Asunto(s)
Ascitis , Humanos , Ascitis/etiología , Ascitis/diagnóstico , Masculino , Diagnóstico Diferencial , FemeninoRESUMEN
OBJECTIVE: Aim: To evaluate the peculiarities of the course of complications and the provision of care for portal hypertension associated with the development of diureticresistant ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and variceal bleeding. PATIENTS AND METHODS: Materials and Methods: This research is based on a review of the literature in PubMed, CrossRef, Google Scholar sources on complicated portal hypertension. Such complications of portal hypertension as spontaneous bacterial peritonitis, ascites, hepatorenal sÑndrome, variceal bleeding caused by sinistral portal hypertension are considered. The effectiveness of interventional treatment methods and laparoscopic surgical interventions has been demonstrated. CONCLUSION: Conclusions: Diagnosis and treatment of patients with complicated portal hypertension requires a multidisciplinary approach, which is due to the diverse pathophysiological process of portal hypertension. The possibilities of providing emergency care to this category of patients depend on the level of medical training of the staff, the possibilities of medical and technical support in the provision of interventional care, the ineffectiveness of which necessitates surgical treatment using minimally invasive technologies.
Asunto(s)
Ascitis , Hipertensión Portal , Humanos , Hipertensión Portal/terapia , Hipertensión Portal/complicaciones , Ascitis/terapia , Ascitis/etiología , Síndrome Hepatorrenal/terapia , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/diagnóstico , Peritonitis/terapia , Peritonitis/etiología , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Servicios Médicos de Urgencia , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/etiologíaRESUMEN
Eosinophilic gastroenteritis poses a significant diagnostic challenge, particularly in developing countries, where the awareness of this condition may be limited. Here, the case of a patient in her early 30s, who presented with recurrent episodes of abdominal pain and diarrhea, is reported. Initial standard laboratory investigations revealed normal complete blood counts and elevated total serum immunoglobulin E levels. Upper and lower endoscopic evaluations with systemic biopsies did not reveal any significant abnormalities. However, computed tomography revealed a thickened small intestine wall, halo signs, and mild ascites. Analysis of the ascitic fluid confirmed eosinophilia. These findings prompted a diagnosis of eosinophilic gastroenteritis. The patient responded well to a targeted elimination diet, corticosteroids, and antileukotriene medication. The present case emphasizes the importance of considering eosinophilic gastroenteritis in the differential diagnosis of patients who present with abdominal pain and eosinophilic ascites.
Asunto(s)
Ascitis , Enteritis , Eosinofilia , Gastritis , Humanos , Eosinofilia/diagnóstico , Eosinofilia/patología , Ascitis/diagnóstico , Ascitis/patología , Ascitis/etiología , Femenino , Enteritis/diagnóstico , Enteritis/patología , Vietnam , Gastritis/diagnóstico , Gastritis/patología , Gastritis/complicaciones , Adulto , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Diagnóstico DiferencialRESUMEN
Eosinophilic gastroenteritis (EG) is an inflammatory bowel condition characterised by eosinophilic infiltration of the stomach and small bowel. Smoking and certain foods can trigger EG.A man in his 40s presented to the emergency department with acute abdominal pain. He had rebound tenderness and guarding on his initial abdominal examination. A subsequent CT scan showed jejunal wall thickening and ascitesHe had similar attacks of abdominal pain and was misdiagnosed with familial Mediterranean fever and Crohn's disease.Paracentesis revealed eosinophilic ascites. No mucosal abnormality was detected on gastroduodenoscopy and colonoscopy. A double-balloon enteroscopy revealed mucosal inflammation in the jejunum and a biopsy was taken. In this biopsy, eosinophilic jejunitis was detected. He was given corticosteroids and montelukast and his condition was resolved promptly. After discharge, he had attacks of EG until he quit smoking. After quitting smoking, he had an attack once in the last 2 years after consuming eggplant.
Asunto(s)
Abdomen Agudo , Ascitis , Enteritis , Eosinofilia , Gastritis , Humanos , Masculino , Eosinofilia/diagnóstico , Eosinofilia/complicaciones , Abdomen Agudo/etiología , Enteritis/diagnóstico , Enteritis/complicaciones , Enteritis/tratamiento farmacológico , Gastritis/diagnóstico , Gastritis/complicaciones , Adulto , Ascitis/etiología , Diagnóstico Diferencial , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The management of malignant ascites is critical for treating patients with advanced pancreatic cancer. The purpose of this study was to assess the safety of cell-free and concentrated ascites reinfusion therapy (CART) and its impact on the prognosis of patients with advanced pancreatic cancer who have massive malignant ascites. METHODS: This study analyzed 47 procedures in 29 patients who underwent CART for ascites caused by pancreatic cancer between 2015 and 2022. Among them, 7 patients who received chemotherapy following CART were classified as the chemotherapy group, while 22 patients without chemotherapy after CART were classified as the palliative care group. RESULTS: Among the 47 procedures, adverse events (AEs) were observed in 9 procedures (19 %). Grade 2 adverse events were observed only in one procedure, manifested as fever. There were no grade 3 or 4 AEs, nor were there any treatment-related deaths. The median survival time was 4.0 months in the chemotherapy group and 0.7 months in the palliative care group (p = 0.004). The albumin level in the chemotherapy group was significantly higher than that in the palliative care group. CONCLUSION: CART is feasible and might be the optimal option to enable prolonged use of chemotherapy to improve the prognosis for late-stage pancreatic cancer patients.
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Ascitis , Cuidados Paliativos , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/terapia , Ascitis/terapia , Ascitis/etiología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Cuidados Paliativos/métodos , Estudios de Factibilidad , Resultado del Tratamiento , Anciano de 80 o más Años , Adulto , Estudios Retrospectivos , Pronóstico , Antineoplásicos/uso terapéutico , Antineoplásicos/efectos adversosRESUMEN
Pseudo-Meigs syndrome is a rare syndrome characterized by hydrothorax and ascites associated with pelvic masses, and patients occasionally present with elevated serum cancer antigen-125 (CA125) levels. Hydropic leiomyoma (HLM) is an uncommon subtype of uterine leiomyoma characterized by hydropic degeneration and secondary cystic changes. Rapidly enlarging HLMs accompanied by hydrothorax, ascites, and elevated CA125 levels may be misdiagnosed as malignant tumors. Here, we report a case of HLM in a 45-year-old Chinese woman who presented with ascites and hydrothorax. Preoperative abdominopelvic CT revealed a giant solid mass in the fundus uteri measuring 20 × 15 × 12 cm. Her serum CA125 level was elevated to 247.7 U/ml, while her hydrothorax CA125 level was 304.60 U/ml. The patient was initially diagnosed with uterine malignancy and underwent total abdominal hysterectomy and adhesiolysis. Pathological examination confirmed the presence of a uterine hydropic leiomyoma with cystic changes. After tumor removal, the ascites and hydrothorax subsided quickly, with no evidence of recurrence. The patient's serum CA125 level decreased to 116.90 U/mL on Day 7 and 5.6 U/mL on Day 40 postsurgery. Follow-up data were obtained at 6 months, 1 year, and 2 years after surgery, and no recurrence of ascites or hydrothorax was observed. This case highlights the importance of accurate diagnosis and appropriate management of HLM to achieve successful outcomes.
Asunto(s)
Antígeno Ca-125 , Leiomioma , Síndrome de Meigs , Neoplasias Ováricas , Neoplasias Uterinas , Humanos , Femenino , Leiomioma/diagnóstico , Leiomioma/complicaciones , Persona de Mediana Edad , Antígeno Ca-125/sangre , Síndrome de Meigs/diagnóstico , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/patología , Diagnóstico Diferencial , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/patología , Neoplasias Ováricas/sangre , Ascitis/etiología , Ascitis/diagnóstico , Hidrotórax/etiología , Hidrotórax/diagnóstico , Histerectomía , Proteínas de la MembranaRESUMEN
An immigrant woman in her 60s with a complex medical history and remote occupational exposure to patients with tuberculosis (TB) presented with abdominal pain, early satiety, bloating and weight loss. Physical exam showed abdominal distention and ascites. Diagnostic paracentesis revealed low serum ascites albumin gradient and elevated ascitic lymphocytic count. However, fluid cytology, bacterial and mycobacterial cultures were negative. An interferon-gamma release assay for TB was indeterminate. MRI of the abdomen and pelvis showed a thickened endometrial stripe. Endometrial biopsy demonstrated non-caseating granulomatous endometritis. No organisms were identified on Grocott methenamine silver or acid-fast bacilli special stains. A tissue block from the endometrial biopsy submitted for DNA sequencing was positive for mycobacterium tuberculosis (MTB) complex Urine mycobacterial cultures were obtained and the patient was started on isoniazid, rifampin, ethambutol and pyrazinamide, with significant improvement in her symptoms. Urine mycobacterial cultures were eventually positive for pansusceptible MTB.
Asunto(s)
Dolor Abdominal , Antituberculosos , Ascitis , Mycobacterium tuberculosis , Humanos , Femenino , Ascitis/microbiología , Ascitis/etiología , Ascitis/diagnóstico , Dolor Abdominal/etiología , Mycobacterium tuberculosis/aislamiento & purificación , Persona de Mediana Edad , Antituberculosos/uso terapéutico , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Dolor Crónico/etiología , Dolor Crónico/microbiologíaRESUMEN
In 2023, Chinese Society of Hepatology of Chinese Medical Association convened a panel of experts to update the Chinese guidelines on the management of ascites and associated complications in cirrhosis which was launched in 2017 and renamed this guidelines as "Guidelines on the Management of Ascites in Cirrhosis." This comprehensive resource offers essential recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome.
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Ascitis , Síndrome Hepatorrenal , Cirrosis Hepática , Humanos , Cirrosis Hepática/complicaciones , Ascitis/terapia , Ascitis/etiología , Ascitis/diagnóstico , China , Síndrome Hepatorrenal/terapia , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/diagnóstico , Peritonitis/terapia , Peritonitis/diagnóstico , Peritonitis/etiología , Sociedades Médicas , Gastroenterología/normasRESUMEN
RATIONALE: Bacterascites are a rare complication of cesarean sections (C/S). Here, we report the case of a patient with bacterascites after an emergent C/S. PATIENT CONCERN: A 41-year-old female reported diffuse abdominal tightness and pain for a week after C/S, who received C/S at 38 4/7 weeks due to superimposed preeclampsia and prolonged labor. DIAGNOSES: Bacterascites caused by Salmonella species after C/S was diagnosed. INTERVENTIONS: Initial treatment included cefmetazole and metronidazole. On day 2, paracentesis was performed, followed by albumin and hydroxyethyl starch administration. By day 3, the patient developed pulmonary edema, necessitating Lasix administration. On day 6, ascites culture revealed Salmonella species resistant to third-generation cephalosporins, leading to meropenem therapy adjustment. This resulted in improved symptoms. Meropenem was continued for 14 days to complete the treatment regimen. OUTCOMES: Follow-up ultrasonography revealed a decrease in ascites. As the patient clinical condition improved, she was discharged on day 20 and scheduled for outpatient department follow-up. No recurrence of ascites was observed during the subsequent follow-up period of 3 months. No ascites were noted 8 days after discharge. LESSONS: Postoperative bacterascites with Salmonella were diagnosed. Antibiotic treatment and therapeutic paracentesis were effective for this condition.
Asunto(s)
Antibacterianos , Cesárea , Infecciones por Salmonella , Salmonella , Humanos , Femenino , Adulto , Cesárea/efectos adversos , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Salmonella/aislamiento & purificación , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/tratamiento farmacológico , Embarazo , Meropenem/uso terapéutico , Meropenem/administración & dosificación , Ascitis/etiología , Ascitis/microbiología , Bacteriemia/microbiología , Bacteriemia/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Paracentesis/métodosRESUMEN
Preeclampsia is a multisystem disorder associated with defective trophoblast invasion, maternal syndrome, and capillary endothelial leak. The presence of ascites/third space fluid accumulation increases the risk of maternal morbidity and mortality. The current criteria/guidelines of preeclampsia do not establish the presence of ascites as a marker of severity or recognize the timing and need for early delivery despite associated complications. Medline and Embase databases were searched to identify relevant literature, reported up to December 2023, regarding the pathophysiology, pregnancy outcome, and management of preeclampsia complicated with ascites. A total of 5 studies on pathophysiology and eight on pregnancy outcomes met the inclusion criteria, with 41 case reports on ascites in preeclampsia. The etiopathogenesis for the development of ascites in preeclampsia includes endothelial damage, capillary hyperpermeability, release of vasoconstrictive agents, reduced intravascular oncotic pressure, and raised intraabdominal pressure. The presence of ascites represents the extreme form of microvascular damage, which also correlates with the raised sFlt-1 levels in this condition. The adverse pregnancy outcomes include increased risk of congestive heart failure, eclampsia, renal failure, disseminated intravascular coagulation, acute respiratory distress syndrome, and maternal death. The presence of ascites in preeclampsia is associated with the deterioration of the maternal condition. Hence, it is indicative of preeclampsia with severe features and requires vigilant monitoring, and prompt delivery may be considered.
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Ascitis , Preeclampsia , Resultado del Embarazo , Humanos , Embarazo , Femenino , Ascitis/fisiopatología , Ascitis/etiología , Ascitis/terapia , Preeclampsia/fisiopatología , Preeclampsia/diagnóstico , Preeclampsia/terapiaRESUMEN
Managing cirrhosis complications is an important measure for improving patients' clinical outcomes. Therefore, in order to provide a complete disease assessment and comprehensive treatment, improve quality of life, and improve the prognosis for patients with cirrhosis, it is necessary to pay attention to complications such as thrombocytopenia and portal vein thrombosis in addition to common or severe complications such as ascites, esophagogastric variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. The relevant concept that an effective albumin concentration is more helpful in predicting the cirrhosis outcome is gradually being accepted; however, the detection method still needs further standardization and commercialization.
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Encefalopatía Hepática , Cirrosis Hepática , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Encefalopatía Hepática/etiología , Encefalopatía Hepática/diagnóstico , Encefalopatía Hepática/terapia , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/terapia , Ascitis/etiología , Ascitis/terapia , Ascitis/diagnóstico , Trombocitopenia/etiología , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapiaRESUMEN
BACKGROUND: The established use of non-selective beta-blockers (NSBB) in the primary and secondary prevention of esophageal varices has recently been questioned in the subgroup of patients with diuretic-refractory ascites. OBJECTIVE: Critically analyze the body of evidence on the topic in order to assist clinical decisions. METHODS: A literature review was carried out in the Pubmed® and Scielo® databases. In total, 20 articles between 2010 and 2023 were read by independent researchers. CONCLUSION: It remains doubtful whether the use of NSBB is deleterious in cirrhotic patients with refractory ascites, however our literature review allows us to conclude that these drugs should not be proscribed in these patients. On the contrary, a doctor-patient decision based on tolerability and hemodynamic parameters certainly seems to be a safe conduct.
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Antagonistas Adrenérgicos beta , Ascitis , Várices Esofágicas y Gástricas , Cirrosis Hepática , Humanos , Ascitis/tratamiento farmacológico , Ascitis/etiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/tratamiento farmacológico , Antagonistas Adrenérgicos beta/uso terapéutico , Várices Esofágicas y Gástricas/tratamiento farmacológico , Várices Esofágicas y Gástricas/complicacionesRESUMEN
BACKGROUND: Vasodilatation and bacterial dislocation are the main contributors to the catastrophic events in patients with decompensated liver cirrhosis (DLC). AIM: The aim of this study was to evaluate the impacts of adding midodrine and rifaximin on morbidity, mortality, and quality of life in patients with DLC. METHODS: This interventional clinical study included 100 consecutively enrolled DLC patients randomized 1â :â 1 into two groups. Group A received oral midodrine (5â mg/8â h) and rifaximin (550â mg/12â h) with standard diuretic therapy, while group B received only standard diuretic therapy. Clinical and laboratory data, including the McGill Quality of Life Questionnaire, were evaluated over a 3-month treatment period. RESULTS: In the study group, there was a significant reduction in Child-Pugh and Model for End-Stage Liver Disease scores, international normalized ratio, and mean arterial blood pressure at 2, 6, and 12 weeks (Pâ <â 0.05). Ascites, spontaneous bacterial peritonitis incidence, hematemesis, paracentesis need, and hepatic encephalopathy showed improvement after 12 weeks compared with the control group. McGill Quality of Life Questionnaire significantly improved after 6 and 12 weeks (Pâ <â 0.05). Survival rates demonstrated a noteworthy improvement (Pâ =â 0.014), substantiated by evidence in both univariate and multivariate regression analyses. CONCLUSION: Combined midodrine with rifaximin represents an endowment to patients with DLC with spectacular improvements in synthetic liver functions, along with improved quality of life, and survival.
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Cirrosis Hepática , Midodrina , Calidad de Vida , Rifamicinas , Rifaximina , Humanos , Rifaximina/uso terapéutico , Femenino , Midodrina/uso terapéutico , Midodrina/efectos adversos , Masculino , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Cirrosis Hepática/tratamiento farmacológico , Persona de Mediana Edad , Rifamicinas/uso terapéutico , Rifamicinas/efectos adversos , Resultado del Tratamiento , Quimioterapia Combinada , Adulto , Ascitis/etiología , Ascitis/tratamiento farmacológico , Ascitis/mortalidad , Encefalopatía Hepática/tratamiento farmacológico , Encefalopatía Hepática/etiología , Anciano , Encuestas y Cuestionarios , Peritonitis/mortalidad , Factores de TiempoRESUMEN
This article presents three detailed case reports and a brief review of the literature on a rare manifestation of systemic lupus erythematosus (SLE) known as Pseudo-Pseudo Meigs' Syndrome (PPMS). The patients' condition was characterized by elevated CA-125 levels, massive ascites andpleural effusion which is typically associated with ovarian malignancies but can also present in various non-malignant conditions, including SLE. A thorough literature review was conducted, summarizing similar cases and their clinical outcomes to provide a broader understanding of this uncommon syndrome. The findings emphasize the need for heightened awareness and consideration of pseudo-pseudo Meigs' syndrome in patients with SLE presenting with unexplained ascites and pleural effusion.
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Ascitis , Antígeno Ca-125 , Lupus Eritematoso Sistémico , Síndrome de Meigs , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Antígeno Ca-125/sangre , Ascitis/etiología , Ascitis/diagnóstico , Femenino , Síndrome de Meigs/diagnóstico , Síndrome de Meigs/etiología , Adulto , Persona de Mediana Edad , Derrame Pleural/etiología , Derrame Pleural/diagnóstico , BiomarcadoresRESUMEN
Preliminary work has shown that portal hypertension plays a key role for the prognosis in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Specifically, the presence of ascites appears to be a strong negative predictor for these patients. However, it remains unclear whether different ascites volumes influence prognosis. Therefore, the aim of this work was to investigate the influence of different ascites volumes on survival for patients with HCC undergoing TACE. A total of 327 treatment-naïve patients with HCC undergoing initial TACE at our tertiary care center between 2010 and 2020 were included. In patients with ascites, the fluid was segmented, and the volume quantified by slice-wise addition using contrast-enhanced CT imaging. Median overall survival (OS) was calculated and univariate and multivariate Cox regression analysis has been performed. Ascites was present in 102 (31.9%) patients. Ascites volume as continuous variable was significantly associated with an increased hazard ratio in univariate analysis (p < 0.001) and remained an independent predictor of impaired median OS in multivariate analysis (p < 0.001). Median OS without ascites was 17.1 months, and therefore significantly longer than in patients with ascites (6.4 months, p < 0.001). When subdivided into groups of low and high ascites volume in relation to the median ascites volume, patients with low ascites volume had a significantly longer median OS (8.6 vs 3.6 months, p < 0.001). Ascites in patients with HCC undergoing TACE is strongly associated with a poor prognosis. Our results show that not only the presence but also the amount of ascites is highly relevant. Therefore, true ascites volume as opportunistic quantitative biomarker is likely to impact clinical decision-making once automated solutions become available.
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Ascitis , Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/complicaciones , Quimioembolización Terapéutica/métodos , Ascitis/terapia , Ascitis/mortalidad , Ascitis/etiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Ascitis , Hipertensión Portal , Miositis , Humanos , Ascitis/etiología , Ascitis/diagnóstico , Hipertensión Portal/diagnóstico , Hipertensión Portal/etiología , Hipertensión Portal/fisiopatología , Miositis/diagnóstico , Miositis/complicaciones , Miositis/inmunología , Resultado del Tratamiento , Femenino , Persona de Mediana Edad , Masculino , AdultoRESUMEN
Esophageal and gastric varices (EGV) bleeding is a dangerous side effect of liver cirrhosis. Ascites may affect the effectiveness of carvedilol in preventing EGV rebleeding. A retrospective analysis was done on patients with EGV bleeding who visited our gastroenterology department between January 1, 2015, and October 29, 2020, and were given carvedilol therapy again. Patients were classified based on whether they had ascites. The primary outcome was EGV rebleeding. A total of 286 patients were included, with a median follow-up of 24.0 (19.0-42.0) months, comprising those without ascites (N = 155) and those with ascites (N = 131). The mean age of the patients was 55.15 ± 12.44 years, and 177 (61.9%) of them were men. There were 162 (56.6%) Child-Pugh A grades. The etiology of cirrhosis included 135 (47.2%) cases of hepatitis B. After carvedilol therapy, the patient's portal vein diameter (DPV) was widened (p < 0.05), velocity of portal vein (VPV) was slowed (p = 0.001). During the 1-year follow-up, patients with ascites had a substantially higher rebleeding rate than patients without ascites, with 24 (18.3%) versus 13 (8.4%), respectively (p = 0.013). On univariate analysis, ascites was a risk factor for rebleeding (p = 0.015). The multivariate analysis remained significant after adjusting for age, gender, etiology of cirrhosis, and previous endoscopic treatment, with OR of 2.37 (95% CI: 1.12-5.04; p = 0.025). Ascites was a risk factor for EGV rebleeding in patients undergoing carvedilol therapy. After carvedilol therapy, the patient's DPV was widened and VPV was slowed.
Asunto(s)
Ascitis , Carvedilol , Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Cirrosis Hepática , Humanos , Carvedilol/uso terapéutico , Carvedilol/administración & dosificación , Carvedilol/efectos adversos , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Cirrosis Hepática/complicaciones , Cirrosis Hepática/tratamiento farmacológico , Ascitis/tratamiento farmacológico , Ascitis/etiología , Estudios Retrospectivos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/prevención & control , Anciano , Adulto , Resultado del Tratamiento , Recurrencia , Vena PortaRESUMEN
Objective: The prognosis of malignant tumors with peritoneal metastases and cancerous ascites has generally been poor, with limited treatment options. The PRaG regimen, which comprised of hypofractionated radiotherapy, programmed cell death-1 (PD-1) inhibitor, and granulocyte-macrophage colony-stimulating factor (GM-CSF), showed a survival advantage in patients with advanced solid tumors who failed at least the first line of standard systemic treatment. Intraperitoneal infusion of PD-1 inhibitors may be a novel therapeutic strategy for managing malignant ascites. Integrating the PRaG regimen with intraperitoneal perfusion of a PD-1 inhibitor might control malignant ascites and provide further survival benefits in these patients. This proposed study aims to investigate the safety and efficacy of intraperitoneal infusion of serplulimab in combination with the PRaG regimen in patients with simultaneous advanced solid tumors and cancerous ascites who fail at least the first-line treatment. Methods: This proposed study is a prospective, single-arm, open-label, multicenter clinical trial. All eligible patients will receive 2 cycles of intensive treatment, a combination of PRaG regimen with an intraperitoneal infusion of PD-1 inhibitor. The patients who are beneficially treated with intensive treatment will receive consolidation treatment every 2 weeks until ascites disappear, disease progression occurs, intolerable toxicity occurs, or for up to 1 year. Phase I of this study will be conducted using a modified 3 + 3 design. The dose of intraperitoneal infusion of PD-1 inhibitor for phase II will be determined according to dose-limiting toxicity evaluation in the phase I study. Conclusion: This prospective, open-label, multicenter study will potentially lead to intraperitoneal perfusion of a PD-1 inhibitor being a new strategy for malignant ascites patients and provide a meaningful efficacy and safety of the combination of PRaG regimen with an intraperitoneal infusion of PD-1 inhibitor for these patients.