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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Exudative v/s transudative ascites: differentiation based on fluid echogenicity on high resolution sonography.

Real time sonography was performed in 52 patients with ascites to evaluate the accuracy of sonography in differentiating an exudative from a transudative collection. The echogenicity of ascites was graded I, II and III using the echogenicity of normal abdominal viscera as comparative standard reference points. Grade I collections (31 patients) were either absolutely anechoic, or showed few internal echoes secondary to particulate matter. Grade II collections (7 patients) were hypoechoic as compared to the liver and spleen. Grade III collections (14 patients) had an echogenicity similar to or greater than that of the liver and spleen. The results of diagnostic aspiration in all patients were then compared to the sonographic grade of the ascitic fluid. All transudates (28 patients) had a Grade I echogenicity. Only 3 patients with an exudative ascites had a Grade I echogenicity. The remaining 21 patients with an exudative collection had an echogenicity equal to or greater than Grade II. Using these results, an ascitic fluid echogenicity of Grade I had a 92.32% sensitivity, 100% specificity, a positive predictive value of 1 and a negative predictive value of 0.875 in diagnosing transudates. An ascitic fluid echogenicity of Grade II or more had a sensitivity of 87.5%, specificity of 100%, a positive predictive value of 1 and a negative predictive value of 0.903 in diagnosing transudates.

Adult↗
PubMed1995

[Diagnostic efficacy of albumin gradient in different causes of ascitis].

The aim of this study was to compare the serum-ascites albumin gradient (GS-A) to the transudate-exudate concept in the classification of ascites. The second objective was to analyze the predictive value and efficacy of GS-A, ascites total protein, LDH, Ratio and ascites cholesterol in patients with liver disease and malignant ascites. For this purpose we studied prospectively 98 patients (in prospective form). The transudate-exudate concept classified correctly the causes of ascites only in 65.6% of the patients. In contrast, the GS-A did it 95.7% of the patients. In differentiating ascites caused either by chronic liver disease or by malignancy, the tests with best efficacy were cholesterol (98%), (predictive value 97%) and GS-A efficacy 94% (predictive value 94%). We conclude that GS-A was better than the traditional transudate-exudate concept in classification of ascites. The test with the best efficcacy separating ascites caused by chronic liver disease or by malignancy was the ascites cholesterol.

Adult↗
PubMed1991

Peritoneoscopy in diagnosis of ascites.

Diagnostic peritoneoscopies were performed in 226 patients with ascites. Satisfactory examination was possible in 220 patients. Clinical diagnosis was confirmed at peritoneoscopy in 82.7% of patients. Peritoneoscopic examination corrected the clinical diagnosis in 13.7%, was inconclusive in 2.6% and was incorrect in 0.8% of cases. It was 100% diagnostic in malignant peritonitis and 89.5% in patients with tuberculous peritonitis. Pseudomyxoma peritoneai and mesothelioma were suspected in one patient each at peritoneoscopy and was confirmed histologically. The utility of routine ascitic fluid examination was reviewed in all patients. The ascitic fluid was transudative in 81.9%, exudative in 8.6% and indeterminate in 9.5% of patients with cirrhosis of liver. Patients with tuberculous pertitonitis had exudative, transudative and indeterminate ascites in 71.8%, 3.2% and 25% respectively. The ascites in patients with malignant peritonitis was either exudative (80%) or indeterminate (20%). There was considerable overlap in the nature of ascites present in the three groups of patients. We therefore conclude that peritoneoscopy is the most valuable investigation in the diagnosis of ascites, particularly in exudative and indeterminate types.

Ascites↗
PubMed1988

Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites. Another look.

The serum-ascites albumin difference is reported to be superior to ascitic total protein, ascitic-to-serum total protein ratio, lactic dehydrogenase, and ascitic-to-serum lactic dehydrogenase ratio in differentiating between ascites from liver disease and malignant ascites, S-A greater than 1.1 reflecting portal hypertension. We analyzed ascitic fluid from 46 consecutive patients with chronic liver disease, 28 patients with ascites associated with malignancy, 10 patients with right-sided heart failure, 4 patients with hypothyroidism, and 6 patients with miscellaneous causes of ascites to determine if this albumin difference is indeed a more valuable parameter. Analysis of our data confirms with a larger number of patients that the serum-ascites albumin difference is a more reliable indicator of transudative ascites, better termed portal hypertensive ascites. Malignant ascites without liver metastases had features of nonportal hypertensive ascites, and the serum-ascites albumin difference confirms this. The characteristics of malignant ascites associated with liver metastases, however, resemble those of the portal hypertensive ascites complicating liver disease. This new parameter is also helpful in distinguishing congestive heart failure with high protein ascites and portal hypertensive ascitic features from malignant ascites without liver metastases. Of particular note, myxedematous ascitic fluid, classically categorized as exudative, had an S-A greater than 1.1, indicating the possible role of portal hypertension in the development of ascites in these patients.

Ascitic Fluid↗
PubMed1988

Intracranial synthesis of specific IgG antibody in cerebrospinal fluid of neurocysticercosis patients.

To determine the source of Cysticercus-specific IgG antibody in cerebro-spinal fluid(CSF), paired samples of serum and CSF were collected from confirmed neurocysticercosis, other neurologic diseases and normal control. The antibody levels in serum and CSF were measured by enzyme-linked immunosorbent assay (ELISA). With the measurement of total protein, albumin and IgG concentration in serum and CSF, the contribution of IgG in CSF were calculated in transudation, exudation and intracranial synthesis using the formula of Tourtellotte and Ma (1978). Mean concentrations of total protein, albumin, IgG and proportional IgG levels in CSF by transudation, exudation and intracranial synthesis were elevated in neurocysticercosis. But only the intracranial synthesis of IgG showed a statistically significant correlation with the specific IgG antibody levels in CSF. In CSF from lateral ventricle in the 4th ventricular neurocysticercosis, the protein concentrations were normal and the specific antibody levels were negative. However, in consecutively secured lumbar CSF from the same patients, the former were increased and the latter were positive. These results indicated that, in neurocysticercosis, the specific IgG antibody in CSF was a local product of intracranial synthesis.

Journal Article↗
PubMed1995

[Sero-ascitic gradient of albumin: usefulness and diagnostic limitations].

The serum-ascites albumin (SAA) gradient has been defined as the serum albumin concentration minus the ascitic fluid albumin concentration. The SAA gradient is superior to the exudate-transudate concept to classify ascites, being a exact portal hypertension (PH) marker. An elevated SAA gradient (1.1 g/L or greater) correlates with PH, whereas a low gradient indicates no PH. The SAA gradient correlates well with PH in cirrhotic patients. It is also of particular utility to differentiate between congestive heart failure and malignant ascites without liver metastases (both of them with elevated ascites fluid proteins -AFP-). However, a low SAA gradient do not differentiate between tuberculous and malignant ascites. Consequently, there are still need for tests a cytology, culture for mycobacteria or ascites fluid polymorphonuclear cell count in some cases. The level of AFP, apart from the exudate-transudate concept, has some value for certain cases (a low level of AFP implicates a high risk of spontaneous bacterial peritonitis). The SAA gradient should replace the AFP concentration as the initial test to classify ascites.

Albumins↗
PubMedDate not supplied

Biochemical modes of action of Cassia occidentalis and Cardiospermum halicacabum in inflammation.

The anti-inflammatory activity of Cassia occidentalis leaf powder and an ethanol extract of Cardiospermum halicacabum aerial parts were assayed in male albino rats using carrageenan-induced rat paw edema. C. occidentalis was maximally active at a dose of 2000 mg/kg, while the C. halicacabum extract was maximally effective at a dose of 500 mg/kg. In the cotton pellet granuloma assay, these drugs were able to suppress the transudative, exudative and proliferative components of chronic inflammation. Further, these drugs were able to lower the lipid peroxide content and gamma-glutamyl transpeptidase and phospholipase A2 activity in the exudate of cotton pellet granuloma. The increased alkaline phosphatase activity and decreased A/G ratio of plasma in cotton pellet granulomatous rats were normalized after treatment with these drugs. C. occidentalis powder and C. halicacabum extract were able to stabilize the human erythrocyte membrane against hypotonicity-induced lysis. It is likely that these drugs may exert their anti-inflammatory activity by inhibition of phospholipase A2, resulting in the reduced availability of arachidonic acid, a precursor of prostaglandin biosynthesis, and/or by stabilization of the lysosomal membrane system.

Animals↗