No laboratory test completely distinguishes malignant ascites (MA) from ascites associated with cirrhosis and (or) hepatocellular carcinoma (A/C-HC). Ascitic cytology is highly specific but has a diagnostic sensitivity of only 40-60%. We determined 11 ascitic analytes and cytology in 58 patients with cirrhosis, 15 with hepatocellular carcinoma, and 21 with MA (10 ovarian cancers, 4 mesotheliomas, 6 gastrointestinal neoplasias, 1 leukemia). Ascitic total protein, cholesterol, pseudouridine, and lactate dehydrogenase (LD), and the ascitic:serum ratios of total protein and of LD showed the most significant differences between the two groups of patients. Stepwise multiple linear discriminant analysis (applying the Wilks' lambda criterion) of several variables, corroborated by the "jack-knife" reallocation procedure, showed that the ascitic cholesterol and ascitic LD association correctly identified 100% of MA and A/C-HC; cytology had a diagnostic specificity of 100%, but identified only 48% of MA. This association may represent a primary tool for the discrimination of ascites of unknown origin, particularly in the presence of negative cytology findings.
Objective The effects of carbonated beverages on the gastrointestinal tract have been poorly investigated. Therefore, this study aims to assess the effect of carbonated water intake in patients with functional dyspepsia and constipation. Methods Twenty-one patients with dyspepsia and secondary constipation were randomized into two groups in a double-blind fashion. One group (10 subjects) drank carbonated water and the other (11 subjects) tap water for almost 15 days. Patients were evaluated for dyspepsia and constipation scores, and underwent a satiety test by a liquid meal, radionuclide gastric emptying, sonographic gallbladder emptying and colonic transit time, using radio-opaque markers. Results The dyspepsia score was significantly reduced with carbonated water (before = 7.9 ± 2.8 vs after = 5.4 ± 1.7;P< 0.05) and remained unmodified after tap water (9.7 ± 5.3 vs 9.9 ± 4.0). The constipation score also decreased significantly (P< 0.05) after carbonated water (16.0 ± 3.9 vs 12.1 ± 4.4;P< 0.05) and was not significantly different with tap water (14.7 ± 5.1 vs 13.7 ± 4.7). Satiety was significantly reduced with carbonated water (before = 447 ± 146 kcal vs after = 590 ± 245;P< 0.01). Gallbladder emptying (delta percent contraction) was significantly improved only with carbonated water (39.9 ± 16.1%vs 53.6 ± 16.7%;P< 0.01). Conclusion In patients complaining of functional dyspepsia and constipation, carbonated water decreases satiety and improves dyspepsia, constipation and gallbladder emptying.
The course of chronic hepatitis was retrospectively evaluated in 26 patients in whom both peritoneoscopy and liver biopsy were initially performed. At entry all patients were clinically asymptomatic and showed mild or moderate histological and chemical abnormalities, so that none of them needed steroid treatment. The duration of the follow-up ranged from 24-82 months. At the end of follow-up liver biopsy was obtained in all patients. In a few patients peritoneoscopy was also ultimately performed. In six patients in whom initially chronic persistent hepatitis (CPH) was diagnosed both by peritoneoscopy and liver biopsy, the subsequent course of the disease was benign. In all the nine patients in whom initially peritoneoscopy suggested CPH, in contrast to the histological diagnosis of chronic aggressive hepatitis (CAH), chemical and morphological parameters of liver disease activity did not worsen to require steroid treatment. In five of six patients in whom both liver biopsy and peritoneoscopy initially showed CAH, chemical and morphological abnormalities progressed so that steroids had to be initiated. Finally in four of five patients in whom initially peritoneoscopy showed CAH and liver biopsy CPH, steroid treatment was ultimately required because of chemical and morphological worsening. In conclusion peritoneoscopy may be a useful aid in the management of the asymptomatic patient with moderate chemical and histological features of chronic liver disease.
