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Medically tailored meals for the management of symptomatic ascites:the SALTYFOOD pilot randomized clinical trial

Gastroenterology Report 2020年第6期8卷 453-456,I0002页

作者： Elliot B.Tapper Jad Baki Samantha Nikirk Scott Hummel Sumeet K.Asrani Anna SLok Division of Gastroenterology and Hepatology University of MichiganAnn ArborMIUSA Gastroenterology Section VA Ann Arbor Healthcare SystemAnn ArborMIUSA Department of Biostatistics University of MichiganAnn ArborMIUSA Baylor University Medical Center DallasTXUSA

Background:Ascites is a costly,morbid complication of *** a low-sodium diet is central to the clinical management of ascites,its efficacy is limited by poor *** aimed to determine the feasibility and impact of lowsodium medically tailored meals(MTM)***:We enrolled 40 persons with cirrhosis and ascites at the time of a paracentesis in a 12-week,1:1 randomized trial of standard of care(SOC)(low-sodiumdiet educational handout)or MTM with2,100 kcal,and>80 g of protein including a nocturnal protein *** determined the proportion of eligible candidates recruited and adherence to *** primary outcome was the number of paracenteses performed during weeks *** also collected ascites-specific quality-of-life(ASI-7)***:The median age of the enrolled subjects was 54(IQR,47-63)years,46%were female,with median MELD-Na 18(IQR,11-23)and albumin 2.7(IQR,2.5-3.3)g/*** baseline,subjects reported a median of two(IQR,1-3)paracenteses in the prior 4 *** to the meal schedule was excellent save for when hospitalizations *** 12 weeks,patients in the MTM arm required fewer paracenteses per week than those in the SOC group[median(IQR):0.34(0.14-0.54)vs 0.45(0.25-0.64)].During the trial,four(20%)SOC patients died,whereas two(10%)died and one(5%)was transplanted in the MTM ***-specific quality of life improved to a greater degree in the MTM arm compared to the SOC arm,by 25%(IQR,-11%to 61%)vs 13%(IQR,-28%to 54%).Conclusion:A trial of MTM for persons with ascites is feasible and potentially *** arms experienced benefits,highlighting the role for improved education and closer monitoring in this challenging condition.

关键词： cirrhosis ascites paracentesis sodium

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Spontaneous bacterial peritonitis:risk factors and causative organisms

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Asian Pacific Journal of Tropical Medicine 2009年第6期2卷 52-58页

作者： Mahmoud M Al-Bendary Mahmoud Abdel-Aziz Waleed A Al-Sherbeeny Raghda El-Sayed Farag Abdel-Hady El-Gilany Mohammad Hosam Eldeen Zaghloul Tropical Medicine Unit Community Medicine DepartmentCollege of MedicineMansoura UniversityEgypt Clinical Pathology Department College of MedicineMansoura UniversityEgypt

Objective:To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis(SBP) and their sensitivity pattern,to test the efficiency of different culture techniques in microbial isolation,and to study the diagnostic predictors of such ***:One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross - matched with age and sex without *** fluid was subjected to cytological,biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility ***:The prevalence of SBP was 25.02%.Logistic regression analysis revealed that;previous SBP episode,low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were the independent significant predictors of *** forty - five per cent of SBP episodes were detected by conventional culture compared to 73.15%by modified technique with a significant *** - negative bacteria were the cause of SBP in 46(58.23%) culture positive *** coli and Staphylococcus aureus were the most commonly detected organisms. Resistance to different antibiotics was ***:Culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP *** is a recent increase in Gram - positive pathogen with emergence of multidrug *** recent changes may have an impact on guidelines for management and treatment of SBP in our locality.

关键词： Spontaneous bacterial peritonitis paracentesis Bedside inoculation Blood bottle culture

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Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients

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World Journal of Hepatology 2013年第3期5卷 104-108页

作者： Jean-Franois Cadranel Jean-Baptiste Nousbaum Christophe Bessaguet Pierre Nahon Eric Nguyen-Khac Richard Moreau Thierry Thévenot Christine Silvain Christophe Bureau Olivier Nouel Christophe Pilette Thierry Paupard Arnaud Pauwels Thierry Sapey Jean-Didier Grangé Albert Tran Gastroenterology and Nutrition Department Centre Hospitalier Laennec Department of Hepato-Gastroenterology University Hospital La Cavale Blanche Department d'Information Médicale Centre Hospitalier Department of Hepato-Gastroenterology Hpital Jean Verdier Department of Hepato-Gastroenterology Amiens University Hospital Department of Hepatology Hpital Beaujon Department of Hepatology University Hospital Jean Minjoz Department of Hepato-Gastroenterology Poitiers University Hospital Department of Hepato-Gastroenterology Purpan Hospital Department of Hepato-Gastroenterology Centre Hospitalier de Saint Brieuc Department of Hepato-Gastroenterology Centre Hospitalier Department of Hepato-Gastroenterology Centre Hospitalier de Dunkerque Department of Hepato-Gastroenterology Centre Hospitalier de Gonesse Department of Hepato-Gastroenterology Centre Hospitalier de Chateauroux Department of Hepatology Hpital Tenon Digestive Center University Hospital of Nice

AIM: To compare the incidence of spontaneous bacterial peritonitis in cirrhotic outpatients and inpatients undergoing therapeutic paracentesis METHODS: From January 1 to May 31, 2004, 1041 patients from 70 different hospitals underwent 2123 therapeutic abdominal paracentesis (AP) performed as a outpatient procedure in 355 and as inpatient procedure in 686 cases respectively. The following parameters were compared prospectively between outpatients and inpatients: spontaneous bacterial peritonitis (SBP) prevalence, age, gender, cause of cirrhosis, symptoms, score and grade according to Child-Pugh classification, cirrhosis complications, antibiotics treatment, serum creatinine, platelet count and ascitic protein concentration. RESULTS: SBP was observed in 91 patients. In the whole population the SBP prevalence was 8.7% (95%CI: 7.2-10.6) it was 11.7% (95%CI: 9.5-14.3) in inpatients and 3.1% (95%CI: 1.7-5.5) in outpatients (P paracentesis could be avoided in these patients without significant risk.

关键词： Liver cirrhosis Ascites Ascitic fluid Bacterial infections paracentesis Peritonitis

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Efficacy of tolvaptan in patients with refractory ascites in a clinical setting

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World Journal of Hepatology 2015年第12期7卷 1685-1693页

作者： Takamasa Ohki Koki Sato Tomoharu Yamada Mari Yamagami Daisaku Ito Koki Kawanishi Kentaro Kojima Michiharu Seki Nobuo Toda Kazumi Tagawa Department of Gastroenterology Mitsui Memorial Hospital

AIM: To elucidate the efficacies of tolvaptan(TLV) as a treatment for refractory ascites compared with conventional treatment. METHODS: We retrospectively enrolled 120 refractory ascites patients between January 1, 2009 and September 31, 2014. Sixty patients were treated with oral TLV at a starting dose of 3.75 mg/d in addition to sodium restriction(> 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-60 mg/d furosemide and 25-50 mg/d spironolactone) and 60 patients with large volume paracentesis in addition to sodium restriction(less than 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-120 mg/d furosemide and 25-150 mg/d spironolactone). Patient demographics and laboratory data, including liver function, were not matched due to the small number of patients. Continuous variables were analyzed by unpaired t-test or paired t-test. Fisher's exact test was applied in cases comparing two nominal variables. We analyzed factors affecting clinical outcomes using receiver operating characteristic curves and multivariate regression analysis. We also used multivariate Cox's proportional hazard regression analysis to elucidate the risk factors that contributed to the increased incidence of ***: TLV was effective in 38(63.3%) patients. The best cut-off values for urine output and reduced urine osmolality as measures of refractory ascites improvement were > 1800 mL within the first 24 h and > 30%, respectively. Multivariate regression analysis indicated that > 25% reduced urine osmolality [odds ratio(OR) = 20.7; P < 0.01] and positive hepatitis C viral antibodies(OR = 5.93; P = 0.05) were positively correlated with an improvement of refractory ascites, while the total bilirubin level per 1.0 mg/dL(OR = 0.57;P = 0.02) was negatively correlated with improvement. In comparing the TLV group and controls, only the serum sodium level was significantly lower in the TLV group(133 mE q/L vs 136 mE q/L; P = 0.02). However, there were n

关键词： Refractory ascites Tolvaptan paracentesis Decompensated cirrhosis

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Management of refractory ascites in cirrhosis:Are we out of date?

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World Journal of Hepatology 2016年第28期8卷 1182-1193页

作者： Alagappan Annamalai Lauren Wisdom Megan Herada Mazen Nourredin Walid Ayoub Vinay Sundaram Andrew Klein Nicholas Nissen Comprehensive Transplant Center Cedars Sinai Medical Center

Cirrhosis is a major cause of morbidity and mortality worldwide with liver transplantations as it only possible *** the face of a significant organ shortage many patients die waiting.A major complication of cirrhosis is the development of portal hypertension and *** management of ascites has barely evolved over the last hundred years and includes only a few milestones in our treatment approach,but has overall significantly improved patient morbidity and *** mainstay to ascites management includes changes in diet,diuretics,shunt procedures,and large volume *** understanding of the pathophysiology of cirrhosis and portal hypertension has significantly improved in the last couple of decades but the changes in ascites management have not seemed to mirror this newer *** herein review the history of ascites management and discuss some its current limitations.

关键词： Portal hypertension Cirrhosis Ascites Transhepatic portosystemic shunts paracentesis

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Impact on 30-d readmissions for cirrhotic patients with ascites after an educational intervention: A pilot study

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World Journal of Hepatology 2019年第10期11卷 701-709页

作者： Nicholas Lim Otto Sanchez Andrew Olson Division of Gastroenterology Hepatology and NutritionUniversity of MinnesotaMinneapolisMN 55455United States Division of Renal Diseases and Hypertension University of MinnesotaMinneapolisMN 55455United States Division of General Internal Medicine University of MinnesotaMinneapolisMN 55455United States

BACKGROUND A low proportion of patients admitted to hospital with cirrhosis receive quality care with timely paracentesis an important target for *** hypothesized that a medical educational intervention,delivered to medical residents caring for patients with cirrhosis,would improve quality of *** To determine if an educational intervention can improve quality of care in cirrhotic patients admitted to hospital with *** We performed a pilot prospective cohort study with time-based randomization over six months at a large teaching *** rotating on hospital medicine teams received an educational intervention while residents rotating on hospital medicine teams on alternate months comprised the control *** primary outcome was provision of quality care-defined as adherence to all quality-based indicators derived from evidence-based practice guidelines-in admissions for patients with cirrhosis and *** clinical outcomesincluding length of hospital stay(LOS);30-d readmission;in-hospital mortality and overall mortality-and resident educational outcomes were also *** Eighty-five admissions(60 unique patients)met inclusion criteria over the study period-46 admissions in the intervention group and 39 admissions in the control ***-seven admissions were female patients,and 44 admissions were for alcoholic liver *** model for end-stage liver disease(MELD)-Na score at admission was ***-seven(55.3%)admissions received quality *** was no difference in the provision of quality care(56.41%vs 54.35%,P=0.9)between the two groups.30-d readmission was lower in the intervention group(35%vs 52.78%,P=0.1)and after correction for age,gender and MELD-Na score[RR=0.62(0.39,1.00),P=0.05].No significant differences were seen for LOS,complications,in-hospital mortality or overall mortality between the two *** medical knowledge and self-efficacy with paracentesis improved after the edu

关键词： Cirrhosis Education paracentesis Quality

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Myxedema ascites with high CA-125:Case and a review of literature

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World Journal of Hepatology 2013年第2期5卷 86-89页

作者： Bou Khalil Roula El Rassi Patrick Chammas Nizar Obeid Jean Ghabach Maroun Sakr Charles Itani Tarek Farhat Said Quarantaine Governmental University Medical Hospital Beirut 961Lebanon Saint Georges University Medical Center University of BalamandBeirut 961Lebanon Department of Surgery Lebanese UniversityBeirut 961Lebanon Chairman of Anesthesia Department Rosary HospitalBeirut 961Lebanon

Ascites appearing in a previously healthy female patient is usually ascribed to a variety of causes,among which,is a cancerous process,especially if it comes with a raised CA-125 *** the CA-125 antigen is present on more than 80% of malignant epithelial ovarian tissue of non-mucinous type,it is also found on both healthy and malignant cells of mesothelial and non-mesothelial *** ascites which is caused by hypothyroidism is a rare entity,but on the other hand is easy to *** is one of the differential diagnoses when the ascites is refractory to treatment and no other obvious cause can be *** the diagnosis is delayed,patients will frequently receive unnecessary procedures,while treatment has very good response rates and ascites resolve with serum CA-125 normalization after adequate hormonal treatment.

关键词： Hypothyroidism Refractory ascites High CA-125 Hormonal therapy Abdominal paracentesis

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Accuracy of the automated cell counters for management of spontaneous bacterial peritonitis

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World Journal of Gastroenterology 2008年第37期14卷 5689-5694页

作者： Oliviero Riggio Stefania Angeloni Antonella Parente Cinzia Leboffe Giorgio Pinto Teresa Aronne Manuela Merli Department of Clinical Medicine "Sapienza" University of RomeRome 00185 Italy

AIM： To evaluate the accuracy of automated blood cell counters for ascitic polymorphonuclear （PMN） determination for：（1） diagnosis, （2） efficacy of the ongoing antibiotic therapy, and （3） resolution of spontaneous bacterial peritonitis （SBP）. METHODS： One hundred and twelve ascitic fluid samples were collected from 52 consecutive cirrhotic patients, 16 of them with SBP. The agreement between the manual and the automated method for PMN count was assessed. The sensitivity/specificity and the positive/negative predictive value of the automated blood cell counter were also calculated by considering the manual method as the ＂gold standard＂ RESULTS： The mean ＋ SD of the difference between manual and automated measurements was 7.8 4- 58 cells/ram3, while the limits of agreement were ＋124 cells/mm3 [95% confidence interval （CI）：＋145 to ＋103] and -108 cells/mm3 （95% CI： -87 to -129）. The automated cell counter had a sensitivity of 100% and a specificity of 97.7% in diagnosing SBP, and a sensitivity of 91% and a specificity of 100% for the efficacy of the ongoing antibiotic therapy. The two methods showed a complete agreement for the resolution of infection. CONCLUSION： Automated cell counters not only have a good diagnostic accuracy, but are also very effectivein monitoring the antibiotic treatment in patients with SBP. Because of their quicker performance, they should replace the manual counting for PMN determination in the ascitic fluid of patients with SBP.

关键词： Spontaneous bacterial peritonitis Ascites Polymorphonuclear cell count Automated cell counter paracentesis Cirrhosis

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Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis

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World Journal of Gastroenterology 2009年第31期15卷 3845-3850页

作者： Oliviero Riggio Stefania Angeloni Department of Clinical Medicine "Sapienza" University of Rome

Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an "instant" bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic effi cacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.

关键词： Ascites Ascitic fluid lactoferrin Automatedblood cell counter paracentesis Polymorphonuclear cell count Urinary reagent strips

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Comments on the editorial by Riggio&Ageloni on the ascitic fluid analysis

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World Journal of Gastroenterology 2009年第48期15卷 6137-6138页

作者： Anastasios Koulaouzidis Day Case & Endoscopy Unit Centre of Liver and Digestive DisordersRoyal Infirmary of Edinburgh

Angeloni et al published a landmark study on the use of Coulter counters in spontaneous bacterial peritonitis(SBP)*** and Angeloni have recently published an editorial on the ascitic fluid analysis in diagnosis and mo... 详细信息

关键词： Peritonitis Reagent Dipstick paracentesis Guidelines Ascites

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