Hydrops describes the infant who has generalized edema due to accumulation of excess fluid. In severe case, massive edema with ascites and pleural and pericardial effusions are commonly combined. The main etiology of hydrops fetalis has been changed from immune type which is caused by fetomaternal blood group incompatibility to nonimmune type. Although cardiovascular diseases are the most common (23% to 38%) causes for nonimmune hydrops fetalis, fetal tumors still compromise 5% to 7% of the diseases. We report a case of nonimmune hydrops fetalis due to intraperitoneal hemangioma. The newborn infant was managed surgically and had excellent outcome.
Ascites ; Blood Group Incompatibility ; Cardiovascular Diseases ; Edema ; Hemangioma* ; Humans ; Hydrops Fetalis* ; Infant ; Infant, Newborn ; Pericardial Effusion

OBJECTIVE: We tried to determine the relevance of thrombocytosis as a possible prognostic factor in patient with epithelial ovarian cancer. METHODS: One hundred and eighty-three (183) patients with epithelial ovarian cancer had been surgically treated in our hospital between January 1984 and December 2001. Uni- and multivariate analyses were performed of 9 clinical variables including age, FIGO stage, histologic subtype, grade, volume of residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor marker (CA 125). The Kaplan-Meier method and log-rank test were used for univariate analysis and a multiple regression analysis based on the Cox proportional hazards model was done to find the independent prognostic variables. RESULTS: Prevalence of thrombocytosis was 20.8% and significantly correlated with FIGO stage (p=0.015), tumor grade (p=0.029), presence of ascites (p=0.001) and volume of residual tumor (p=0.032). Significant difference in survival between patients with or without thrombocytosis was found (p=0.006). Multivariate analysis model was used and only volume of residual tumor (p=0.004) was significant independent prognostic variable. Thrombocytosis (p=0.041) was significant independent prognostic variable in patients with early FIGO stage of disease. CONCLUSION: Thrombocytosis is a useful prognostic factor in epithelial ovarian cancer and significantly independent prognostic factor in patients with early FIGO stage of disease.
Ascites ; Blood Platelets ; Humans ; Multivariate Analysis ; Neoplasm, Residual ; Ovarian Neoplasms* ; Prevalence ; Proportional Hazards Models ; Thrombocytosis*

PURPOSE: Mycobacterium tuberculosis is endemic in Korea. Because tuberculous peritonitis is characterized by ascites, abdominal pain, abdominal mass and elevation of serum CA-125, it can be confused with ovarian malignancies. The aim of this study was to evaluate the significance of serum CA-125 level in the differential diagnosis of tuberculous peritonitis and ovarian malignancy in a Mycobacterium tuberculosis-endemic area. MATERIALS AND METHODS: The medical records of patients diagnosed with tuberculous peritonitis (n=48) or epithelial ovarian malignancy (n=370) at Samsung Medical Center from January 2000 to October 2009 were retrospectively reviewed. RESULTS: Median serum CA-125 level in the epithelial ovarian cancer group was significantly higher than that in the tuberculous peritonitis group (p< or =0.01). Only one patient (2.1%) in the tuberculous peritonitis group had a serum CA-125 level over 2000 U/mL. However, 109 patients (29.5%) in the epithelial ovarian cancer group had a serum CA-125 level over 2000 U/mL. At the CA-125 ranges of 400 to 599 and 600 to 799, the proportions of those with tuberculous peritonitis were 24% and 21.9%, respectively. At a serum CA-125 level over 1000 U/mL, however, the proportion of tuberculous peritonitis was much lower (2.1%). CONCLUSION: Tuberculous peritonitis should be considered in the evaluation of female patients with ascites and high serum CA-125.
Ascites/*blood ; CA-125 Antigen/*blood ; Diagnosis, Differential ; Female ; Humans ; Multivariate Analysis ; Ovarian Neoplasms/blood/*diagnosis ; Peritonitis, Tuberculous/blood/*diagnosis ; Republic of Korea ; Retrospective Studies

BACKGROUND/AIMS: The clinical significance of serum CA 125 levels in patients with chronic liver disease has not been widely appreciated in relation to the severity of the disease. We examined serum CA 125 levels in patients with chronic liver disease according to the severity of liver disease and the presence of ascites. METHODS: Fasting serum CA 125 levels were measured by a commercial RIA kit in 92 patients with chronic liver disease: 22 with chronic hepatitis and 70 with liver cirrhosis (Child class A, 19; B, 28; C, 23). Forty-one patients (45%) had ascites. RESULTS: The patients with Child class C liver cirrhosis had significantly higher mean serum CA 125 level than those with class A (p<0.05). In Child class B patients, the mean serum CA 125 level was significantly higher in patients with ascites than in those without (p<0.05). A multiple regression analysis showed that the presence of ascites, serum albumin, and prothrombin time were independent factors related to the increase of serum CA 125 levels. CONCLUSIONS: The presence of ascites is more closely related to the increase of CA125 levels in patients with liver cirrhosis than the severity of liver disease.
Adult ; Aged ; Ascites/blood ; CA-125 Antigen/*blood ; Chronic Disease ; Female ; Hepatitis B, Chronic/*blood ; Humans ; Liver Cirrhosis/*blood ; Male ; Middle Aged

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance

Ascites ; metabolism ; Carcinoma, Hepatocellular ; blood ; metabolism ; pathology ; Chemokine CCL2 ; blood ; metabolism ; Hepatitis B, Chronic ; blood ; metabolism ; Humans ; Immunohistochemistry ; Liver ; metabolism ; pathology ; Liver Cirrhosis ; blood ; metabolism ; pathology ; Liver Neoplasms ; blood ; metabolism ; pathology ; Receptors, CCR2 ; blood ; metabolism

BACKGROUND/AIMS: Intestinal lymphangiectasia is a disease characterized by dilated lymphatics of the intestinal mucosa and excessive enteric loss of plasma proteins. Instead of multiple blind peroral jejunal biopsy, duodenal endoscopy and endoscopic small bowel biopsy were performed. We evaluated the significance of endoscopic small bowel biopsy and the usefulness of the other diagnostic methods in the diagnosis of intestinal lymphangiectasia in children. METHODS: Fourteen children seen between August 1989 and August 1997 with clinically suggestive intestinal lymphangiectasia were analysed. The median age at onset of symptoms was 4 years. Primary intestinal lymphangiectasia occurred in 10 children and secondary intestinal lymphangiectasia occurred in 4 children, of whom two had Fontan operation, one had constrictive pericarditis, and one had Crohn's disease. Low fat, high protein diet with medium chain triglycerides was the mainstay of treatment. RESULTS: 1) Diarrhea was present in 14 patients, and edema in 11 patients. Hypocalcemic tetany occurred in 6 children and vomiting in 5 children. Dight children had ascites and three of these had chylous ascites. Growth retardation was present in four patients, chylothorax in one, and lymphedema in one. The initial serum albumin concentration was 1.8 g/dl, the serum calcium level 6.7 mg/dl, and the total lymphocyte count 623 /mm(3). 2) Dilated lymphatics in the small bowel mucosa was confirmed by endoscopic biopsy in 14 children(100%). The sensitivity of alpha1-antitrypsin clearance was 100%. Duodenal endoscopy showed scattered white spots covering mucosa in 11 children(79%). Small bowel series revealed thickened mucosal folds in 10 children(77%). Four(31%) had positive finding of 99mTc-antimony lymphoscintigraphy. 3) Responses to treatment in children with primary intestinal lymphangiectasia were graded as good if the symptoms resolved, and poor if there was no lasting resolution of symptoms and repeated albumin administration. Response to therapy was good in four and poor in six patients. The mean age at onset of symptoms was 8 years in good resonse group, and 2 years in poor response group (p<0.05). CONCLUSION: The diagnosis of intestinal lymphangiectasia is confirmed by duodenoscopy and endoscopic small bowel biopsy in a child with diarrhea, edema, hypoalbuminemia, and lymphocytopenia. As compared with other diagnostic methods such as small bowel series and lymphoscintigraphy, duodenoscopy and endoscopic small bowel biopsy are very sensitive and should be performed early.
Ascites ; Biopsy* ; Blood Proteins ; Calcium ; Child* ; Chylothorax ; Chylous Ascites ; Crohn Disease ; Dental Caries ; Diagnosis* ; Diarrhea ; Diet ; Duodenoscopy ; Edema ; Endoscopy ; Fontan Procedure ; Humans ; Hypoalbuminemia ; Intestinal Mucosa ; Lymphedema ; Lymphocyte Count ; Lymphopenia ; Lymphoscintigraphy ; Mucous Membrane ; Pericarditis, Constrictive ; Serum Albumin ; Tetany ; Triglycerides ; Vomiting

PURPOSE: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). MATERIALS AND METHODS: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. RESULTS: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 > or = 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count > or =400,000 cells/mm3, staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). CONCLUSION: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.
Ascites ; Blood Cell Count ; Blood Platelets* ; Diagnosis ; Disease-Free Survival ; Fallopian Tubes* ; Female ; Humans ; Lymph Node Excision* ; Lymphocytes* ; Multivariate Analysis ; Neutrophils* ; Platelet Count

OBJECTIVETo evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma (HCC).

METHODSA total of 54 patients with HCC who underwent hepatectomy were divided into two groups: RIP group (regional ischemic preconditioning with continuous clamping, n=15) and HHV group (hemi-hepatic vascular inflow occlusion, n=39). HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed. In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion. The clinical indicators of the two groups were compared.

RESULTSThe volume of intraoperative blood loss had significant difference between the two groups (P=0.039). One case (6.7%) in the RIP group and 17 cases (43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010). No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time (P>0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001). Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase (P>0.05) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006).

CONCLUSIONThe results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.

Ascites ; Bilirubin ; Blood Loss, Surgical ; Blood Transfusion ; Carcinoma, Hepatocellular ; surgery ; Constriction ; Hepatectomy ; Hepatic Artery ; Humans ; Ischemic Preconditioning ; Length of Stay ; Liver Neoplasms ; surgery ; Portal Vein ; Postoperative Period