Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites: proposal of a diagnostic sequence

Article Abstract:

Ascites fluid is fluid that accumulates in the peritoneal cavity. (The abdominal cavity is lined with a membrane called the peritoneum and the peritoneal cavity is the space within.) Ascites may result from a number of different causes, including the presence of cancer cells in the peritoneum. Unfortunately, there is no completely satisfactory method for determining whether ascites fluid is related to a malignancy or not. The presence of cancer cells in the ascites fluid is proof positive of malignancy-related ascites, but in 30 to 60 percent of cancer cases, cancer cells are not detected. An investigation was undertaken to determine which features of ascites fluid may prove most useful in distinguishing between malignancy-related ascites (MRA) and nonmalignant ascites (NMA). As might be expected, the observation of malignant cells indicated MRA in all cases. However, malignant cells were observed in only 70 percent of cases of MRA. Similarly, the presence of the protein carcinoembryonic antigen (CEA) always indicated cancer, but it was present in only 45 percent of the cancer cases. It was found, however, that the level of cholesterol in the ascites fluid was an important indicator of malignancy. Malignant cells were never found in ascites fluid when the cholesterol level was below 45 milligrams per 100 milliliters (mg/ml). Increased amounts of cholesterol, however, do not necessarily indicate cancer. Therefore, the combination of tests may prove most useful. Cholesterol is tested first, and if less than 45 mg/100 ml, the test is negative. If the cholesterol is above 45 mg/100 ml, then examination for cells and measurement of carcinoembryonic antigen is performed. This sequence of tests was performed on 119 patients with ascites, 65 without cancer and 54 with malignancy. The sequence of tests failed to identify only nine percent of the cases of malignancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis

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Ascites after pleuroperitoneal shunting

Article Abstract:

Some terminal cancer patients develop effusions of fluid in the pleural cavities which enclose the lungs. These effusions have a serious effect upon the well-being of the patient. Consequently, the patient's quality of life may be substantially improved by draining this fluid. Often tube drainage or the aspiration of fluid with a syringe is adequate. However, in some cases a shunt may be inserted to facilitate drainage into the peritoneal cavity, between the linings of the abdominal organs and the abdominal cavity. However, in a recent case, physicians observed a patient in whom the implantation of such a shunt resulted in the accumulation of ascites fluid in the patient's abdominal cavity. Sometimes such fluid accumulation results from the presence of cancer cells in the peritoneal cavity, but malignant cells could not be observed in this case. On the presumption that ascites was a result of shunting the pleural fluid, a new shunt was implanted to return the pleural fluid to the venous circulation. Ascites did not recur after the shunt was changed. The patient died six months later of multiple lung metastases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Case studies, Pleural effusions, Pleural effusion, Peritoneovenous shunts, Peritoneovenous shunt

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The diagnostic challenge of acute polyarthritis

Article Abstract:

Patients treated with corticosteroids may later develop multiple joint damage due to an inadequate blood supply to these joints. Magnetic resonance imaging may be the best imaging technique for identifying this condition in its earliest stages. A 22-year-old woman was treated with dexamethasone four times daily for 30 days following a head injury. Bone pain affected her ability to move both hips, knees, elbows, shoulders, and ankles within one year following corticosteroid treatment. The pain worsened following treatment with water therapy and non-steroidal inflammatory drugs. X-rays showed bone damage due to an inadequate blood supply in both of her hips and shoulders and in the left elbow. This patient may require hip joint reconstruction or replacement.

Development and progression, Dexamethasone, Avascular necrosis

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