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J Rodes - One of the best experts on this subject based on the ideXlab platform.
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transjugular intrahepatic portosystemic shunting versus Paracentesis plus albumin for refractory ascites in cirrhosis
Gastroenterology, 2002Co-Authors: Pere Gines, Patrick S. Kamath, Vicente Arroyo, Juan Uriz, B Calahorra, Guadalupe Garcia Tsao, Luis Ruiz Del Arbol, R Planas, Jaime Bosch, J RodesAbstract:Abstract Background & Aims: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated Paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain. Methods: Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated Paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs. Results: Twenty patients treated with TIPS and 18 treated with Paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 ± 43 vs. 325 ± 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the Paracentesis group ( P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the Paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the Paracentesis group. Conclusions: In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated Paracentesis plus albumin. GASTROENTEROLOGY 2002;123:1839-1847
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Paracentesis induced circulatory dysfunction mechanism and effect on hepatic hemodynamics in cirrhosis
Gastroenterology, 1997Co-Authors: Luis Ruizdelarbol, Wladimiro Jiménez, Alberto Monescillo, A Garciaplaza, V Arroyo, J RodesAbstract:Abstract BACKGROUND & AIMS: Therapeutic Paracentesis may be associated with a circulatory dysfunction, manifested by a marked increase of the plasma renin activity and plasma norepinephrine. The aim of the study was to characterize the systemic and hepatic hemodynamic changes associated with Paracentesis-induced circulatory dysfunction. METHODS: Changes in plasma renin, aldosterone, and norepinephrine, and in systemic and hepatic hemodynamics were assessed 1 hour and 6 days after complete mobilization of ascites in 37 patients treated by total Paracentesis plus intravenous dextran-70 infusion. RESULTS: Paracentesis-induced circulatory dysfunction occurred in 10 patients (renin and norepinephrine increased from 9.0 +/- 10.5 to 28.8 +/- 19.0 ng.mL-1.h-1 and from 752.0 +/- 364.0 to 1223.0 +/- 294.0 pg/mL, respectively) and was associated with significant reduction in systemic vascular resistance (-13.0% +/- 2.6%; P CONCLUSIONS: Paracentesis-induced circulatory dysfunction is predominantly caused by an accentuation of the arteriolar vasodilation already present in untreated cirrhotic patients with ascites. The homeostatic activation of endogenous vasoactive systems may account for the increased intrahepatic vascular resistance associated with this condition. (Gastroenterology 1997 Aug;113(2):579-86)
Pere Gines - One of the best experts on this subject based on the ideXlab platform.
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effects of a selective vasopressin v2 receptor antagonist satavaptan on ascites recurrence after Paracentesis in patients with cirrhosis
Journal of Hepatology, 2010Co-Authors: Florence Wong, Pere Gines, Hugh Watson, Yves Horsmans, Paolo Angeli, Paul J Gow, Pascal Minini, Mauro BernardiAbstract:Background & Aims Cirrhotic patients with recurrent ascites frequently require Paracentesis despite diuretic therapy. Vasopressin receptor antagonists, by increasing free water clearance, may reduce the recurrence of ascites. To investigate the effects of the addition of a vasopressin V 2 receptor antagonist, satavaptan, to 100mg spironolactone on ascites recurrence after a large volume Paracentesis in patients with liver cirrhosis irrespective of the presence of hyponatraemia. Methods One hundred and fifty one cirrhotic patients with recurrent ascites with or without hyponatraemia, and normal to mildly abnormal renal function were randomised in a double-blind study to receive either 5mg ( n =39), 12.5mg ( n =36), 25mg ( n =40) of satavaptan or placebo ( n =36) for 12weeks. Their Child–Pugh scores were 9.2±1.3, 8.7±1.7, 8.8±1.3, and 9.0±1.5, respectively. Results Median time to first Paracentesis was 23, 26, and 17days with satavaptan 5, 12.5, and 25mg, respectively, versus 14days with placebo (ns for all doses). The frequency of paracenteses was decreased significantly ( p 0.05) in all satavaptan groups versus placebo. Mean increase in ascites was 2.82±0.48L/week for placebo versus 2.12±0.40, 2.14±0.33, and 2.06±0.40L/week for the 5, 12.5, and 25mg of satavaptan, respectively (ns for all doses). Similar numbers of patients experienced major adverse events in all groups. Increases in serum creatinine, orthostatic changes in systolic pressure and thirst were more common with satavaptan. Conclusions Satavaptan has the potential to reduce recurrence of ascites after a large volume Paracentesis at doses from 5 to 25mg in cirrhotic patients with ascites.
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transjugular intrahepatic portosystemic shunting versus Paracentesis plus albumin for refractory ascites in cirrhosis
Gastroenterology, 2002Co-Authors: Pere Gines, Patrick S. Kamath, Vicente Arroyo, Juan Uriz, B Calahorra, Guadalupe Garcia Tsao, Luis Ruiz Del Arbol, R Planas, Jaime Bosch, J RodesAbstract:Abstract Background & Aims: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated Paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain. Methods: Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated Paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs. Results: Twenty patients treated with TIPS and 18 treated with Paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 ± 43 vs. 325 ± 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the Paracentesis group ( P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the Paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the Paracentesis group. Conclusions: In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated Paracentesis plus albumin. GASTROENTEROLOGY 2002;123:1839-1847
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Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites.
The New England journal of medicine, 1991Co-Authors: Pere Gines, Vicente Arroyo, Victor Vargas, Ramon Planas, F. Casafont, Julià Panés, Melchor Hoyos, L Viladomiu, Antoni Rimola, Rosa Maria MorillasAbstract:Abstract Background. There is no satisfactory treatment for refractory ascites in patients with cirrhosis. Both peritoneovenous shunts and Paracentesis have been used, but there is uncertainty about their relative merits. Methods. We studied 89 patients with cirrhosis and refractory ascites who were randomly assigned to receive either repeated large-volume Paracentesis plus intravenous albumin or a LeVeen peritoneovenous shunt. Patients in the Paracentesis group in whom recurrent tense ascites developed during follow-up were treated with Paracentesis, and those in the peritoneovenous-shunt group with diuretic agents or by the insertion of a new shunt if there was shunt obstruction. Results. During the first hospitalization, ascites was removed in all 41 patients in the Paracentesis group and in 44 of the 48 patients in the peritoneovenous-shunt group. The mean (±SD) duration of hospitalization in the two groups was 11±5 and 19±9 days, respectively (P
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Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites
The New England Journal of Medicine, 1991Co-Authors: Pere Gines, Vicente Arroyo, Victor Vargas, Ramon Planas, F. Casafont, Julià Panés, Melchor Hoyos, L Viladomiu, Antoni Rimola, Rosa Maria MorillasAbstract:Abstract Background. There is no satisfactory treatment for refractory ascites in patients with cirrhosis. Both peritoneovenous shunts and Paracentesis have been used, but there is uncertainty about their relative merits. Methods. We studied 89 patients with cirrhosis and refractory ascites who were randomly assigned to receive either repeated large-volume Paracentesis plus intravenous albumin or a LeVeen peritoneovenous shunt. Patients in the Paracentesis group in whom recurrent tense ascites developed during follow-up were treated with Paracentesis, and those in the peritoneovenous-shunt group with diuretic agents or by the insertion of a new shunt if there was shunt obstruction. Results. During the first hospitalization, ascites was removed in all 41 patients in the Paracentesis group and in 44 of the 48 patients in the peritoneovenous-shunt group. The mean (±SD) duration of hospitalization in the two groups was 11±5 and 19±9 days, respectively (P<0.01 ). There were no significant differences in the nu...
Arun Sharma - One of the best experts on this subject based on the ideXlab platform.
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Terlipressin versus albumin in Paracentesis‐induced circulatory dysfunction in cirrhosis: A randomized study
Journal of Gastroenterology and Hepatology, 2006Co-Authors: Virendra Singh, Ramesh Kumar, Chander K. Nain, Baljinder Singh, Arun SharmaAbstract: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.
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terlipressin versus albumin in Paracentesis induced circulatory dysfunction in cirrhosis a randomized study
Journal of Gastroenterology and Hepatology, 2006Co-Authors: Virendra Singh, Ramesh Kumar, Chander K. Nain, Baljinder Singh, Arun SharmaAbstract: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.
Virendra Singh - One of the best experts on this subject based on the ideXlab platform.
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Terlipressin versus albumin in Paracentesis‐induced circulatory dysfunction in cirrhosis: A randomized study
Journal of Gastroenterology and Hepatology, 2006Co-Authors: Virendra Singh, Ramesh Kumar, Chander K. Nain, Baljinder Singh, Arun SharmaAbstract: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.
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Terlipressin versus albumin in Paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study.
Journal of gastroenterology and hepatology, 2006Co-Authors: Virendra Singh, Ramesh Kumar, Chander K. Nain, Baljinder Singh, Arun K SharmaAbstract: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. 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. 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. Terlipressin may be as effective as intravenous albumin in preventing Paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic Paracentesis.
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terlipressin versus albumin in Paracentesis induced circulatory dysfunction in cirrhosis a randomized study
Journal of Gastroenterology and Hepatology, 2006Co-Authors: Virendra Singh, Ramesh Kumar, Chander K. Nain, Baljinder Singh, Arun SharmaAbstract: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.
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Noradrenaline and albumin in Paracentesis‐induced circulatory dysfunction in cirrhosis: a randomized pilot study
Journal of internal medicine, 2006Co-Authors: Virendra Singh, Chander K. Nain, Baljinder Singh, B. Kumar, N Sharma, Ashish Bhalla, Arun K SharmaAbstract: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. 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. 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). 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.
Vicente Arroyo - One of the best experts on this subject based on the ideXlab platform.
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transjugular intrahepatic portosystemic shunting versus Paracentesis plus albumin for refractory ascites in cirrhosis
Gastroenterology, 2002Co-Authors: Pere Gines, Patrick S. Kamath, Vicente Arroyo, Juan Uriz, B Calahorra, Guadalupe Garcia Tsao, Luis Ruiz Del Arbol, R Planas, Jaime Bosch, J RodesAbstract:Abstract Background & Aims: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated Paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain. Methods: Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated Paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs. Results: Twenty patients treated with TIPS and 18 treated with Paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 ± 43 vs. 325 ± 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the Paracentesis group ( P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the Paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the Paracentesis group. Conclusions: In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated Paracentesis plus albumin. GASTROENTEROLOGY 2002;123:1839-1847
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beneficial effects of intravenous albumin infusion on the hemodynamic and humoral changes after total Paracentesis
Hepatology, 1995Co-Authors: Angelo Luca, Vicente Arroyo, Wladimiro Jiménez, Juan C Garciapagan, Jaume Bosch, Faust Feu, Angels Gines, Mercedes Fernandez, Angels Escorsell, Joan RodesAbstract:The study investigated the hemodynamic and neurohumoral effects of albumin infusion after total Paracentesis in 18 patients with cirrhosis and tense ascites. Measurements of systemic and splanchnic hemodynamics, and vasoactive neurohumoral systems were performed before and immediately after total Paracentesis. The patients were then randomized to receive albumin or not, and hemodynamic and humoral measurements were repeated at 24 hours. Hemodynamic and humoral changes just after Paracentesis were similar in patients later randomized to receive albumin infusion or not. Twenty-four hours after total Paracentesis, patients nor receiving albumin had total significant reductions in cardiac index (-13%; P = .005), femoral blood flow (-17%; P = .004), and pulmonary capillary pressure (-16%; P = .02), which were accompanied by significant increases in plasma renin activity (PRA) and plasma aldosterone (PA) and by significant decreases in atrial natriuretic factor (ANF) and plasma sodium. By contrast, there was no significant changes in patients receiving albumin, except for an increase in ANF and a further decrease in PA. In both groups, hepatic venous pressure gradient (HVPG) and azygos blood flow decreased just after Paracentesis returning to baseline at 24 hours. This study shows that albumin infusion prevents the impairment in systemic hemodynamics, vasoactive neurohumoral systems, and plasma sodium after a large-volume Paracentesis, without detrimental effects on portal pressure and portocollateral blood flow.
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Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites.
The New England journal of medicine, 1991Co-Authors: Pere Gines, Vicente Arroyo, Victor Vargas, Ramon Planas, F. Casafont, Julià Panés, Melchor Hoyos, L Viladomiu, Antoni Rimola, Rosa Maria MorillasAbstract:Abstract Background. There is no satisfactory treatment for refractory ascites in patients with cirrhosis. Both peritoneovenous shunts and Paracentesis have been used, but there is uncertainty about their relative merits. Methods. We studied 89 patients with cirrhosis and refractory ascites who were randomly assigned to receive either repeated large-volume Paracentesis plus intravenous albumin or a LeVeen peritoneovenous shunt. Patients in the Paracentesis group in whom recurrent tense ascites developed during follow-up were treated with Paracentesis, and those in the peritoneovenous-shunt group with diuretic agents or by the insertion of a new shunt if there was shunt obstruction. Results. During the first hospitalization, ascites was removed in all 41 patients in the Paracentesis group and in 44 of the 48 patients in the peritoneovenous-shunt group. The mean (±SD) duration of hospitalization in the two groups was 11±5 and 19±9 days, respectively (P
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Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites
The New England Journal of Medicine, 1991Co-Authors: Pere Gines, Vicente Arroyo, Victor Vargas, Ramon Planas, F. Casafont, Julià Panés, Melchor Hoyos, L Viladomiu, Antoni Rimola, Rosa Maria MorillasAbstract:Abstract Background. There is no satisfactory treatment for refractory ascites in patients with cirrhosis. Both peritoneovenous shunts and Paracentesis have been used, but there is uncertainty about their relative merits. Methods. We studied 89 patients with cirrhosis and refractory ascites who were randomly assigned to receive either repeated large-volume Paracentesis plus intravenous albumin or a LeVeen peritoneovenous shunt. Patients in the Paracentesis group in whom recurrent tense ascites developed during follow-up were treated with Paracentesis, and those in the peritoneovenous-shunt group with diuretic agents or by the insertion of a new shunt if there was shunt obstruction. Results. During the first hospitalization, ascites was removed in all 41 patients in the Paracentesis group and in 44 of the 48 patients in the peritoneovenous-shunt group. The mean (±SD) duration of hospitalization in the two groups was 11±5 and 19±9 days, respectively (P<0.01 ). There were no significant differences in the nu...
