1/2. Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management.Two cases of right hepatic hydrothorax occurring in the absence of clinical ascites are reported. diagnosis was confirmed by the intraperitoneal and intrapleural injection of radioisotope 99mTc-sulfur colloid that demonstrated the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavities. In contrast, radioisotope injected into the peritoneal cavity of 5 patients with pleural effusions secondary to pulmonary or cardiac disease failed to traverse the diaphragm and localize in the pleural space. Medical therapy with salt and water restriction and diuretics resulted in both of the patients with hepatic hydrothorax developing signs of intravascular volume depletion without significant mobilization of the pleural fluid. thoracotomy allowed identification of the diaphragmatic defects that were repaired by chemical and traumatic pleurodesis followed by postoperative peritoneal and pleural drainage. This therapy resulted in complete resolution of the pleural effusions, which have not recurred despite the subsequent development of clinical ascites in both patients.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/2. Improvement of renal failure with repeated head-out water immersions in patients with hepatorenal syndrome associated with alcoholic hepatitis.Two patients with severe hepatorenal syndrome associated with alcoholic hepatitis are reported, in whom repeated daily courses of head-out water immersion were dramatically effective in producing an improvement of the renal function. Using repeated 2-hour courses of head-out water immersion for 7 days in the 1st patient, an immediate increase in urine output was observed. A slight increase in renal sodium excretion was also noted. The patient lost 7 kg over 1 week. serum creatinine decreased from 520 to 370 mumol/l, and the renal function continued to improve thereafter. In the 2nd patient, repeated head-out water immersion was associated with a progressive improvement of the renal function, an effect that was absent during an initial therapy of volume load. The acute effects of immersion in in this 2nd patient were characterized by a dramatic increase in urine output and renal sodium excretion as well as in p-aminohippurate and creatinine clearances. These effects were associated with a decrease in the activity of the renin-angiotensin system and a modest increase in plasma atrial natriuretic peptide levels. Thus, these 2 cases emphasize the potential benefits of repeated head-out water immersions in improving the renal function of patients with hepatorenal syndrome.- - - - - - - - - - ranking = 8keywords = water (Clic here for more details about this article) |