Fibronectin, cholesterol and triglycerides ascitic fluid concentration in the prediction of malignancy.

There have been few trials comparing the efficacy of determinations of cholesterol, fibronectin and triglycerides for diagnosis of malignant ascites. In this study we measured these in 200 ascitic fluids from 93 cirrhotic patients (Group A), 47 hepatocellular-carcinoma patients (Group B), 60 extra-hepatic tumour patients (Group C), 44 of them with malignant cells (Group Cpos) and 16 without (Group Cneg). Anova one-way and the Bonferroni test for multiple comparisons showed that fibronectin and cholesterol were significantly higher in the ascitic fluids of patients of group C than of groups A and B (mean +/- ESM) (Cholesterol in A: 27.2 +/- 2.8; in B 23.5 +/- 1.5; in C: 68.6 +/- 5.3 mg/dl. Fibronectin in A: 32.7 +/- 2.8; in B 31.3 +/- 2.6; in C 127.7 +/- 11.1 mg/l). Both were significantly higher in Group Cpos than in Group Cneg (Cholesterol in Cneg: 41.2 +/- 6.7; in Cpos: 78.6 +/- 6.2 mg/dl. Fibronectin in Cneg: 55.0 +/- 11.2; in Cpos 154 +/- 12.3 mg/dl). We found no differences between cirrhotic ascites and malignant ascites due to primary liver hepatocellular-carcinoma. No difference at all in triglycerides were detected. With the Receiver-Operating Characteristic (ROC) curve, cholesterol had the best Youden Index (57%) at a cut-off of 32 mg/dl (sensitivity 78.3%, specificity 79.3% at this level); the best Youden Index (64%) for fibronectin had a cut-off of 60 mg/dl (sensitivity 65%, specificity 89.3%). Triglycerides appeared to be a great deal less effective as a diagnostic marker, with their best Youden Index (23%) at a cut-off 32 mg/dl (sensitivity 66.7%, specificity 56.4%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnostic value of ascitic fluid lactic dehydrogenase, protein, and WBC levels

Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of greater than 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of greater than 0.6, and an ascitic fluid-serum protein ratio of greater than 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites. The ascitic fluid LDH level did not exceed 400 SU in any patient with uncomplicated chronic liver disease, whereas in patients with malignant, tuberculous, or pancreatic ascites it exceeded 500 SU in 12/19 patients. The finding of two of the three characteristics indicated a nonhepatic cause for the ascites whereas the absence of all three strongly suggested uncomplicated liver disease as the sole cause. The ascitic fluid WBC count was also useful in that values exceeded 500/cu mm in bacterial and tuberculous peritonitis whereas it was low (297 +/- 49/cu mm) in chronic liver disease.     

Amylase levels in ascitic fluid

The amylase concentration of ascitic fluid and serum were measured in patients with various types of ascites to determine their normal range. The mean (+/- SD) nonpancreatic ascites amylase concentration was 42 +/- 44 IU/L (range 4-234) and the mean ascitic fluid/serum amylase concentration ratio was 0.44 +/- 0.33 (range 0.10-1.55). Of the various types of non-pancreatic ascites (sterile cirrhotic, infected, malignant, etc.), no group had a significantly different ascitic fluid amylase concentration or concentration ratio than any other group. Two patients with pancreatic ascites had a mean ascitic fluid amylase concentration of 1,957 +/- 1,093 IU/L and a mean amylase concentration ratio of 5.59 +/- 0.02--both significantly (p less than 0.001) greater than those of nonpancreatic ascites.     

Tuberculous peritonitis: Diagnostic value of the ascitic/blood glucose ratio

In a study of 25 consecutive patients presenting with ascites, the use of the ascitic/blood glucose ratio in assisting in the diagnosis of tuberculous peritonitis was investigated. In all 13 patients with histologically confirmed tuberculous peritonitis the ratio was less than 0.96, and in 10 patients with non-tuberculous ascites the ratio was greater than 0.96, this difference being statistically significant (P<0.001). In 2 patients with probable non -tuberculous ascites butwith pulmonarytuberculosis the results were excluded from statistical analysis, as they had received anti-tuberculosis therapy in addition to their other treatment.The conclusion drawn from this study is that the ascitic/blood glucose ratio is a useful test in the differentiation of tuberculous peritonitis from ascites due to other causes.     

Diagnostic value of pleural fluid N-terminal pro-brain natriuretic peptide levels in patients with cardiovascular diseases

Background and objective:   The diagnosis of the cause of pleural effusions caused by cardiovascular diseases such as congestive heart failure (CHF) and acute pulmonary embolism is sometimes difficult. The purpose of the present study was to evaluate the utility of pleural fluid levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in differentiating pleural effusions due to CHF, pulmonary embolism and post-coronary artery bypass graft (CABG) surgery.
Methods:   The levels of pleural fluid NT-proBNP were measured by ELISA in a total of 40 patients: 10 with CHF, 10 with pulmonary embolism, 10 post-CABG and 10 with carcinoma.
Results:   The median level of NT-proBNP in the pleural fluid of patients with CHF was 5390 pg/mL (25th to 75th percentiles, 4566 to 8158 pg/mL), which was significantly higher than that in patients with post-CABG effusions (424 pg/mL, 352 to 873), with pulmonary embolism (311 pg/mL, 212 to 1159), or with carcinoma (302 pg/mL, 208 to 626) ( P  < 0.001, CHF group vs all other groups). In receiver-operating curve analysis, an NT-proBNP level of ≥2220 pg/mL demonstrated a sensitivity of 100% and a specificity of 96.7% for the identification of CHF.
Conclusions:   Measurement of the NT-proBNP level in pleural fluid is accurate in diagnosing the etiology of the effusion as CHF. Pleural fluid levels above 2220 pg/mL are essentially diagnostic that the pleural effusion is due to CHF.     

Differentiation of malignant and non-malignant origin of ascites by determination of levels of cholesterol and lactate dehydrogenase in ascitic fluid is not absolute

The authors Castaldo et al. (Clin. Chem., 1994, 30: 478-83) state, that the ascitic lactate dehydrogenase and ascitic cholesterol association correctly identified 100% of malignant ascites from ascites associated with cirrhosis and/or hepatocellular carcinoma, with help of stepwise multiple linear discriminant analysis. The free software Capsules--Ascites is via internet available (http:?www.leeds.ac.uk/acb), which use the mathematical formula from this article. As we argue, Castaldo's state is not correct. Three independent multidimensional statistical methods--bivariate reference regions (program EVAL-KIT), cluster analysis (program BioAnalyst), geometrical distance classification (program GEODICLA) applicated on Castaldo's original data showed that lactate dehydrogenase and cholesterol have not satisfactory absolute discriminative power between malignant from nonmalignant ascites in general, but the probability to determinate the right diagnosis is about 91-93%. Research conducted in correctly selected probands should provide information which is valid not only for the selected sample but for the entire population, to achieve more generally valid conclusions, useful for practical decisions. In addition, in the compiled table show we sensitivity and specificity of different laboratory parameters publicated in 11 original articles in the nineties, all with diagnostic efficiency less 100%.     

端粒酶检测在良恶性腹水鉴别诊断中的价值

目的探讨脱落细胞中端粒酶活性在良恶性腹水鉴别诊断中的价值。方法应用端粒酶TRAP-PCR-ELISA法分别检测60例腹水患者脱落细胞中的端粒酶活性,并与细胞学及相关肿瘤标志物进行对比分析。结果恶性腹水中的端粒酶活性水平明显高于良性腹水,在良性腹水中端粒酶活性的阳性率为10%,明显低于恶性腹水中端粒酶活性的阳性率90%,同时恶性腹水中端粒酶活性的阳性率同脱落细胞病理学检查、腹水综合指标测定(癌胚抗原、甲胎蛋白等)以及乳酸脱氢酶腹水/血清检测结果相比较,差异亦具有显著性(P<0·01)。结论脱落细胞中端粒酶活性检测可作为良恶性腹水的鉴别诊断标志。     

Incidence of spontaneous bacterial peritonitis in patients with ascites. Diagnostic value of white blood cell count and pH measurement in ascitic fluid

During a 21-month period, 65 consecutive patients admitted with ascites were included in a prospective study of the incidence of spontaneous bacterial peritonitis, and paracentesis was performed on admission. The ascitic fluid was cultured, ascitic leucocytes were counted and pH was measured. Bacterial growth was found in five patients with chronic liver disease, who were diagnosed as having spontaneous bacterial peritonitis (SBP), since no intra-abdominal focus could be demonstrated. Thus, the incidence of SBP in this material was 7.7% (95% confidence limits: 2.5-17%). SBP was caused by Escherichia coli (n = 3), coagulase negative staphylococcus (n = 1), and Bacteroides species (n = 1). Abdominal tenderness, abnormal intestinal sounds, fever and hepatic encephalopathy were equally frequent in the group with SBP and in patients with sterile ascites. Infection was not anticipated in any of the patients with SBP. In contrast to several previous studies, neither ascites pH nor ascites leucocyte counts were any help in obtaining a rapid diagnosis. Survival time of patients with SBP was significantly shorter than of patients without SBP.     

Measurement of lactate in ascitic fluid

Lactate concentrations were measured in the ascitic fluid of patients using the Monotest Lactate Kit, an inexpensive, reliable bedside test that gives results within 15 min. The values were significantly higher in 24 patients with proven bacterial peritonitis, eight of them with spontaneous bacterial peritonitis, than in 53 patients with uninfected ascites of various other etiologies. In only two patients from the latter group, both with hepatic carcinoma and peritoneal metastases, were the values in the range found in bacterial peritonitis. Lactate determination was at least as sensitive as measurement of WBC levels for diagnosing peritonitis. Serial determinations in two patients with peritonitis showed declining values as the disease responded to treatment. The test has particular relevance for patients with spontaneous bacterial peritonitis, because this disease, which is potentially life-threatening although frequently asymptomatic, requires immediate treatment, yet currently depends on time-consuming culture procedures for diagnosis.     

Selective intestinal decontamination increases serum and ascitic fluid C3 levels in cirrhosis

Selective intestinal decontamination for 7 days with norfloxacin was performed in 14 cirrhotic patients with ascites and low ascitic fluid total protein. Variations in serum and ascitic fluid of C3 and C4 and ascitic fluid total protein after therapy were compared with those of a control group of 14 untreated patients with similar characteristics. After oral norfloxacin administration, we saw a significant increase of C3 in serum (p less than 0.05) and ascitic fluid (p = 0.01). A significant increase was also observed in ascitic fluid total protein (p less than 0.05) but not in serum and ascitic fluid C4. There were no changes in serum C3, ascitic fluid C3, ascitic fluid C4 or in ascitic fluid total protein in group 2. These data demonstrate that selective intestinal decontamination increases serum and ascitic fluid C3 levels and, therefore, might be useful in preventing spontaneous infections in cirrhotic patients at high risk of infection.     

Analysis of ascitic fluid in cirrhosis

In order to determine the composition of normal ascitic fluid, the results of analysis of the first paracentesis on 347 consecutive cirrhotic patients with ascites at the West Haven Veterans Administration Hospital between 1955 and 1976 were examined. The ascites was considered normal in 259 patients. Bacterial peritonitis was present in 51, malignant ascites in 18, pancreatitic ascites in 15, and ascites of other types in 4 patients. Normal ascites is sterile, usually clear, and contains 281±25 leukocytes/mm³ (mean±Sem), 27±2% of which are polymorphonuclear. Inspontaneous bacterial peritonitis the fluid is usually cloudy, contains 6084±858 white blood cells/mm³, 77±4% of which were PMN and culture is positive for a single bacterial species, usually enteric in origin.Malignant andpancreatitis ascites are sterile, often cloudy, and contain an average of 696±273 and 1821±833 leukocytes/mm³, respectively, about half of which are polymorphonuclear. Amylase activity is increased in pancreatitic ascites, but not in other types of ascites. Stained smears of sediment for bacteria are often positive in bacterial peritonitis, but not in the other categories. Neither the specific gravity, protein concentration, nor glucose level is useful in the differential diagnosis of ascites. Based on the critical number of leukocytes alone, (500/mm³), one can accurately differentiate infected from uninfected fluid in over 90% of ascitic patients.     

Diagnostic value of asbestos bodies in bronchoalveolar lavage fluid

Asbestos bodies (AB) were counted by light microscopy in bronchoalveolar lavage (BAL) fluid obtained from 563 subjects. The presence of AB was found to reflect occupational exposure to asbestos and was rarely found in unexposed control subjects at concentrations above 1/ml of fluid (6.9% of white collar workers and 17.8% of blue collar workers). The overlap of results observed between subjects with definite exposure and those without underlines the difficulty in assessing exposure by questioning alone, which leads to underestimations or even overestimations of the risk. The highest counts (log mean, 120.5 AB/ml; range, 0 to 42,600) were found in patients with radiologic evidence of asbestosis, most likely reflecting the known association of this disease with retention of large amounts of long amphiboles, rather than in patients with pleural disease. A considerable overlap of results was also observed between groups with different diseases or without any apparent disease. Apart from uncertainties in the radiologic diagnosis, this may be explained by differences in latency since first exposure, in individual response to asbestos inhalation, or in pathogenic properties of different asbestos types. Because the presence of AB in BAL fluid appears to be a marker of exposure and not of disease, AB are more likely to be detected in patients presenting with asbestos-related diseases but in whom exposure is not confirmed by the occupational history (65 of 78 cases).