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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritoneovenous shunts of the Denver type were inserted into 36 patients to control malignant ascites. The Denver system features a compressible pump chamber bearing a pressure sensitive valve. Initially, all the shunts functioned well. The shunt remained open until death in 21 patients, and at the beginning of the analysis, another two patients were still alive with an open shunt. Blockage of the shunt occurred in 13 patients before death. The cumulative survival time for patients after shunt insertion was 129 months and the cumulative shunt functioning time was 92 months. The over-all median survival time after shunt installation was 13 weeks, and calculated actuarially, the median shunt functioning time for long term survivors was 14 weeks. The cytologic state of the ascitic fluid did not make a statistically significant difference to the blockage-free interval (p = 0.99), neither did the type of primary tumor (p = 0.37). Complications were of a minor type. There was no laboratory or clinical evidence of disseminated intravascular coagulation. Tumor spread through the tubing was seen in one of the three autopsies performed. Denver type peritoneovenous shunting appears to provide effective palliation in the majority of patients. It should, however, only be performed as a last resort.
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PMID:The Denver type for peritoneovenous shunting of malignant ascites. 242 17

Malignant ascites is often refractory to therapy and rapidly deteriorating the nutritional and physical state of the cancer patient. Nevertheless, ascites does not always implicate preterminal state of the cancer process (e.g. ovarian carcinoma). A short review is made of the pathophysiology of ascites in cirrhosis and in malignancy, and different modes of treatment are discussed. The results of medical therapy of malignant ascites (salt and water restriction, diuretics, intraperitoneal cytostatics or radiocolloids) are not convincing. The immunotherapy with OK-432, as worked out by Katano (16-46) has to prove its value. The best and most hopeful results in cases of massive previously resistant ascites, are obtained with a peritoneojugular shunt, improving immediately the nutritional status and life condition, providing excellent palliation. The superiority of the Denver shunt versus the Le Veen shunt has been assessed recently, especially for malignant ascites. Some technical and perioperative details merit more attention, to limit the high risk ratio. Control of the intrathoracic position of the catheter tip, the maintenance of the bloodflow in the jugular vein, the intramuscular tunnelisation of the peritoneal catheter, the discard of 3 or 5 liters ascitic fluid and the substitution of part of it by physiological fluid, perioperative prophylactic antibiotics and heparinisation, flow-rate control in the postoperative period by changing patients position, respiratory exercises, daily flushing, all those measures limit the risk of fibrinolysis (DIC), shunt occlusion, fluid overload and infection. The fear of metastasis by shunt is unfounded, since the survival of the primary tumor is mostly too short (41). The postoperative follow up in an intensive care unit is necessary during 24-72 hours.
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PMID:[The Denver shunt in malignant ascites]. 258 Apr 8

The cases of 42 patients with malignant ascites treated with a peritoneal venous shunt over a 5-year period are reviewed to establish the incidence of surgical and postsurgical complications. Although the yield of malignant cells found in the peripheral blood was increased after shunting, no new hematogenous metastases were observed after the operation. No evidence of disseminated intravascular coagulation was observed after shunt placement. While the shunt effectively relieved the discomfort due to abdominal distention and respiratory impairment, no restoration of cutaneous hypersensitivity was observed in the nine patients who were anergic prior to surgery. The median survival of patients with breast and gynecological cancer, after surgery, was significantly longer than the survival of patients with primary gastrointestinal neoplasma. In conclusion, peritoneal venous shunt appears to be an effective and safe method to improve the quality of life of patients with malignant ascites.
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PMID:Peritoneovenous shunt and neoplastic ascites: a 5-year experience report. 376 70

A prospective analysis of the morbidity and mortality after peritoneovenous shunting was carried out in 25 patients who had a total of 27 shunts for refractory ascites. Major complications were limited to the patients in whom ascites was secondary to hepatic rather than peritoneal disease. Immediate postoperative complications followed 17 out of the 23 shunts carried out in patients with liver disease and included septicaemia (two), profound hypotension (two), pulmonary oedema (one), and clinically evident disseminated intravascular coagulation (14). Long term morbidity was again limited to the patients with liver disease and included chronic shunt infection (two) and major venous thrombosis (two). Shunt associated mortality was only seen in the patients with liver disease. Despite late shunt blockage in five long term survivors with alcoholic liver disease fluid retention was easily controlled by simple medical means probably because of improved liver function associated with abstinence from alcohol. It is concluded that: (1) patients with hepatic and malignant ascites respond differently to the insertion of a peritoneovenous shunt; (2) Shunt patency should be monitored regularly in patients with liver disease and, because of the potential for septic and thrombotic complications, if blocked the shunt should be removed and; (3) because of the morbidity and mortality of peritoneovenous shunt surgery in patients with liver disease and refractory ascites, an alternative mode of therapy, such as repeated ultrafiltration and reinfusion of ascitic fluid, may be a more effective initial therapeutic approach especially in patients in whom there is a reversible element to their underlying liver disease.
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PMID:Morbidity and mortality after peritoneovenous shunt surgery for refractory ascites. 405 6

A peritoneovenous (PV) shunt was placed in eight patients with intractable malignant ascites. The shunt successfully controlled the ascites in six patients. The median survival time of the entire group was 2 months, with one patient alive at 22 months. Two of seven patients had secondary shunt failure: one from an unknown cause which could not be corrected by revision and another which was corrected by revision following removal of psammoma bodies in the valve. The complications of the shunt included transient edema (four patients), transient intravascular coagulation (four patients), and fever (two patients). Tumor embolization was suspected pathologically in two of eight patients although the ascitic fluid contained malignant cells in seven of eight patients. The PV shunt is a satisfactory palliative procedure for malignant ascites in the presence of adequate cardiac function and in the absence of urinary obstruction. The presence of bloody effusion or major intra-abdominal mass lesions contra-indicates a successful PV shunt. The acute adverse effets of the PV shunt (fever, fluid overload, and fulminant disseminated intravascular coagulation) may be prevented or minimized by preoperative fluid removal to obviate a major intravascular infusion of colloid and biologically active pyrogen and thromboplastin.
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PMID:Complications of peritoneovenous shunt for malignant ascites. 615 65

Peritoneovenous shunting for the treatment of malignant ascites has become increasingly popular. This technique can be complicated by tumor embolization, congestive heart failure, and disseminated intravascular coagulation. Arterial thromboembolism has been encountered in two patients following LeVeen shunt insertion. Recurrent bilateral femoral artery thromboemboli and a cerebrovascular accident occurred in one patient and cerebrovascular thromboembolism developed in a second patient. Major arterial embolization is potentially a serious, although infrequent, complication of peritoneovenous shunting in patients who have malignant ascites.
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PMID:Arterial thromboembolic complications of peritoneovenous shunting for malignant ascites. 620 87

A 44-year-old white male with pseudomyxoma peritonei and intractable malignant ascites is described. This patient underwent three peritoneovenous shunt procedures utilizing first the LeVeen shunt and finally the Denver shunt in a surgical attempt at palliative decompression of his malignant ascites. The peritoneovenous shunts resulted in massive tumor embolization to the pulmonary vasculature, clinically asymptomatic disseminated intravascular coagulation, and partial thrombosis of the superior vena cava. The pulmonary tumor embolization was manifest clinically as moderate pulmonary hypertension with increased pulmonary vascular resistance and persistent hypoxia.
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PMID:Fatal pulmonary tumor embolization following peritoneovenous shunting for malignant ascites. 625 78

Peritoneovenous shunts have been inserted into 26 patients to control malignant ascites. All benefitted and most required no further paracentesis until death from progressive malignancy. Shunt blockage, which is the major problem at present, occurred in 8 patients. Five patients suffering from far advanced malignancy died within a month of operation. There was no clinical evidence of enhanced tumour spread or disseminated intravascular coagulation. We do not consider that the procedure is the first line of management, neither has it much to offer the patient with viscous, bloodstained or loculated ascites. We suggest criteria which help to identify the patient most likely to benefit from a peritoneovenous shunt.
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PMID:Peritoneovenous shunts in the management of malignant ascites. 687 38

Ten patients with intractable ascites were treated with the LeVeen peritoneovenous shunt. Of these, three died perioperatively. Three patients with malignant ascites died within 2-3 months, but with good shunt function. In four patients, the shunt became occluded, after 2 weeks to 8 months. Percutaneous puncture of the shunt and injection of radiopaque dye revealed the occlusion t be due to thrombosis of the venous limb of the shunt. In one patient, superior vena cava thrombosis occurred. Another ten patients were treated with the Denver peritoneovenous shunt. One patient died perioperatively; four patients with malignant ascites and one with cirrhosis died after 11 days-3 months, but with good shunt function. One patient with cirrhosis is alive after 5 months, with good function. In three patients the shunt became occluded after 5 days-1 month but two of these could be cleared with the fluschchamber of the Denver shunt. It seems that the Denver shunt functions better than the LeVeen shunt, and that the primary indication for peritoneovenous shunting is malignant ascites. Here palliation is excellent. No patient developed clinical signs of disseminated intravascular coagulation following ascites infusion and in six patients where coagulation variables were studed, there were no signs of a consumption coagulopathy.
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PMID:Peritoneovenous shunting for intractable ascites. 716 89

Coagulopathy is a well recognised complication of peritoneovenous shunting for ascites. The relative contributions of primary fibrinolysis and disseminated intravascular coagulation remain controversial. Plasminogen activating activity was significantly lower in malignant ascites (n = 10, median < 0.02 (range < 0.02-1.26) IU/ml) than in alcoholic ascites (n = 10, 1.07 (0.30-1.49) IU/ml) (p < 0.05). Fibrinolytic activity was determined by a balance between tissue plasminogen activator and plasminogen activator inhibitor-1. There was no significant difference between the two groups in the concentration of tissue plasminogen activator (34 (12-64) ng/ml in malignant ascites v 29 (12-43) ng/ml in alcoholic ascites), but the concentration of plasminogen activator inhibitor-1 was significantly higher in malignant ascites (736 (213-1651) ng/ml) than in alcohol ascites (29 (12-43) ng/ml) (p < 0.05). Malignant ascites contained significantly higher concentrations of urokinase (0.7 (< 0.1-1.3) ng/ml v 0.2 (< 0.1-0.6) ng/ml in alcoholic ascites) and plasminogen activator inhibitor-2 (33 (< 6-140) ng/ml v 9 (< 6-28) ng/ml alcoholic ascites). The plasminogen activating activity of alcohol ascites may lead to primary fibrinolysis after peritoneovenous shunting. The considerably lower activity found in malignant ascites may explain why coagulopathy after shunting is less pronounced in this group of patients.
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PMID:Fibrinolytic activity of ascites caused by alcoholic cirrhosis and peritoneal malignancy. 817 65


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