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At least 19 recordsLinked to original sources

PubMed1992

Paracentesis with Dextran 70 vs. paracentesis with albumin in cirrhosis with tense ascites. Results of a randomized study.

Forty-one patients with cirrhosis and tense ascites were randomized to receive daily paracentesis of 5 liters associated with Dextran 70 as volume expander (6 g for each 1000 ml of ascites removed) (group I = 20 patients) or paracentesis with albumin (6 g for each 1000 ml of ascites) (group II = 21 patients). The basal clinical features, laboratory data, and plasma renin activity were similar in both groups. The volume of ascites removed was 12.9 +/- 4.4 and 10.9 +/- 3.7 liters in group I and II, respectively (n.s.). No significant changes were observed in liver and renal function tests, KPTT, platelet count, factor VIII, serum electrolytes or plasma renin activity 24 and 96 h after the last paracentesis in both groups, except for a decrease in bilirubin in group I and a transient increase of serum albumin in group II. Four patients developed complications in each group, mainly hyponatremia, while one patient in each group developed renal impairment. One patient from group I died with hepatic encephalopathy. Moreover, the probability of survival and readmission to the hospital because of tense ascites were similar in both groups of patients during the follow-up. The treatment cost with Dextran 70 was 15.50 dollars vs. 364.30 dollars with albumin for each patient treated. These results indicate that repeated large volume paracentesis associated with Dextran 70 is as effective and safe as paracentesis associated with albumin in cirrhotic patients with tense ascites. However, due to its reduced cost, paracentesis with Dextran 70 may be considered the treatment of choice in cirrhotic patients with tense ascites without liver cancer and renal failure.

Ascites↗

PubMed1997

A randomized trial of paracentesis plus intraperitoneal tumor necrosis factor-alpha versus paracentesis alone in patients with symptomatic ascites from recurrent ovarian carcinoma.

PURPOSE: Previous phase I and II studies of intraperitoneal recombinant human tumor necrosis factor-alpha (rhTNF-alpha) suggested a high degree of efficacy in reducing or eliminating ascitic fluid. To more accurately determine the efficacy of this agent, the role of paracentesis versus paracentesis plus intraperitoneal rhTNF-alpha was studied in a randomized trial. PATIENTS AND METHODS: Thirty-nine patients with symptomatic ascites with a volume of > 1000 ml from recurrent epithelial ovarian carcinoma or primary peritoneal carcinoma, which was refractory to standard therapy, were randomized either to receive 0.06 mg/m2 rhTNF-alpha (Knoll, Canada) (the dose determined optimal from phase I and II studies) intraperitoneally after drainage of fluid or to receive drainage alone. A maximum of three treatments were given at weekly intervals. Eighteen patients were randomized to receive rhTNF-alpha. RESULTS: None of 18 evaluable rhTNF-alpha patients had either a complete response (CR) (no clinical evidence of ascites and < 400 ml of fluid on ultrasound) or a partial response (PR) (asymptomatic ascites and < or = 1000 ml of fluid ultrasound). There were no CRs or PRs in the 17 evaluable patients who received drainage alone. The intraperitoneal infusion of rhTNF-alpha was generally well tolerated. Moderate to severe toxicity consisted of pain/discomfort in 42.1%, fever/chills in 36.9%, nausea/vomiting in 10.5%, edema in 10.5%, and hypotension in 5.3% of patients receiving rhTNF-alpha. CONCLUSION: rhTNF-alpha, as given in this study, was not effective in preventing recurrence of ascites in this patient population.

Ascites↗

PubMed2001

[A new paracentesis needle for ascites and pleural effusion compared with the venous indwelling catheter. A prospective, randomized study].

BACKGROUND: Diagnostic or therapeutic paracentesis of ascites or pleural effusions is part of the daily routine on many hospital wards and in outpatient clinics. In Germany, paracentesis is usually performed with angiocaths. However, the therapeutic large volume paracentesis of ascites and paracentesis of pleural effusions with angiocaths is often cumbersome and quite often paracentesis fails, forcing the physician to repuncture. This is mainly due to the fact that angiocaths are not designed for such interventions. PATIENTS AND METHOD: 45 patients with ascites or pleural effusions were treated with a new needle specially designed for paracentesis, or with an angiocath. The new paracentesis needle was compared with the angiocath needle under the following aspects: necessity and number of positional corrections of the needle, necessity of and reasons for repuncture, duration of puncture, flow capacity, subjective practicability of paracentesis and patient acceptance of the paracentesis needle. RESULTS: The paracentesis needle was superior to the angiocath in all investigated respects. Significantly, the paracentesis needle had a much higher success rate in the complete drainage than had the angiocath. CONCLUSION: The paracentesis needle was objectively superior as compared to the angiocath. It might help to avoid additional complications due to repuncture and it will increase the patients' comfort.

Adult↗

PubMed2004

Mechanisms of early decrease in systemic vascular resistance after total paracentesis: influence of flow rate of ascites extraction.

BACKGROUND: An early decrease in systemic vascular resistance (SVR) after total paracentesis has been observed in ascitic patients who developed paracentesis-induced circulatory dysfunction. AIMS: To investigate the mechanisms of early changes in SVR after total paracentesis and the influence of intra-abdominal pressure and the flow rate of ascites extraction on the development of an early decrease in SVR. METHODS: Twenty-two cirrhotic patients with tense ascites were treated by total paracentesis (7 +/- 0.4 l). Measurements of intra-abdominal pressure and the volume of ascites removed were recorded every 10 min. Hormonal and haemodynamic measurements were performed at baseline and 3 h after total paracentesis. RESULTS: SVR decreased 3 h after paracentesis in 17 patients and remained stable in five patients. Patients with a decrease in SVR showed a significant increase in nitrite/nitrate serum values (4.4 +/- 0.9 to 7.4 +/- 1 nmol/ml; P < 0.05). A significant correlation was observed between the decrease in SVR and nitrite/nitrate serum values (r = 0.566; P < 0.05). The volume of ascites removed was similar in patients with and without a decrease in SVR. Patients with a decrease in SVR showed higher baseline intra-abdominal pressure, shorter duration of paracentesis (60 +/- 4.9 vs 88 +/- 0.4 min; P < 0.01) and higher flow rate of ascites extraction (1.18 +/- 0.08 vs 0.81 +/- 0.12 l/min; P < 0.05). CONCLUSIONS: Our results confirm that an early decrease in SVR after total paracentesis is due to an increase in arterial vasodilation that may be related to an abrupt decrease in intra-abdominal pressure after fast paracentesis. Haemodynamic disturbances after total paracentesis could be prevented by reducing the flow rate of ascites extraction.

Abdomen↗

PubMed2006

Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study.

BACKGROUND: Therapeutic paracentesis in patients with cirrhosis induces arterial vasodilatation, causes a decrease in effective arterial blood volume and leads to circulatory dysfunction, which can be prevented by intravenous albumin. However, the use of albumin, being a blood product, is controversial. Recently, terlipressin, a vasoconstrictor, has been successfully used to combat this adverse effect of therapeutic paracentesis. Therefore, the aim of the present study was to investigate the preventive effect of terlipressin on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared with that of intravenous albumin. METHODS: Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or terlipressin in a randomized pilot study at a tertiary center. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 4-6 days after treatment. RESULTS: Effective arterial blood volumes as indicated by plasma renin activity before and 4-6 days after paracentesis did not differ in the two groups (19.15 +/- 12.1 to 20.33 +/- 12.8 ng/mL per h, P = 0.46 in the albumin group; and 20.11 +/- 10.6 to 21.08 +/- 10.52 ng/mL per h, P = 0.44 in the terlipressin group). Plasma aldosterone concentrations before and 4-6 days after paracentesis were also similar in both groups (1334.75 +/- 1058 to 1440.0 +/- 1161 pg/mL, P = 0.06 in the albumin group; and 1473.0 +/- 1168 to 1572.29 +/- 1182 pg/mL, P = 0.24 in the terlipressin group). Both terlipressin and albumin prevented paracentesis-induced renal impairment in these patients. CONCLUSIONS: Terlipressin may be as effective as intravenous albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis.

Albumins↗

PubMed1998

Hemodynamic changes in patients developing effective hypovolemia after total paracentesis.

BACKGROUND/AIMS: In many centers paracentesis is considered the treatment of choice for tense ascites. However, the mechanism of effective hypovolemia after paracentesis, the main complication associated with this procedure, remains unknown. In the current study, systemic hemodynamics was sequentially studied before and after total paracentesis in 46 patients with cirrhosis and tense ascites. The aim of the study was to assess the mechanism of effective hypovolemia after paracentesis. METHODS: Plasma renin activity and aldosterone, mean arterial pressure, cardiac output (ECO-Doppler) and systemic vascular resistance were measured before, and 3 h, 6 h and 6 days after total paracentesis associated with plasma volume expansion. RESULTS: Effective hypovolemia after paracentesis (defined as 50% increase in plasma renin activity up to a level over 4 ng x m(-1) x h(-1) at the 6th day after paracentesis) occurred in 20 cases [plasma renin activity increased from 8+/-17 to 19+/-2.7 ng x m(-1) x h(-1)]. In the remaining 26 cases no changes in plasma renin activity [8.5+/-2.4 vs. 8.7+/-2.2 ng x m(-1) x h(-1)] were observed. The amounts of ascitic fluid volume removed were similar. Effective hypovolemia after paracentesis was associated with a significant decrease in mean arterial pressure (89+/-2 vs. 81+/-3 mmHg) and systemic vascular resistance [1263+/-67 vs. 1014+/-80 dyn x s(-1) x cm(-5)] 6 days after treatment. In contrast, no significant changes in these parameters were observed in patients not developing this complication. In the whole group of patients a significant inverse relation was observed between changes in plasma renin activity and in systemic vascular resistance (r=0.74;p< 0.001). CONCLUSIONS: These results indicate that effective hypovolemia after paracentesis in cirrhosis is predominantly due to an accentuation of the arteriolar vasodilation already present in these patients.

Adult↗

PubMed1998

Effects of repeated abdominal paracentesis on uterine and intraovarian haemodynamics and pregnancy outcome in severe ovarian hyperstimulation syndrome.

The aims of this study were to investigate the effects of paracentesis on uterine and intraovarian haemodynamics by colour Doppler ultrasound and the influences of repeated paracentesis on pregnancy outcome in severe ovarian hyperstimulation syndrome (OHSS). Forty-one abdominal paracenteses were performed on seven pregnant women with tense ascites and eight thoracocenteses were performed on three pregnant women with pleural effusion. Pulsatility index (PI) and maximum peak systolic velocity (MPSV) of uterine and intraovarian arteries were measured before and after each intervention. The mean PI of uterine arteries was decreased significantly after paracentesis, but not after thoracocentesis. Furthermore, uterine PI was decreased in 13 out of 14 (92.9%) paracenteses with <2500 ml ascites removed, compared with eight out of 13 (61.5%) with >2500 ml ascites removed. After paracentesis, there were no significant changes in the intraovarian PI and MPSV in either group. The 24-hour urine output increased significantly in the paracentesis group, but not in the thoracocentesis group. There were no significant changes in haematocrit and electrolytes as a result of paracentesis. However, gradual falls in serum total proteins and albumin concentrations were observed in all patients after repeated paracentesis, necessitating post-paracentesis albumin infusion. There was no significant difference in miscarriage rates between the two groups. We conclude that repeated abdominal paracentesis increases uterine perfusion and has no adverse effects on pregnancy outcome in severe OHSS. Extraction of 2500 ml of ascitic fluid did not impair uterine perfusion.

Adult↗

PubMed2006

Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study.

OBJECTIVE: Therapeutic paracentesis in patients with cirrhosis is associated with a circulatory dysfunction. Intravenous albumin has been used to prevent the circulatory dysfunction; however, the use of albumin is controversial and costly. Splanchnic vasodilation is mainly responsible for circulatory dysfunction in these patients. There are no reports of use of noradrenaline, a vasoconstrictor, on the prevention of paracentesis-induced circulatory dysfunction in patients with cirrhosis. Therefore, we studied the preventive effect of noradrenaline on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared it with that of intravenous albumin in a randomized pilot study. METHODS: Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or noradrenaline in a randomized controlled trial at a tertiary centre. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 6 days after treatment. RESULTS: Effective arterial blood volume as indicated by plasma renin activity before and 6 days after paracentesis did not differ in the two groups (20.62 +/- 10.27-22.02 +/- 10.15 ng mL(-1) h(-1); P = 0.11 in the albumin group and 19.66 +/- 8.91-20.78 +/- 9.41 ng mL(-1) h(-1); P = 0.37 in the noradrenaline group). Plasma aldosterone concentration before and 6 days after paracentesis were also similar in both groups (1196.5 +/- 434.2-1217.0 +/- 405.7 pg mL(-1); P = 0.7 in the albumin group and 1206.0 +/- 522.5-1273.5 +/- 444.8 pg mL(-1); P = 0.22 in the noradrenaline group). The cost of noradrenaline treatment was significantly lower when compared with that of albumin (P < 0.001). CONCLUSIONS: Noradrenaline is as effective as albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis, but at a fraction of the cost.

Adult↗

PubMed2002

Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study.

BACKGROUND: Patients with cirrhosis and tense ascites treated by paracentesis alone have a decrease in effective arterial blood volume after ascites removal. Although intravenous albumin is effective in preventing paracentesis induced decreased arterial blood volume, its clinical use is controversial. As paracentesis induces arteriolar vasodilation which plays a role in the development of decreased effective arterial blood volume, administration of a vasoconstrictor (terlipressin) could prevent circulatory alterations due to paracentesis. AIMS: To perform a pilot study comparing the effects of terlipressin and albumin on effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites. METHODS: Twenty patients with cirrhosis and tense ascites were randomly assigned to be treated by either paracentesis and terlipressin or paracentesis and albumin. Terlipressin (3 mg) or albumin (8 g/l of removed ascites) were administered on the day of paracentesis. Effective arterial blood volume was assessed by measuring plasma renin concentrations at baseline and on the day of hospital discharge (4-6 days after treatment). Decreased effective arterial blood volume was defined as an increase in plasma renin concentrations on the day of hospital discharge of more than 50% of baseline values. RESULTS: Irrespective of the treatment group, mean values for plasma renin concentrations at hospital discharge did not differ from their respective baseline values (p=0.10). Baseline plasma levels of renin concentrations did not differ between the terlipressin and albumin groups (p=0.61). Changes from baseline in plasma renin concentrations did not differ between groups (p=0.39). Three patients in the terlipressin group and three in the albumin group developed decreased arterial blood volume. CONCLUSIONS: This randomised pilot study suggests that terlipressin may be as effective as intravenous albumin in preventing a decrease in effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites.

Albumins↗

PubMed1988

Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis.

It has recently been shown that repeated large-volume paracentesis associated with intravenous albumin infusion is a rapid, effective, and safe therapy of ascites in cirrhosis. To investigate whether intravenous albumin infusion is necessary in the treatment of cirrhotics with large-volume paracentesis, 105 patients with tense ascites were randomly allocated into two groups. Fifty-two patients (group 1) were treated with paracentesis (4-6 L/day until disappearance of ascites) plus intravenous albumin infusion (40 g after each tap), and 53 (group 2) with paracentesis without albumin infusion. After disappearance of ascites, patients were discharged from the hospital with diuretics. Patients developing tense ascites during follow-up were treated according to their initial schedule. Paracentesis was effective in eliminating the ascites in 50 patients from group 1 and in 48 from group 2, with the duration of the hospital stay being approximately 11 days in both groups. Paracentesis plus intravenous albumin did not induce significant changes in standard renal function tests, plasma renin activity, and plasma aldosterone. In contrast, paracentesis without albumin was associated with a significant increase in blood urea nitrogen, a marked elevation in plasma renin activity and plasma aldosterone concentration, and a significant reduction in serum sodium concentration. One patient from group 1 and 11 from group 2 developed renal impairment or severe hyponatremia after treatment, or both (chi 2 = 9.19; p less than 0.01). The development of these complications could not be predicted by clinical and laboratory data before treatment. Although the probability of survival after entry into the study was similar in patients from both groups, a multivariate analysis identified the development of hyponatremia or renal impairment, or both, following the first paracentesis treatment and the occurrence of other complications during the first hospitalization (encephalopathy, gastrointestinal bleeding, and severe infection) as being the only independent predictors of mortality. These results indicate that intravenous albumin infusion is important in avoiding renal and electrolyte complications and activation of endogenous vasoactive systems in cirrhotics with ascites who are treated with repeated large-volume paracentesis. The development of such complications may impair survival in these patients.

Albumins↗

PubMed1992

Effect of paracentesis upon the blood-aqueous barrier of cynomolgus monkeys.

Anterior chamber paracentesis disrupts the blood aqueous barrier (BAB) of rabbits and nonhuman primates, but the magnitude and duration of breakdown in monkeys has not been clarified. We have studied anterior chamber paracentesis in cynomolgus monkeys as a potential model of postoperative BAB breakdown. The effect of a single paracentesis upon fluorescein sodium concentration in the anterior chamber after an intravenous injection was measured in 16 eyes of 8 animals. In an additional 10 eyes of 5 animals, aqueous humor was withdrawn for analysis 24 hours and one week following paracentesis. Anterior chamber fluorescein concentration was 57 +/- 22 ng/ml (mean +/- standard deviation) before paracentesis, rose to 81 +/- 47 ng/ml 24 hrs after paracentesis, and was 60 +/- 36 ng/ml at 72-96 hours. Twenty-four hours after paracentesis, total protein concentration was elevated, but ascorbic acid and transforming growth factor-beta levels were not. Paracentesis in monkeys has only a small and short lasting effect upon BAB integrity and is therefore unlikely to be a good model for assessing the effect of agents designed to stabilize the BAB. However, the short-lived effect of paracentesis may permit the repetitive collection of "primary aqueous" for physiologic and biochemical studies.

Animals↗

PubMed2002

Effect of paracentesis of ascitic fluids on urinary output and blood indices in patients with severe ovarian hyperstimulation syndrome.

OBJECTIVE: To determine the isolated effect of abdominal paracentesis of ascitic fluid in women with severe OHSS on urine production and blood indices. DESIGN: Retrospective interventional study. SETTING: Gynecology department at the Lis Maternity Hospital, affiliated to Tel Aviv University. PATIENT(S): Thirty women with severe OHSS. INTERVENTION(S): Abdominal paracentesis according to clinical indications. MAIN OUTCOME MEASURE(S): Urinary output, blood urea nitrogen, as well as a complete blood count were measured before and following the procedure. RESULT(S): Urinary output increased from 1890 +/- 128 mL per 24 hours on the day before paracentesis to 2,660 +/- 226 mL per 24 hours after the procedure. Blood urea nitrogen values were 8.9 +/- 0.56 mg/dL and 7.8 +/- 0.53 mg/dL on the days before and after paracentesis, respectively. White blood cell count decreased from 15.4 +/- 1.1 (x 10(3) cells/mm(3)) on the days before the paracentesis to 13.3 +/- 0.9 (x 10(3) cells/mm(3)) after the procedure. Hematocrit was reduced significantly from 35.2 +/- 1.0% before the paracentesis to 33.4 +/- 0.8% after paracentesis. CONCLUSION(S): Paracentesis of ascitic fluids in women with severe OHSS has an isolated effect in improving renal function, as is evident by the increased urinary output and reduced blood urea nitrogen.

Adult↗

PubMed2000

A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites.

BACKGROUND: In patients with cirrhosis and ascites, creation of a transjugular intrahepatic portosystemic shunt may reduce the ascites and improve renal function. However, the benefit of this procedure as compared with that of large-volume paracentesis is uncertain. METHODS: We randomly assigned 60 patients with cirrhosis and refractory or recurrent ascites (Child-Pugh class B in 42 patients and class C in 18 patients) to treatment with a transjugular shunt (29 patients) or large-volume paracentesis (31 patients). The mean (+/-SD) duration of follow-up was 45+/-16 months among those assigned to shunting and 44+/-18 months among those assigned to paracentesis. The primary outcome was survival without liver transplantation. RESULTS: Among the patients in the shunt group, 15 died and 1 underwent liver transplantation during the study period, as compared with 23 patients and 2 patients, respectively, in the paracentesis group. The probability of survival without liver transplantation was 69 percent at one year and 58 percent at two years in the shunt group, as compared with 52 percent and 32 percent in the paracentesis group (P=0.11 for the overall comparison, by the log-rank test). In a multivariate analysis, treatment with transjugular shunting was independently associated with survival without the need for transplantation (P=0.02). At three months, 61 percent of the patients in the shunt group and 18 percent of those in the paracentesis group had no ascites (P=0.006). The frequency of hepatic encephalopathy was similar in the two groups. Of the patients assigned to paracentesis in whom this procedure was unsuccessful, 10 received a transjugular shunt a mean of 5.5+/-4 months after randomization; 4 had a response to this rescue treatment. CONCLUSIONS: In comparison with large-volume paracentesis, the creation of a transjugular intrahepatic portosystemic shunt can improve the chance of survival without liver transplantation in patients with refractory or recurrent ascites.

Adult↗

PubMed2001

Large-volume paracentesis in the management of ascites in children.

BACKGROUND: Large-volume paracentesis has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. There are no published data relating to the safety, efficacy, or methods of this procedure in children. The objective of this study was to characterize the authors' initial experience with large-volume paracentesis (> 50 ml/kg of ascites) for removal of tense abdominal ascites in the pediatric population. METHODS: Retrospective chart review was performed of 21 large-volume paracentesis sessions in seven children (ages 6 months-18 years) with tense ascites that did not respond to other measures. RESULTS: Mean volume removed was 3,129 +/- 2,966 ml (mean +/- standard deviation) or 118 +/- 56 ml/kg over 2.9 +/- 3.7 hours by a 16-gauge intravascular catheter in 6 sessions, by an 18-gauge intravascular catheter in three sessions, and by a 15-gauge fenestrated, stainless-steel paracentesis needle in 12 sessions. Large-volume paracenteses performed with the paracentesis needle had significantly shorter duration of drainage and faster flow rates than those performed with the intravascular catheter. The only complication encountered was decreased urine output in one session. CONCLUSIONS: Large-volume paracentesis is a safe and effective therapeutic method for managing tense abdominal ascites in children. The use of the paracentesis needle significantly improved the speed and efficiency of large-volume paracentesis compared with the intravascular catheter.

Adolescent↗

PubMedDate not supplied

Effects of therapeutic paracentesis on systemic and hepatic hemodynamics and on renal and hormonal function.

Thirteen patients with cirrhosis and tense ascites (six with and seven without peripheral edema) underwent 4- to 15-liter paracentesis without intravenous "colloid" replacement. Cardiac output increased from 6.6 +/- 0.7 liters per min at baseline to 8.2 +/- 0.7 liters per min (p less than 0.003) 1 hr after large-volume paracentesis completion and fell to 7.5 +/- 0.69 liters per min (p less than 0.05 vs. baseline, p less than 0.02 vs. 1 hr) 24 hr after large-volume paracentesis completion. There was no change in mean arterial pressure or mean pulmonary artery pressure. Central venous pressure fell from 9.1 +/- 0.8 mm Hg at baseline to 8.6 +/- 1.4 mm Hg 1 hr post-large-volume paracentesis to 6.8 +/- 1.0 mm Hg (p less than 0.005 vs. baseline, p less than 0.02 vs. 1 hr value) at 24 hr, and pulmonary capillary wedge pressure fell from 13.1 +/- 0.9 to 11.1 +/- 1.3 mm Hg 1 hr after large-volume paracentesis and to 9.89 +/- 1.2 (p less than 0.01 vs. baseline, p less than 0.03 vs. 1 hr after large-volume paracentesis) at 24 hr. Heart rate fell from 90 +/- 3.0 to 85 +/- 2.9 beats per min (p less than 0.01) 1 hr after large-volume paracentesis completion, but increased to 89 +/- 2.5 beats per min (p less than 0.02 vs. 1 hr after large-volume paracentesis) at 24 hr.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Effects of large-volume paracentesis on pulmonary function in patients with tense cirrhotic ascites.

Large-volume paracentesis is an accepted therapeutic modality for the treatment of tense ascites in patients with cirrhosis. Whereas the effects of large-volume paracentesis on the cardiovascular system have been studied in great detail, the effects of tense ascites and large-volume paracentesis on the respiratory system have undergone only limited evaluation. Most patients report symptomatic improvement in breathing after large-volume paracentesis. The aim of our study was to prospectively evaluate the effects of large-volume paracentesis on the pulmonary function of patients with tense ascites. Nine patients with alcoholic cirrhosis and tense ascites underwent large-volume paracentesis (mean, 3,500 ml of ascites removed) followed by intravenous albumin infusion (10 gm/L ascites removed). Pulmonary function tests were performed just before and 2 hr after large-volume paracentesis. The functional residual capacity increased from 2.46 +/- 0.92 to 2.99 +/- 0.97 L (p = 0.01) and total lung capacity from 5.08 +/- 1.18 to 5.72 +/- 1.32 L (p = 0.03). The forced vital capacity, expiratory reserve volume and residual volume also increased but were not statistically significant (p = 0.07 for all). We noted no significant improvement in forced expiratory volume in 1 sec, forced expiratory effort 25% to 75%, vital capacity or diffusion capacity. There was marked symptomatic improvement in all patients. We conclude that large-volume paracentesis improves measured lung volumes within hours in patients with tense ascites.

Ascites↗

PubMed1994

Effect of large-volume paracentesis on pulmonary function in patients with cirrhosis and tense ascites.

The effect of large-volume paracentesis on lung function was evaluated in 12 male patients with cirrhosis. All underwent pulmonary function tests including spirometry, plethysmography and single-breath carbon-monoxide diffusing capacity 1 day before and after paracentesis. The amount of ascitic fluid removed ranged from 3.6 to 131 (mean +/- SD, 7.4 +/- 3.01). After paracentesis, forced vital capacity, forced expiratory volume at 1 s, total lung capacity, functional residual capacity, inspiratory capacity, expiratory reserve volume, diffusing capacity and alveolar volume increased significantly. In contrast, Kco (diffusing capacity corrected by alveolar volume) decreased significantly. After paracentesis, the increase in diffusing capacity was highly correlated with lung volumes and the amount of removed ascitic fluid. Nevertheless, a significantly negative correlation was found between the change of Kco before and after paracentesis and that of lung volumes. The increase in lung volumes and ventilation to the lower lungs with unfavorable ventilation-perfusion matching might explain the discrepancy between changes in diffusing capacity and Kco after large-volume paracentesis. In conclusion, these results suggest that pulmonary function in patients with cirrhosis and tense ascites is partly improved by large-volume paracentesis. Large-volume paracentesis might be useful for symptomatic relief in selected patients with tense ascites.

Ascites↗

PubMed1991

Large-volume paracentesis versus dialytic ultrafiltration in the treatment of cirrhotic ascites.

We compared the clinical efficacy and safety of large-volume paracentesis and dialytic ultrafiltration in the treatment of refractory ascites in cirrhotic patients. A group of cirrhotic subjects (age 49-80 years) were randomly allocated to either continuous paracentesis (1-1.5 l/hour) or dialytic ultrafiltration until disappearance of ascites. Each patient was maintained on bed rest, fluid restriction (1 l/day) and a low (25 mmol/day) sodium diet for 14 days. Five patients (three in the paracentesis group and two in dialytic ultrafiltration group) developed massive ascites 3-5 months later, and received the crossover treatment. The average volume of fluid removed was similar in the two groups (4.70 +/- 1.47 l for dialytic ultrafiltration versus 4.69 +/- 1.84 l for paracentesis), but the treatment period was significantly shorter with dialytic ultrafiltration. The plasma creatinine significantly increased three days after paracentesis but did not increase in patients treated with dialytic ultrafiltration. There was an initial fall in mean arterial pressure during the first two hours of either treatment; a further fall in blood pressure was observed with paracentesis but not with dialytic ultrafiltration. Pretreatment plasma renin activity was elevated, but was not altered by either treatment. Plasma atrial natriuretic peptide levels were in the high-normal range before treatment. Paracentesis was associated with a delayed fall in plasma atrial natriuretic peptide, while dialytic ultrafiltration induced a modest but significant rise. No complication was experienced with dialytic ultrafiltration in the two weeks following treatment, but four of the eight patients who underwent paracentesis had developed severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗