting (e.g., staging, chemotherapy, surgery, platinum-sensitivity). Multivariate logistic regression and survival analysis was conducted. A two-step cluster analysis SPSS tool was used for subgroup analysis. Platinum sensitivity/resistance was also analyzed, as well as multivariate and cluster analysis. (3) Results: We included 57 patients, 41.4% first line responders and 59.6% non-responders. The median OS of responders was 23 months versus 8 months in non-responders (p < 0.001). This difference was verified in platinum-sensitive (mOS 28 months vs. 8 months, p < 0.001) and platinum-resistant populations (mOS 16 months vs. 7 months, p < 0.001). Thirty-one patients reached the second line, of which only 10.3% responded to treatment. Three patients out of thirty-one who did not respond in the first line of relapse, responded in the second line. In the second line, the mOS for the responders' group vs. non-responders was 31 months versus 13 months (p = 0.02). The two step cluster analysis tool found two different subgroups with different prognoses based on overall response rate, according to consolidation chemotherapy, neoadjuvant chemotherapy, FIGO staging and surgical treatment. Cluster analysis showed that even patients with standard clinical and treatment variables associated with poor prognosis might achieve treatment response (the opposite being also true). (4) Conclusions: Our data clearly show that relapsed HGSOC patients benefit from treatment. If given an effective treatment upfront, this can lead to a ~3 times increase in mOS for these patients. Moreover, this was irrespective of patient disease and treatment characteristics. Our results highlight the urgent need for a sensitivity test to tailor treatments and improve efficacy rates in a personalized manner.
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Affiliation(s)
- Mariana Rebordão-Pires
- Medical Oncology Unit, Instituto Português De Oncologia De Coimbra Francisco Gentil, 3000-075 Coimbra, Portugal; (M.R.-P.); (G.S.)
| | - Marta F. Estrada
- Cancer Development and Innate Immune Evasion Laboratory, Champalimaud Foundation, 1400-038 Lisboa, Portugal
| | - António Gomes
- Surgery Unit, Hospital Vila Franca de Xira, 2600-153 Vila Franca de Xira, Portugal;
| | - Filipa Silva
- Gynecology Unit, Champalimaud Foundation, 1400-038 Lisboa, Portugal;
| | - Carlota Baptista
- Medical Oncology Unit, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal; (C.B.); (P.S.)
| | - Maria João Ramos
- Medical Oncology Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal;
| | - Ana Fortuna
- Medical Oncology Unit, Centro Hospitalar do Algarve, 8500-338 Portimão, Portugal;
| | - Pedro Simões
- Medical Oncology Unit, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal; (C.B.); (P.S.)
| | - Gabriela Sousa
- Medical Oncology Unit, Instituto Português De Oncologia De Coimbra Francisco Gentil, 3000-075 Coimbra, Portugal; (M.R.-P.); (G.S.)
| | - Ana Marreiros
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal;
- Algarve Biomedical Center Research Institute, University of Algarve, 8005-139 Faro, Portugal
| | - Rita Fior
- Cancer Development and Innate Immune Evasion Laboratory, Champalimaud Foundation, 1400-038 Lisboa, Portugal
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Du L, Wei N, Maiwall R, Song Y. Differential diagnosis of ascites: etiologies, ascitic fluid analysis, diagnostic algorithm. Clin Chem Lab Med 2023; 0:cclm-2023-1112. [PMID: 38112289 DOI: 10.1515/cclm-2023-1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
Ascites is the pathological accumulation of fluid within the peritoneal cavity. It often occurs as results of liver cirrhosis, malignant neoplasia, tuberculous infection, cardiac insufficiency, renal diseases, etc. Determining the etiology is an essential step in the management of patients with new-onset ascites. Abdominal paracentesis with appropriate ascitic fluid analysis is probably the most cost-effective method of determining the cause of ascites. We performed a literature search of PubMed and identified articles published in the field of ascites, to evaluate diagnostic values of various parameters in defining the etiologies of ascites and then provides diagnostic algorithm for patients with new-onset ascites. In patients with ascites, the constituent ratio of underlying etiology varies between developed and developing countries. It is a challenge to define the etiologies of ascites in developing countries. Routine ascitic fluid analysis should include the serum ascites albumin gradient (SAAG), total protein concentration, cell count and differential. Optional ascitic fluid analysis includes cholesterol, fluid culture, cytology, tumor markers, lactate dehydrogenase, adenosine deaminase (ADA), triglyceride, amylase, glucose, brain natriuretic peptide (BNP), etc. Our review evaluated diagnostic values of the above parameters in defining the etiologies of ascites. Diagnostic algorithm established in this review would provide a practical and convenient diagnostic strategy for clinicians in diagnosing patients with new-onset ascites.
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Affiliation(s)
- Li Du
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ning Wei
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yuhu Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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Friis KH, Thomsen KL, Laleman W, Montagnese S, Vilstrup H, Lauridsen MM. Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy-A Review of the Past Decade's Literature Focusing on Incidence, Risk Factors, and Prophylaxis. J Clin Med 2023; 13:14. [PMID: 38202028 PMCID: PMC10779844 DOI: 10.3390/jcm13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its' complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE over the past decade. Incidence varies widely (7-61%), with factors like age, liver function, hyponatremia, and spontaneous portosystemic shunts influencing risk. Procedural aspects, including TIPS timing, indication, and stent characteristics, also contribute. Pharmacological prophylaxis with lactulose and rifaximin shows promise, but current evidence is inconclusive. Procedural preventive measures, such as shunt embolization and monitoring portal pressure gradients, are explored. Treatment involves pharmacological options like lactulose and rifaximin, and procedural interventions like stent diameter reduction. Ongoing studies on novel predictive markers and emerging treatments, such as faecal microbiota transplant, reflect the evolving landscape in post-TIPS HE management. This concise review provides clinicians with insights into the multifaceted nature of post-TIPS HE, aiding in improved risk assessment, prophylaxis, and management for patients undergoing TIPS procedures.
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Affiliation(s)
- Karina Holm Friis
- Department of Gastroenterology and Hepatology, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Karen Louise Thomsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Sara Montagnese
- Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Mette Munk Lauridsen
- Department of Gastroenterology and Hepatology, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
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Wahab A, Sapkota K, Jayakumar K, Syed EUR, Amin RU, Ullah H, Khan N. Unexplained Chronic Liver Disease and Hemolytic Anemia in a Young Girl: A Case of Wilson's Disease. Cureus 2023; 15:e50724. [PMID: 38234952 PMCID: PMC10792352 DOI: 10.7759/cureus.50724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Wilson's disease (WD) is an autosomal recessive disorder affecting the metabolism of copper that can present with a variety of clinical symptoms. Low levels of serum copper and ceruloplasmin, increased excretion of copper in the urine, and/or increasing quantities of copper in the liver are diagnostic indicators. The gold standard for diagnosis is genetic testing. The care approach includes the utilization of liver transplants as a therapeutic option in advanced patients and the use of copper-chelating medications. We describe a unique case of WD in a 14-year-old girl who presented with ascites, hemolytic anemia, and liver dysfunction. There was no indication of abdominal TB, and her viral, autoimmune, and hemolytic profiles were all normal. Low serum ceruloplasmin, elevated urine copper, and distinctive liver histology all supported the WD diagnosis. After starting penicillamine medication, the patient's symptoms improved, but her blood counts did not. This example emphasizes how crucial it is to rule out WD in patients with chronic liver disease, hemolytic anemia, and unexplained ascites, particularly in younger age groups.
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Affiliation(s)
- Abdul Wahab
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Kriti Sapkota
- Internal Medicine, Medical University of Gdańsk, Gdańsk, POL
| | | | | | - Rooh Ul Amin
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Hidayat Ullah
- Medical Unit, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Nauman Khan
- Internal Medicine, Khyber Medical College, Peshawar, PAK
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Gomes Santos P, Calças Marques R, Martins Dos Santos P, Carreira da Costa C, Mogildea M. Ascites, Pleural, and Pericardial Effusion in Primary Hypothyroidism: A Rare Case Report. Cureus 2023; 15:e50429. [PMID: 38222246 PMCID: PMC10784868 DOI: 10.7759/cureus.50429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Hypothyroidism is caused by a deficiency of thyroid hormones and is a common endocrine disorder worldwide. It can affect nearly every organ, resulting in multiple clinical manifestations. Ascites, pleural effusion, and pericardial effusion, although less frequent than peripheral edema, can also be present. These manifestations are thought to be caused by increased vascular permeability to albumin, extravasation of mucopolysaccharides, and inappropriate antidiuretic hormone secretion. Most effusions in hypothyroid patients resolve with thyroxine replacement therapy. However, due to the insidious and nonspecific nature of these symptoms, hypothyroidism is seldom considered a differential diagnosis. We report a case of a 48-year-old male with pericardial effusion, pleural effusion, and ascites due to primary hypothyroidism. Although isolated effusions can be frequent in patients with hypothyroidism, the presentation of Hashimoto's thyroiditis as a combination of pericardial effusion, pleural effusion, and ascites is extremely rare. With this case report, we highlight the importance of considering hypothyroidism as a possible cause of unexplained polyserositis, even in the absence of other signs and symptoms.
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Affiliation(s)
- Pedro Gomes Santos
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Hospital de Faro, Faro, PRT
| | | | | | | | - Mihail Mogildea
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Hospital de Faro, Faro, PRT
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Kim BK, Bergstrom J, Loomba R, Tamaki N, Izumi N, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Truong E, Yang JD, Noureddin M, Allen AM, Loomba R, Ajmera V. Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study. Hepatology 2023; 78:1858-1866. [PMID: 37203233 PMCID: PMC10663382 DOI: 10.1097/hep.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD. APPROACH AND RESULTS This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts ( p < 0.05). CONCLUSIONS An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
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Affiliation(s)
- Beom Kyung Kim
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaclyn Bergstrom
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Rohan Loomba
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey
| | - Mesut Gumussoy
- Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey
| | - Digdem Kuru Oz
- Ankara University School of Medicine, Department of Radiology, Ankara Turkey
| | - Ayse Erden
- Ankara University School of Medicine, Department of Radiology, Ankara Turkey
| | - Emily Truong
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Ju Dong Yang
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Mazen Noureddin
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- School of Public Health, University of California, San Diego
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
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Miceska S, Skof E, Bucek S, Kuhar CG, Gasljevic G, Smrkolj S, Prevodnik VK. The prognostic significance of tumor-immune microenvironment in ascites of patients with high-grade serous carcinoma. Radiol Oncol 2023; 57:493-506. [PMID: 38038414 PMCID: PMC10690755 DOI: 10.2478/raon-2023-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND High-grade serous carcinoma (HGSC) is often associated with ascites at presentation. Our objective was to quantify immune cells (ICs) in ascites prior to any treatment was given and evaluate their impact on progression-free survival (PFS) and overall survival (OS). PATIENTS AND METHODS Forty-seven patients with primary HGSC and ascites were included. Flow-cytometric analysis was performed to detect percentages of CD3+ T cells (CD4+, CD8+, Tregs, and NKT cells), B cells, NK cells (CD56brightCD16- and CD56dimCD16+ subsets), macrophages and dendritic cells (DCs). Furthermore, CD103 expression was analyzed on T cells and their subsets, while PD-1 and PD-L1 expression on all ICs. Cut-off of low and high percentages of ICs was determined by the median of variables, and correlation with PFS and OS was calculated. RESULTS CD3+ cells were the predominant ICs (median 51%), while the presence of other ICs was much lower (median ≤10%). CD103+ expression was mostly present on CD8+, and not CD4+ cells. PD-1 was mainly expressed on CD3+ T cells (median 20%), lower expression was observed on other ICs (median ≤10%). PD-L1 expression was not detected. High percentages of CD103+CD3+ T cells, PD-1+ Tregs, CD56brightCD16- NK cells, and DCs correlated with prolonged PFS and OS, while high percentages of CD8+ cells, macrophages, and PD-1+CD56brightCD16- NK cells, along with low percentages of CD4+ cells, correlated with better OS only. DCs were the only independent prognostic marker among all ICs. CONCLUSIONS Our results highlight the potential of ascites tumor-immune microenvironment to provide additional prognostic information for HGSC patients. However, a larger patient cohort and longer follow-up are needed to confirm our findings.
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Affiliation(s)
- Simona Miceska
- Department of Cytopathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Erik Skof
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Simon Bucek
- Department of Cytopathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Cvetka Grasic Kuhar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gorana Gasljevic
- Department of Pathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Spela Smrkolj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Division of Gynaecology and Obstetrics, University Medical Centre, Ljubljana, Slovenia
| | - Veronika Kloboves Prevodnik
- Department of Cytopathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Ahmed M, Islam M, Gogokhia L, Borz-Baba C, Wakefield D, Jakab SS. Hospital Utilization for Patients With Cirrhosis and Severe Ascites in a Model of Outpatient Paracentesis by Interventional Radiology. Cureus 2023; 15:e51397. [PMID: 38292997 PMCID: PMC10826452 DOI: 10.7759/cureus.51397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Paracentesis is currently performed by interventional radiologists (IR) rather than gastroenterologists/hepatologists or internists. In this model of care, there is usually no evaluation of patients' renal function or adjustment of their medications at the time of paracentesis. The objectives of this study were to analyze hospital utilization and cirrhosis complications within six months of index outpatient paracentesis by IR and to identify potential areas of improvement in care. METHODS This is a retrospective study of patients with cirrhosis and ascites who underwent outpatient paracentesis by IR between October 15, 2015, and October 15, 2018, at a tertiary academic medical center. We collected demographics, data on cirrhosis etiology/complications, laboratory tests, provider notes, outpatient paracentesis dates, emergency department (ED) visits, hospitalizations, and ICU admissions within the following six months post index paracentesis. Associations between categorical predictors and clinical outcomes were analyzed using the chi-square test. Associations between quantitative predictors and clinical outcomes were analyzed using the Wilcoxon rank sum test. RESULTS Our study included 69 unique patients who had at least one outpatient encounter for paracentesis by IR in the study period. Most patients were men (71%), had alcohol-related cirrhosis as primary etiology (53.6%), an average age of 60 years, and an average Model for End-Stage Liver Disease-sodium (MELDNa) score at baseline of 16. Within six months from index paracentesis, 44 patients (64.7%) underwent repeat IR outpatient paracentesis (total 187 paracenteses, 4.25 paracenteses/patient), 43 patients (62.3%) had ER visits (total 118 ER visits, 2.8/patient), 41 patients (59.4%) had hospital admissions (total 88 admissions, 2.2/patient), and 11 patients required ICU admission. Complications of cirrhosis noted during follow-up included hepatic encephalopathy (40.5%), acute kidney injury (38.2%), upper gastrointestinal (UGI) bleeding (16%), and spontaneous bacterial peritonitis (SBP) in 15%. The mortality rate at six months was 20%. On multivariate analysis, the predictive factors for mortality were older age (p = 0.03) and MELDNa score (p = 0.02). Baseline MELDNa was predictive of acute kidney injury (p = 0.02), UGI bleed (p < 0.01), and ICU admission (p < 0.01), but not of SBP, encephalopathy, ED visit, or hospital admissions. Among patients with more than one paracentesis (64%),six patients underwent transjugular portosystemic shunt (TIPS), but there was no documentation of TIPS consideration in 31 patients (70.4%). A total of 20 patients (29%) were waitlisted for liver transplantation. CONCLUSION In this contemporary cohort of patients with cirrhosis undergoing outpatient IR paracentesis, we found a high rate of short-term cirrhosis complications and hospital utilization, while TIPS consideration was very low. Further data are needed to identify specific gaps in care, but IR paracentesis should be integrated within a multidisciplinary management model, with emphasis on early TIPS in eligible patients, as recommended by the current practice guidelines.
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Affiliation(s)
- Mustajab Ahmed
- Internal Medicine, Saint Mary's Hospital, Waterbury, USA
| | - Masuma Islam
- Internal Medicine, Saint Mary's Hospital, Waterbury, USA
| | - Lasha Gogokhia
- Gastroenterology and Hepatology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, USA
| | | | - Dorothy Wakefield
- Statistics, Department of Research, Saint Francis Hospital & Medical Center, Hartford, USA
| | - Sofia S Jakab
- Gastroenterology and Hepatology, Yale School of Medicine, New Haven, USA
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50
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Berger JM, Alany A, Berchtold L, Puhr R, Friedrich A, Scheiner B, Prager GW, Preusser M, Berghoff AS, Bergen ES. Prognosticators of survival in patients with metastatic pancreatic cancer and ascites. ESMO Open 2023; 8:102048. [PMID: 37977000 PMCID: PMC10774951 DOI: 10.1016/j.esmoop.2023.102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identification of factors associated with survival after ascites diagnosis in metastatic pancreatic cancer (mPC) patients may guide treatment decisions and help to maintain quality of life in this highly symptomatic patient collective. PATIENTS AND METHODS All patients treated for mPC at the Medical University of Vienna between 2010 and 2019 developing ascites throughout their course of disease were identified by retrospective chart review. General risk factors, metastatic sites, systemic inflammation and liver function parameters, as well as type of treatment after ascites diagnosis were investigated for associations with survival. RESULTS One hundred and seventeen mPC patients with ascites were included in this study. Median time from mPC to ascites diagnosis was 8.9 months (range 0-99 months) and median overall survival (OS) after ascites diagnosis was 27.4 days (range 21.3-42.6 days). Identified prognostic factors at ascites diagnosis independently associated with an impaired OS were presence of liver metastases [hazard ratio (HR): 2.07, 95% confidence interval (CI) 1.13-3.79, P = 0.018), peritoneal carcinomatosis (HR: 1.74, 95% CI 1.11-2.71, P = 0.015), and portal vein obstruction (HR: 2.52, 95% CI 1.29-4.90, P = 0.007). Compared with best supportive care, continuation of systemic therapy after ascites diagnosis was independently associated with survival (HR: 0.35, 95% CI 0.20-0.61, P < 0.001) with a median OS of 62 days (95% CI 51-129 days, P < 0.001) versus 16 days (95% CI 11-24 days), respectively. CONCLUSIONS Liver and peritoneal metastases as well as portal vein obstruction were found to be prognostic factors after ascites diagnosis in mPC patients. Continuation of systemic therapy after ascites diagnosis was associated with a longer OS, which needs to be evaluated in larger clinical trials including quality-of-life assessment.
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Affiliation(s)
- J M Berger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - A Alany
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - L Berchtold
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - R Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - A Friedrich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - B Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - G W Prager
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - E S Bergen
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna.
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