BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) contributes to poorer short-term mortality in cirrhotic patients with ascites. However, it is unknown how long the effect of the first SBP event persists in these patients. METHODS: The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to identify and enroll 7,892 cirrhotic patients with ascites who were hospitalized between January 1 and December 31, 2007. All patients were free from episodes of SBP from 1996 to 2006. RESULTS: The study included 1,176 patients with SBP. The overall 30-day, 90-day, 1-year, and 3-year mortality rates in this group were 21.8%, 38.9%, 57.5%, and 73.4%, respectively. The overall 30-day, 90-day, 1-year, and 3-year mortality rates in the non-SBP group were 15.7%, 32.5%, 53.3%, and 72.5%, respectively. After adjusting for gender, age, and other medical comorbidities, the adjusted hazard ratios of SBP for 30-day, 30- to 90-day, 90-day to 1-year, and 1- to 3-year mortality were 1.49 (95% confidence interval [CI], 1.30 to 1.71), 1.19 (95% CI, 1.02 to 1.38), 1.04 (95% CI, 0.90 to 1.20), and 0.90 (95% CI, 0.77 to 1.05), respectively, compared with the non-SBP group. CONCLUSIONS: The effect of SBP on the mortality of cirrhotic patients with ascites disappeared in those surviving more than 90 days after the first SBP event.
Ascites* ; Comorbidity ; Fibrosis ; Humans ; Mortality* ; National Health Programs ; Peritonitis* ; Taiwan*

Chylous effusion is an unusual complication of malignant neoplasm, usually lymphoma. In cases with cancer, the tumor was usually extensive, and the prognosis was invariably poor with a one year mortality rate of 80%. It was also reported that chylous effusion could also result from liver cirrhosis. The incidence of this complication was reported to be 0.5% in patients with liver cirrhosis and ascites. Here we report a case of 62 year old male with chronic alcoholism history who presented with abdom-inal distension and right cervical mass. He was subsequently diagnosed as non-Hodgkin's lymphoma and chylous ascites with liver cirrhosis and treated with chemotherapy. In spite of treatment, lymphoma progressed and the patient expired.
Alcoholism ; Ascites ; Chylous Ascites* ; Drug Therapy ; Humans ; Incidence ; Liver Cirrhosis* ; Liver* ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Male ; Middle Aged ; Mortality ; Prognosis

Meconium peritonitis is the chemical inflammation or foreign body reaction of peritoneum resulted from the prenatal bowel perforation associated with or without obstructive lesion during late intrauterine or early neonatal periods. Prenatal ultrasonographic findings of meconium peritonitis are intraperitoneal calcification, ascites, and pseudocyst. These provides the preparation for proper management which should reduce mortality and morbidity of neonate. We have experienced a case of meconium peritonitis in utero diagnosed by prenatal ultrasonography and present this case with a brief review of literatures.
Ascites ; Foreign-Body Reaction ; Humans ; Infant, Newborn ; Inflammation ; Meconium* ; Mortality ; Peritoneum ; Peritonitis* ; Ultrasonography, Prenatal*

OBJECTIVE: To evaluate the value of intrauterine shunting and to investigate the complication and outcome of these procedures for different fetal indications. METHODS: 7 fetuses who underwent 13 intrauterine catheter shunting from 1992 to 1997 were reviwed. The indications were uni-or bilateral hydrothorax in 4 cases, ascites in one case, and obstructive uropathy in 2 cases. RESULTS: Catheter migration occurred 6 times out of the 13 shunts (46%). Procedure related death rate was 23% (3/13); within 48 hours of pleuroamniotic shunting, amniorrhexis and coincidental abruptio placenta resulting in one fetal death and each one of amniorrhexis and premature labor resulting in 2 neonatal deaths. Pregnancy was terminated after shunting in one case of urethral atresia. Postnatal survival rate was 50% (3/6). CONCLUSION: A high complication rate requires the selection of cases for shunting. A large prospective controlled trial is needed to determine its value.
Ascites* ; Catheters ; Female ; Fetal Death ; Fetus ; Hydrothorax* ; Mortality ; Obstetric Labor, Premature ; Placenta ; Pregnancy ; Survival Rate

Surgeons are often faced with the problem of bowel obstruction in a patient who has previously undergone operation for malignant disease. Mechanical obstruction secondary to recurrent carcinoma is associated with poor survival. Surgical attempts to relieve malignant obstruction have significant morbidity and mortality rates and limited success in resolving symptoms. Then there is a temptation to assume that the obstruction is due to advanced malignancy and that death is inevitable. But a benign, correctable cause of obstruction will be found in about 25% of these patients. For this study, we had selected 63 cases of small bowel obstruction in patients with a previous operation for cancer which were admitted at Korea University Hospital between 1990 to 1995. The 43 men and 20 women had a mean age of 55.5 years. Forty one cases(65%) had obstruction due to recurrent carcinoma. The location of primary malignancies were as follows: 47 of the patients(74.6%) had adenocarcinoma of the stomach, 16 patients(25.4%) had adenocarcinoma of the colorectum. The median interval from the original operation for the malignancies until the development of bowel obstruction was 17.5 months. In our study, the small bowel obstruction due to recurrent carcinoma was frequently predicted when ascites and pleural effusion were present. We concluded that patients with no known recurrence or a short interval to the development of mechanical obstruction should be aggressively treated with surgery and for patients with known abdominal recurrence in whom nonoperative therapy fail, the surgical palliation are inevitable.
Adenocarcinoma ; Ascites ; Female ; Humans ; Korea ; Male ; Mortality ; Pleural Effusion ; Recurrence ; Stomach

Pseudomembranous colitis (PMC) is a frequent cause of morbidity and mortality among hospitalized patients. Although diarrhea is the most common manifestation, PMC may be associated with intraperitoneal fluid accumulation in the severe cases. And a few cases showing both ascites and pleural effusion have been reported in patients with PMC. We report a case of PMC who showed elevated serum and ascites levels of carcinoembryonic antigen (CEA) with a normal CEA level in pleural effusion and who successfully recovered after oral administration of metronidazole. After treatment, the serum CEA level returned to the reference range.
Administration, Oral ; Ascites ; Carcinoembryonic Antigen* ; Diarrhea ; Enterocolitis, Pseudomembranous* ; Humans ; Metronidazole ; Mortality ; Pleural Effusion ; Reference Values

Ascites is a common complication in patients with liver cirrhosis and is the most common cause of hospitalization in these patients. The development of ascites is associated with a poor prognosis in patients with liver cirrhosis with a higher mortality rate than in those without ascites. Furthermore, the presence of cirrhotic ascites is related to the development of various serious complications, such as refractory ascites, spontaneous bacterial peritonitis, acute kidney injury, and hepatorenal syndrome. Therefore, early detection and appropriate management for the development of ascites and their complications is very important in these patients. Recently, there have been significant revisions in the diagnostic criteria and treatment of cirrhotic ascites and their complications. This manuscript reviews these revisions.
Acute Kidney Injury ; Ascites* ; Hepatorenal Syndrome ; Hospitalization ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver* ; Mortality ; Peritonitis ; Prognosis

Ascites is the most common complication of liver cirrhosis and the first presentation of hepatic decompensation in most of patients with liver cirrhosis. In addition, the development of ascites is the significant predictor for poor prognosis. The therapeutic modalities for the control of uncomplicated ascites include low sodium diet and diuretics. Spironolactone is the drug of choice for the control of cirrhotic ascites, while furosemide is generally used as an adjunct to spironolactone. In patients with refractory ascites, repeated large-volume paracentesis is the treatment choice. Spontaneous bacterial peritonitis (SBP) is the most common infection in patients with liver cirrhosis. Although inhospital mortality of patients with SBP have significantly reduced with the rapid diagnosis and choice of effective antibiotics, still 15~20% of patients died during hospitalization. Third-generation cephalosporin is the drug of choice for the treatment of SBP, which can cover about 95% of causative organisms. In patients with high-risk of SBP, prophylactic antibiotics should be considered.
Anti-Bacterial Agents ; Ascites ; Diet ; Diuretics ; Furosemide ; Hospital Mortality ; Hospitalization ; Humans ; Liver Cirrhosis ; Paracentesis ; Peritonitis ; Prognosis ; Sodium ; Spironolactone

OBJECTIVES: Liver biopsy is an essential tool to confirm suspected diagnosis and to guide specific therapy in patients with liver disease. But, the standard percutaneous needle biopsy is contraindicated in patients with coagulopathy and large amount of ascites. The transjugular approach has been developed for these problem cases, but its efficacy and safety has not been adequately tested in korea. METHODS: We retrospectively analysed 21 transjugular liver biopsy cases, and the success rate of procedure, the adequacy of obtained specimen for diagnosis and procedure related complications were reviewed. RESULTS: The major reasons for trasjugular liver biopsy were coagulopathy(71%) and massive ascites(19%). Liver tissue was obtained successfully in 20 of 21 cases. The mean number of specimens was 3.4+/-1.1 per case and the mean size of specimen was 1.8+/-0.7mm. Pathologists reviewed and judged as adequate for diagnosis in 13 cases(65%), helpful in 6 cases(30%), and inadequate in 1 case. Minor complications such as neck pain, hematoma at puncture site, or transient fever occurred in 5 cases (23.8%) but there was no major complication or procedure-related mortality. CONCLUSION: Transjugular liver biopsy is a safe and valuable technique that provides adequate diagnostic informations in about two thirds of patients for whom conventional percutaneous biopsy is contraindicated.
Ascites ; Biopsy* ; Biopsy, Needle ; Diagnosis ; Fever ; Hematoma ; Humans ; Korea ; Liver Diseases ; Liver* ; Mortality ; Neck Pain ; Punctures ; Retrospective Studies

BACKGROUND: There are only limited numbers of reports about long-term results of tricuspid valve replacement (TVR) with bioprosthetic and mechanical prostheses. We analyzed risk factors for tricuspid valve replacement and compared long-term clinical results of bioprosthetic and mechanical valves in tricuspid position. MATERIAL AND METHOD: We reviewed 77 cases of TVR, which were performed between October 1978 and December 1996. Mean age was 38.8 15.9 years. Bioprostheses were implanted in 26 cases and mechanical prostheses were implanted in 51 cases. RESULT: The operative mortality was 15.6% and late mortality was 12.3%. Survival for bioprosthetic and mechanical valve group at 5, 10 and 13 years was 81.3% vs. 100%, 66.1% vs. 100%, 60.6% vs. 100% (p= 0.0175). Free from valve related re-operation for bioprosthetic and mechanical valve group at 5, 10 and 13 years was 100 % vs. 93.9%, 100% vs. 93.9% and 58.3% vs. 93.9% (p=0.3274). Linealized incidences of valve related re-operation for bioprosthetic and mechanical valve group was 2.27 %/patient-years and 1.10 %/patient-years. Risk factor analysis showed that presence of preoperative ascites, hepatomegaly larger than 2 finger breaths, poor preoperative NYHA functional class and number of tricuspid valve replacement were risk factors for early mortality, and the use of bioprosthetic valve and number of open heart surgery were risk factors for late mortality. CONCLUSION: Long-term survival of mechanical valve was superior to bioprosthetic valve in tricuspid position. We recommend mechanical valve in tricuspid position if the patient can be closely followed up.
Ascites ; Bioprosthesis ; Fingers ; Heart Valve Prosthesis ; Hepatomegaly ; Humans ; Incidence ; Mortality ; Prostheses and Implants ; Risk Factors ; Thoracic Surgery ; Tricuspid Valve*