Humans ; Tolvaptan/therapeutic use* ; Ascites/drug therapy* ; Receptors, Vasopressin ; Liver Cirrhosis/drug therapy* ; Sodium

Chinese Society of Hepatology of Chinese Medical Association organized relevant experts to update the Guidelines on the management of ascites and complications in cirrhosis in 2017 and renamed it as Guidelines on the management of ascites in cirrhosis. It provides guiding recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS).
Humans ; Ascites/therapy* ; Asian People ; Hepatorenal Syndrome/therapy* ; Liver Cirrhosis/therapy* ; Peritonitis/therapy*

This study aims to explore the effects of chemical ingredient groups B and C in Kansui Radix stir-fried with vinegar on the diversity of gut microbiota in the rat model of malignant ascites, identify the key differential microbial taxa, and reveal the biological mechanism of water-expelling effect of the two chemical ingredient groups. The rat model of malignant ascites induced by Walker-256 cells was established, and phenolphthalein was used as the positive drug. The rats were orally administrated with corresponding agents for consecutive 7 days. On day 6, fresh feces samples were collected from the rats, and 16 S rDNA high-throughput sequencing and GC-MS were employed to determine the composition of gut microbiota and the content of short-chain fatty acids, respectively. On day 7, serum and intestinal tissue samples were collected for the determination of related indicators. Compared with the control group, the model group showed decreased feces volume and urine volume(P<0.01), increased volume of ascites and levels of Na~+, K~+, and Cl~- in urine(P<0.01), down-regulated mRNA and protein levels of intestinal AQP8(P<0.01), lowered abundance of beneficial Lactobacillus(P<0.01) while risen abundance of potential pathogenic Lachnospiraceae and Anaeroplasma(P<0.01), and reduced content of short-chain fatty acids(P<0.01). Compared with the model group, administration with chemical ingredient groups B and C alleviated all the above indicators(P<0.01). In conclusion, chemical ingredient groups B and C in Kansui Radix stir-fried with vinegar could alleviate the disordered gut microbiota in rats with malignant ascites to expel water through increasing the abundance of beneficial Lactobacillus and reducing the abundance of harmful Lachnospiraceae and Anaeroplasma. This study can provide a reference for the reasonable clinical application of Kansui Radix stir-fried with vinegar.
Acetic Acid/chemistry* ; Animals ; Ascites/drug therapy* ; Euphorbia/chemistry* ; Gastrointestinal Microbiome ; Plant Roots/chemistry* ; Rats

ascites, and presence of operative complications were independently and significantly associated with postoperative complications.CONCLUSION: Morbidity of extensive surgical approach should be kept in mind in ovarian cancer surgery aimed at leaving no residual tumor. Patient-based management with an appropriate preoperative evaluation may avoid morbidity of extended/extensive surgical approaches.]]>
Ascites ; Drug Therapy ; Humans ; Intensive Care Units ; Intraoperative Complications ; Length of Stay ; Neoplasm, Residual ; Ovarian Neoplasms ; Postoperative Complications

3.38, PLR >210, CA125 >365, advanced stage, suboptimal disease, serous type, and ascites were significant predictive factors for platinum resistance. However, only NLR >3.38 and advanced stage were independent predictive factors with an adjusted odds ratio of 1.880 and 3.333, respectively. Regarding factors associated with poor survival outcomes, only PLR >210 and advanced stage were independent factors, with a hazard ratio of 1.578 and 3.994, respectively.CONCLUSION: High NLR and advanced stage were potential independent predictive factors for platinum resistance, whereas high PLR and advanced stage were potential independent predictive factors for poor survival outcomes.]]>
Ascites ; Blood Platelets ; Drug Therapy ; Fallopian Tubes ; Female ; Humans ; Lymphocytes ; Medical Records ; Multivariate Analysis ; Neutrophils ; Odds Ratio ; Ovarian Neoplasms ; Platinum ; Prognosis ; Retrospective Studies ; ROC Curve

OBJECTIVE: To observe the clinical efficacy of umbilical needling therapy of I-Ching at 1 PM to 3 PM for cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention. METHODS: Forty-eight patients of cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention were randomly divided into an observation group and a control group, 24 cases in each one. Both groups were treated with routine treatment of western medicine combined with TCM decoction. In addition, the patients in the observation group were treated with umbilical needling therapy of I-Ching at locations of , , and . The treatment was given at 1 PM to 3 PM, once a day; 10-d treatment was a course of treatment, and a total of 20-d treatment was given. The abdominal circumference, urine volume, body mass, liver function and prothrombin time were observed before and after treatment in the two groups, and the clinical efficacy of the two groups was compared. RESULTS: The total effective rate was 91.7% (22/24) in the observation group, which was higher than 87.5% (21/24) in the control group (<0.05). After treatment, the improvement of abdominal circumference, urine volume, body mass, liver function and prothrombin time between the two groups was significantly different (<0.05), the observation group was better. CONCLUSION Based on the western medicine treatment, the combination of TCM decoction and umbilical needling therapy of I-Ching shows significant efficacy for cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention.
Ascites ; etiology ; therapy ; Humans ; Liver Cirrhosis ; complications ; Needles ; Spleen ; Syndrome ; Umbilicus

PURPOSE: Gastric cancer (GC) patients with peritoneal metastasis (PM) have poor prognosis. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with systemic chemotherapy is a novel treatment option for patients in stage IV of the disease. MATERIALS AND METHODS: Between November 2015 and June 2018, prospective data collection was performed in 24 patients with GC and PM (median age, 57; range, 44–75 years). These patients underwent 46 PIPAC procedures with a median number of 2 interventions per patient (range, 1–6). A laparoscopic access was used and a combined therapy of cisplatin and doxorubicin aerosol was administered. RESULTS: The median peritoneal carcinomatosis index before the 1st PIPAC was 14 (range, 2–36), and the median ascites volume in patients before the 1st PIPAC was 100 mL (range, 0–6 mL, 300 mL). Eleven patients, who received 2 or more PIPAC procedures, had decreased and stable volumes of ascites, while only 3 patients displayed increasing volume of ascites. The median overall survival was 121 days (range, 66–625 days) after the 1st PIPAC procedure, while 8 patients who received more than 3 PIPAC procedures had a median survival of 450 days (range, 206–481 days) (P=0.0376). CONCLUSIONS: Our data show that PIPAC is safe and well tolerated, and that the production of ascites can be controlled by PIPAC in GC patients. Patients, who received 2 or more PIPAC procedures, reported a stable overall quality of life. Further studies are required to document the significance of PIPAC as a palliative multimodal therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03100708
Ascites ; Carcinoma ; Cisplatin ; Data Collection ; Doxorubicin ; Drug Therapy* ; Humans ; Neoplasm Metastasis* ; Prognosis ; Prospective Studies ; Quality of Life ; Stomach Neoplasms*

Signet ring cell carcinoma is a rare form of gallbladder cancer and has a worse prognosis. Since few cases have been reported, information regarding the behavior and prognosis of the gallbladder carcinoma is limited. About twenty four cases of gallbladder signet ring cell carcinoma have been reported so far. We present a rare case of primary signet ring cell carcinoma of the gallbladder. A 58-year-old male presented with epigastric pain. Abdominal computed tomography showed diffuse gallbladder wall thickening with enhancement, gallstones, and choledocholithiasis. After endoscopic treatment of choledocholithiasis, laparoscopic cholecystectomy was performed. Pathologic examination of the resected gallbladder revealed adenocarcinoma of signet ring cell type in the epithelium. Immunohistochemical stain for cytokeratin 7 was positive for tumor cells. The final pathologic diagnosis was primary signet ring cell carcinoma of the gallbladder. Lymph node metastasis was detected and he received chemotherapy and radiotherapy. After one year of follow-up, bone metastasis in the lumbar spine and malignant ascites were found. The patient is being provided with palliative care.
Adenocarcinoma ; Ascites ; Carcinoma, Signet Ring Cell* ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Choledocholithiasis ; Diagnosis ; Drug Therapy ; Epithelium ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Keratin-7 ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Radiotherapy ; Spine

OBJECTIVE: To report an efficacy of gonadotropin releasing hormone (GnRH) antagonist administration after freezing of all embryos for treatment of early type ovarian hyperstimulation syndrome (OHSS). METHODS: In 10 women who developed fulminant early type OHSS after freezing of all embryos, GnRH antagonist (cetrorelix 0.25 mg per day) was started at the time of hospitalization and continued for 2 to 4 days. Fluid therapy and drainage of ascites was performed as usual. RESULTS: Early type OHSS was successfully treated without any complication. At hospitalization, the median (95% confidence interval [CI]) of the right and the left ovarian diameter was 10.0 cm (7.6 to 12.9 cm) and 8.5 cm (7.5 to 12.6 cm). After completion of GnRH antagonist administration, it was decreased to 7.4 cm (6.2 to 10.7 cm) (P=0.028) and 7.8 cm (5.7 to 12.2 cm) (P=0.116), respectively. The median duration of hospital stay was 6 days (3 to 11 days). Trans-abdominal drainage of ascites was performed in 2 women and drainage of ascites by percutaneous indwelling catheter was performed in 4 women. No side effect of GnRH antagonist was noted. CONCLUSION: GnRH antagonist administration appears to be safe and effective for women with fulminant early type OHSS after freezing all embryos. Optimal dose or duration of GnRH antagonist should be further determined.
Ascites ; Catheters, Indwelling ; Drainage ; Embryonic Structures ; Female ; Fluid Therapy ; Freezing ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Hospitalization ; Humans ; Length of Stay ; Ovarian Hyperstimulation Syndrome*

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
Anastomosis, Roux-en-Y ; adverse effects ; China ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; surgery ; Gastrectomy ; adverse effects ; methods ; mortality ; Gastric Outlet Obstruction ; etiology ; prevention & control ; Gastric Stump ; surgery ; Hemostatic Techniques ; Hernia ; etiology ; prevention & control ; therapy ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Jejunum ; blood supply ; surgery ; Lymph Node Excision ; adverse effects ; instrumentation ; Lymphatic System ; injuries ; Postoperative Complications ; classification ; diagnosis ; mortality ; prevention & control ; Prognosis ; Stomach ; surgery ; Stomach Neoplasms ; complications ; surgery ; Suture Techniques ; standards ; Thoracic Duct ; injuries ; Wound Closure Techniques ; standards