OBJECTIVETo investigate the levels of lipopolysaccharide binding protein (LBP) in serum and ascites of cirrhotic patients, and determine their diagnostic value for spontaneous bacterial peritonitis (SBP).

METHODSCirrhotic patients were divided into groups according to diagnosis of SBP, ascites without SBP, no ascites. To explore the significance of LBP in clinically suspect SBP cases, the ascites without SBP group was sub-divided into two groups according to the symptoms of abdominal pain or elevated white blood cell (WBC) count, and abdominal pain combined with elevated WBC count. Two control groups were composed of patients with intraperitoneal pus and a group of healthy, non-cirrhotic individuals. The LBP levels in serum and ascites were determined by enzyme-linked immunosorbent assay (ELISA). The ascites routine, ascites culture and albumin assay were carried out in the Second Affiliated Hospital of Chongqing Medical University. Data between the two groups were compared using the t-test or nonparametric test of independent samples, and the areas under the curve were compared using the Z test. Results The levels of LBP in serum and pus were significantly higher in the intraperitoneal pus group than in the cirrhosis group with ascites (P less than 0.01).

RESULTSThe level of serum LBP was significantly higher in the cirrhosis group with SBP than in the cirrhosis group without SBP but with ascites and the cirrhosis group with no ascites (P less than 0.01). There was no significant difference in the level of ascites LBP in the cirrhosis group with SBP and the cirrhosis group without SBP but with ascites (P more than 0.05). In the clinically suspect cases with SBP, the levels of LBP in serum and ascites were significantly higher than those in the cirrhosis group without SBP but with ascites (228.00 mug/ml vs. 80.95 mug/ml and 22.50 mug/ml vs. 11.45 mug/ml, P less than 0.05). Determination of serum LBP had a higher sensitivity than the determination of ascites LBP or ascites WBC.

CONCLUSIONGram-negative bacteria infection in the intra-abdominal cavity causes serum and body fluid levels of LBP to increase significantly. Patients with cirrhosis complicated with SBP have significantly elevated levels of serum LBP. The serum and ascites LBP levels are significantly elevated in SBP patients with suspected clinical diagnosis. Measurements of both the serum LBP and ascites LBP may have diagnostic value for SBP.

Acute-Phase Proteins ; metabolism ; Adult ; Aged ; Ascites ; diagnosis ; microbiology ; Ascitic Fluid ; chemistry ; Bacterial Infections ; complications ; diagnosis ; Carrier Proteins ; blood ; metabolism ; Case-Control Studies ; Female ; Humans ; Liver Cirrhosis ; complications ; microbiology ; Male ; Membrane Glycoproteins ; blood ; metabolism ; Middle Aged ; Peritonitis ; complications ; diagnosis ; microbiology

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascites/diagnosis/metabolism/therapy ; Ascitic Fluid/chemistry ; Cephalosporins/therapeutic use ; Chlamydia Infections/complications/*diagnosis/drug therapy ; Chlamydia trachomatis/genetics/*isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Peritonitis/*diagnosis/etiology/radiography ; Peritonitis, Tuberculous/diagnosis ; Serum Albumin/metabolism ; Tomography, X-Ray Computed

OBJECTIVETo investigate the effect of Ganoderma lucidum polysaccharides (GLP) on the nucleotide contents and cell cycle distribution of the tumor cells in S180 ascitic tumor-bearing mice and explore the possible mechanism of the antitumor effect of GLP.

METHODSMice bearing S180 ascitic tumor were subjected to intragastric administration of GLP (100, 200, and 400 mg/kg), normal saline or subcutaneous injection of cyclophosphamide (CTX) at 25 mg/kg, respectively. The treatment was given once daily for 9 consecutive days, after which the ascitic tumor cells were harvested for determination of the RNA and DNA contents and their ratio as well as the cell cycle alterations. Laser scanning confocal microscopy and acridine orange staining was performed to evaluate the DNA and RNA fluorescence intensity, and flow cytometry with propidium iodide (PI) staining was utilized for cell cycle analysis of the tumor cells.

RESULTSCompared with normal saline group, the tumor cells in the 3 GLP groups all showed reduced RNA and DNA contents, and this reduction was statistically significant in 200 mg/kg GLP group (P=0.000). Significantly reduced RNA/DNA ratio was noted in all the 3 GLP groups (P=0.003, 0.000, 0.008 corresponding to 400, 200, and 100 mg/kg groups), suggesting that ganoderma polysaccharides more effectively reduced RNA content than DNA content. CTX also resulted in reduced RNA and DNA contents but not the RNA/DNA ratio. At the doses of 400, 200, and 100 mg/kg, GLP increased the percentage of G2/G2 phase cells (P=0.003, 0.000, and 0.000) whereas CTX showed the contrary effect (P=0.000). GLP produced no obvious effect on S-phage cells but CTX significantly reduced their percentage (P=0.000). GLP at the 3 doses all decreased the percentage of G2/M phase tumor cells (P=0.014, 0.049, 0.016) and CTX again induced contrary effect (P=0.000).

CONCLUSIONWith different effects from CTX on DNA and RNA contents and cell cycle, GLP inhibits DNA and RNA synthesis in the tumor cells by mobilizing the host immune function to interfere with the normal cell cycles, which might be one of the mechanisms for the antitumor effect of GLP.

Animals ; Antineoplastic Agents ; pharmacology ; Ascitic Fluid ; Cell Cycle ; drug effects ; Cell Line, Tumor ; DNA ; drug effects ; metabolism ; Dose-Response Relationship, Drug ; Immunohistochemistry ; Male ; Mice ; Polysaccharides ; pharmacology ; RNA ; drug effects ; metabolism ; Reishi ; chemistry ; Sarcoma 180 ; genetics ; pathology ; Xenograft Model Antitumor Assays

BACKGROUND/AIMS: Liver cirrhosis and malignant tumors are two major causes of ascites according to the reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic usefulness of various laboratory tests. METHODS: Medical records of 366 patients, who underwent diagnostic paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed. The etiology was confirmed by histology, imaging studies, and ascites analyses. RESULTS: The frequency of cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was 94.2%, and its positive predictive value was 75%. CONCLUSIONS: Liver cirrhosis is the leading cause of ascites, especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine deaminase could precisely differentiate it from other causes.
Adenosine Deaminase/analysis ; Adult ; Aged ; Ascitic Fluid/chemistry/pathology ; Female ; Humans ; Liver Cirrhosis/*diagnosis/epidemiology/etiology ; Liver Cirrhosis, Alcoholic/*diagnosis/epidemiology ; Male ; Middle Aged ; Neoplasms/*diagnosis/epidemiology/etiology ; *Paracentesis ; Peritonitis, Tuberculous/*diagnosis/epidemiology ; Predictive Value of Tests ; Prevalence ; Retrospective Studies

Adenocarcinoma ; diagnosis ; pathology ; Adult ; Aged ; Aged, 80 and over ; Ascitic Fluid ; chemistry ; Cadherins ; analysis ; Calbindin 2 ; Carcinoembryonic Antigen ; analysis ; Diagnosis, Differential ; Epithelial Cells ; chemistry ; Female ; Humans ; Immunohistochemistry ; Keratin-5 ; analysis ; Male ; Middle Aged ; Pericardial Effusion ; chemistry ; diagnosis ; Pleural Effusion ; chemistry ; diagnosis ; Pleural Effusion, Malignant ; chemistry ; diagnosis ; S100 Calcium Binding Protein G ; analysis

OBJECTIVETo evaluate the effect of Group A streptococcus preparation (sapylin) combined with cisplatin on the malignant peritoneal effusion in patients with advanced cancer.

METHODSSixty advanced cancer patients with large amount of peritoneal effusion were divided into two groups: sapylin + cisplatin (DDP) group (30 patients) and control group (DDP alone, 30 cases). All the chemotherapeutic agents were injected intraperitoneally through a catheter.

RESULTSIn sapylin + cisplatin(DDP) group, 11 (36.7%) patients showed CR and 16 (53.3%) PR. The overall response rate (CR + PR) was 90.0%. Those of DDP alone group were 16.7% and 46.7%, the overall response rate was 63.3%. The main adverse effects were fever, nausea, and vomiting.

CONCLUSIONCombined Group A streptococcus preparation (sapylin) and cisplatin is more effective than cisplatin alone for the malignant peritoneal effusion in patients with advanced cancer, and the adverse effects are tolerable.

Adjuvants, Immunologic ; administration & dosage ; Adult ; Aged ; Antineoplastic Agents ; administration & dosage ; Ascitic Fluid ; pathology ; Bacterial Proteins ; administration & dosage ; Biological Products ; administration & dosage ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Female ; Humans ; Immunologic Factors ; administration & dosage ; Injections, Intraperitoneal ; Male ; Middle Aged ; Ovarian Neoplasms ; pathology ; therapy ; Peritoneal Neoplasms ; secondary ; therapy ; Stomach Neoplasms ; pathology ; therapy ; Streptococcus pyogenes ; chemistry

OBJECTIVETo investigate the role of interleukine-16 (IL-16) in the pathogenesis of endometriosis.

METHODSEnzyme-linked immunosorbent assay (ELISA) was used to determine the levels of IL-16 in peritoneal fluid and serum specimens of 22 women with different stage endometriosis and 22 controls.

RESULTSThe median levels of IL-16 in peritoneal fluid and serum were 290.5 pg/ml and 539.4 pg/ml in women with endometriosis, and 296.6 pg/ml and 778.1 pg/ml in controls, respectively; there was no significant difference between two groups (P>0.05). However, the IL-16 levels in peritoneal fluid and serum of patients with minimal/mild stage endometriosis and controls were all significantly higher than those of patients with moderate/severe endometriosis (P<0.01, <0.05). In addition, there was no statistical correlation of peritoneal IL-16 levels with those in serum (P>0.05).

CONCLUSIONReduced levels of IL-16 in peritoneal fluid and serum of women with advanced stage endometriosis may imply a role of IL-16 in the development and progression of endometriosis.

Adult ; Ascitic Fluid ; chemistry ; Endometriosis ; metabolism ; Female ; Humans ; Interleukin-16 ; analysis ; blood ; Middle Aged

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications for patients with liver cirrhosis, and it has a mortality rate of over 20%. Early diagnosis of SBP and immediate use of an adequate antibiotic therapy are very important for achieving a better prognosis. The aim of our study was to assess the usefulness of reagent strips for making the rapid diagnosis of SBP. METHODS: A diagnostic paracentesis procedure was performed upon hospital admission in 257 cirrhotic patients (187 males, 70 females; mean age: 54 years) with ascites. Each fresh sample of ascitic fluid was tested using a reagent strip, and the result was scored as 0, 1+, 2+ or 3+. The leukocyte count, polymorphonuclear cell count, blood bottle culture, and chemistry of ascites were also done. RESULTS: We diagnosed 79 cases of SBP and 2 cases of secondary bacterial peritonitis by means of the polymorphonuclear cell count and the classical criteria. When a reagent strip result of 3+ was considered positive, the test's sensitivity was 86% (70 of 81), the specificity was 100% (176 of 176), and the positive predictive value was 94%. Furthermore, when a reagent strip result of 2+ or more was considered positive, the test sensitivity was 100% (81 of 81), the specificity was 99% (174 of 176), and negative predictive value was 99%. CONCLUSIONS: The use of reagent strips is a very sensitive and specific tool for the rapid diagnosis of SBP in cirrhotic patients. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
Aged ; Ascitic Fluid/chemistry/cytology ; Bacterial Infections/*diagnosis/microbiology ; English Abstract ; Female ; Humans ; Liver Cirrhosis/complications ; Male ; Middle Aged ; Peritonitis/*diagnosis/etiology/microbiology ; Predictive Value of Tests ; *Reagent Strips ; Sensitivity and Specificity

BACKGROUND/AIMS: Nitric oxide (NO) is a molecule involved in vascular dilatation and pathogen suppression. It also has immunologic and regulatory functions. Liver cirrhosis is characterized by an increased risk for bacterial infections, including spontaneous bacterial peritonitis (SBP). The role of NO in SBP which develops in cirrhosis has not been clearly established. The aim of this study was to investigate the role of NO in the pathogenesis of SBP and its clinical usefulness for prediction of disease prognosis. METHODS: This study was designed to investigate the changes of ascites NO in the course of treatment. Nitric oxide metabolite (nitrites+nitrates [NOx]) was measured by chemiluminescence in 84 ascites samples obtained from 84 cirrhotic patients. Among them, the 38 patients with SBP were treated with cefotaxime 2.0 g, q 12hr for 7 days. In 24 of SBP patients, ascites was obtained consecutively before treatment (day 0), during treatment (day 2), and after treatment (day 7). RESULTS: Ascites NO levels in the patients with SBP (n=38; 82.3 +/- 14.4 micro M) were not different from those in patients with sterile ascites (n=46; 54.6 +/- 13.0 micro M). There was no significant change of NO levels in sequential ascites samples during antibiotic treatment. Ascites NO level before treatment was significantly higher in SBP patients who responded to antibiotics (n=26; 101.86 micro M/L) than that in SBP patients who did not respond to antibiotics (n=12; 40.03 micro M/L, P=0.044). A significant direct correlation was found between ascites and serum NO levels before treatment (Pearson correlation, r2=0.86, P=0.001). Among the SBP patients, treatment response rate to antibiotics were significantly higher in those patients with pretreatment NO level>or=80 micro M/L in multivariate analysis. CONCLUSIONS: Ascites NO level was not different between ascites from SBP patients and ascites from cirrhotic patients with sterile ascites. There were no changes of ascites NO in SBP patients during treatment. Therefore ascites NO was not useful to predict the progress of SBP. Ascites NO levels reflect serum NO levels, and the patients with higher NO level may have better response to antibiotics.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/*chemistry ; Bacterial Infections/complications/*drug therapy ; Cefotaxime/therapeutic use ; English Abstract ; Female ; Humans ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Nitric Oxide/*analysis ; Peritonitis/complications/*drug therapy ; Prognosis

OBJECTIVETo evaluate the relationship between levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in serum and peritoneal fluid of endometriosis-associated infertility.

METHODSThe soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20 infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls.

RESULTSThe sFasL levels were significantly higher in infertile patients with endometriosis (175.09 +/- 80.55 pg/mL in serum and 284.50 +/- 152.38 pg/mL in peritoneal fluid) than those of infertile controls (88.47 +/- 43.55 pg/mL in serum and 17.30 +/- 9.62 pg/mL in peritoneal fluid) and fertile controls (16.13 +/- 11.75 pg/mL in serum and 8.84 +/- 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis (828.60 +/- 429.65 pg/mL in serum and 349.61 +/- 288.89 pg/mL in peritoneal fluid) did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease (868.75 +/- 570.48 pg/mL in serum and 181.76 +/- 157.78 pg/mL in peritoneal fluid) and fertile control (822.26 +/- 129.12 pg/mL in serum and 318.42 +/- 145.16 pg/mL in peritoneal fluid).

CONCLUSIONSBased upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.

Ascitic Fluid ; chemistry ; Endometriosis ; complications ; metabolism ; Fas Ligand Protein ; Female ; Humans ; Infertility, Female ; etiology ; metabolism ; Ligands ; Membrane Glycoproteins ; blood ; metabolism ; Pelvic Infection ; complications ; metabolism ; Solubility ; fas Receptor ; blood ; metabolism