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Paracentesis via the umbilicus in an engraving from Scultetus "Armamentarium chirurgicum" Lugduni Batavorum 1693.
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Contexts in source publication
Context 1
... as an acceptable means of treating ascites was the use of abdominal paracentesis (koiliakí parakéntisi, κοιλιακή παρακέντηση), 6 which in Greek translates as a "pierce at the side," whereby the peritoneal cavity is punctured. Paracentesis in the literal sense referred to a lateral abdominal approach, yet it seems that puncture via the umbilicus (Fig. 2) was, for the longest while, the preferred route. The ideal site to puncture the abdomen, however, was a longstanding topic for debate in which the lower abdomen became most favored, either on the right near the liver or on the left (Fig. 3), and even via the scrotum when ascites had entered an inguinoscrotal hernia. 7 Hippocrates ...
Context 2
... as an acceptable means of treating ascites was the use of abdominal paracentesis (koiliakí parakéntisi, κοιλιακή παρακέντηση), 6 which in Greek translates as a "pierce at the side," whereby the peritoneal cavity is punctured. Paracentesis in the literal sense referred to a lateral abdominal approach, yet it seems that puncture via the umbilicus (Fig. 2) was, for the longest while, the preferred route. The ideal site to puncture the abdomen, however, was a longstanding topic for debate in which the lower abdomen became most favored, either on the right near the liver or on the left (Fig. 3), and even via the scrotum when ascites had entered an inguinoscrotal hernia. 7 Hippocrates ...
Citations
... 4,5 The identi cation of these AKI phenotypes, particularly HRS-AKI, stems from seminal work in the 1970s and 1980s using kidney angiography that demonstrated marked renal vasoconstriction -a "functional" form of injury that could potentially reverse if kidney perfusion is restored. [6][7][8][9] Although it is clear that kidney perfusion is markedly disrupted among patients with HRS-AKI, it is not clear how this differs from episodes of non-HRS-AKI, particularly those with ATN. For instance, contemporaneous angiography studies among patients with sepsis or ATN, demonstrated similar patterns of vasoconstriction. ...
Methods
A case-control study of 97 patients hospitalized at our institution. We performed aptamer-based proteomics and metabolomics on serum biospecimens obtained within 72 hours of admission. We compared the proteome and metabolome by the AKI phenotype (i.e., HRS-AKI, ATN) and by AKI recovery (decrease in sCr within 0.3 mg/dL of baseline) using ANCOVA analyses adjusting for demographics and clinical characteristics. We completed Random Forest (RF) analyses to identify metabolites and proteins associated with AKI phenotype and recovery. Lasso regression models were developed to highlight metabolites and proteins could improve diagnostic accuracy. Results: ANCOVA analyses showed no metabolomic or proteomic differences by AKI phenotype while identifying differences by AKI recovery status. Our RF and Lasso analyses showed that metabolomics can improve the diagnostic accuracy of both AKI diagnosis and recovery, and aptamer-based proteomics can enhance the diagnostic accuracy of AKI recovery. Discussion: Our analyses provide novel insight into pathophysiologic pathways, highlighting the metabolomic and proteomic similarities between patients with cirrhosis with HRS-AKI and ATN while also identifying differences between those with and without AKI recovery.
Hepatorenal syndrome (HRS) is a rare and highly morbid form of kidney injury unique to patients with decompensated cirrhosis. HRS is a physiologic consequence of portal hypertension, leading to a functional kidney injury that can be reversed by restoring effective circulating volume and renal perfusion. While liver transplantation (LT) is the only definitive “cure” for HRS, medical management with vasoconstrictors and intravenous albumin are a cornerstone of supportive care. Terlipressin, a V1a receptor agonist that acts on the splanchnic circulation, has been used for many years outside the United States for the treatment of HRS. However, its recent Food and Drug Administration (FDA) approval has generated new interest in this population, as a new base of prescribers now work to incorporate the drug into clinical practice. In this article, we review HRS pathophysiology and diagnostic criteria, clinical use of terlipressin and alternative therapies, and identify areas of future research in the space of HRS and kidney injury in cirrhosis.
