digoxin and Ascites

This paper describes a method for the purification of monoclonal antibodies (rat anti-2,4-dinitrophenyl IgG: IgG(DNP); and mouse antidigoxin IgG: IgG(Dgn)) from ascites fluid. This procedure (for IgG(DNP)) has three steps: (i) precipitation of proteins heavier than immunoglobulins with ammonium sulfate; (ii) formation of cyclic complexes of IgG(DNP) by causing it to bind to synthetic multivalent haptens containing multiple DNP groups; (iii) selective precipitation of these dimers, trimers, and higher oligomers of the target antibody, followed by regeneration of the free antibody. This procedure separates the targeted antibody from a mixture of antibodies, as well as from other proteins and globulins in a biological fluid. This method is applicable to antibodies with a wide range of monovalent binding constants (0.1 microM to 0.1 nM). The multivalent ligands we used (derivatives of DNP and digoxin) isolated IgG(DNP) and IgG(Dgn) from ascites fluid in yields of >80% and with >95% purity. This technique has two advantages over conventional chromatographic methods for purifying antibodies: (i) it is selective for antibodies with two active Fab binding sites (both sites are required to form the cyclic complexes) over antibodies with one or zero active Fab binding sites; (ii) it does not require chromatographic separation. It has the disadvantage that the structure of the hapten must be compatible with the synthesis of bi- and/or trivalent analogues.

Topics: Ammonium Sulfate; Animals; Antibodies, Monoclonal; Ascites; Binding Sites, Antibody; Chemical Precipitation; Chromatography, Gel; Digoxin; Dimerization; Dinitrobenzenes; Haptens; Immunoglobulin G; Mice; Models, Molecular; Rats

Topics: Anti-Arrhythmia Agents; Ascites; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Hydrops Fetalis; Pregnancy; Pregnancy Complications, Cardiovascular; Tachycardia, Supraventricular

Carbohydrate antigen 125, known as a marker for ovarian cancer, has been reported to be elevated in heart failure caused by left ventricular dysfunction. A case of elevated carbohydrate antigen 125 in isolated right heart failure due to atrial septal defect with preserved left ventricular function is reported.

Topics: Aged; Ascites; CA-125 Antigen; Cardiac Output, Low; Cardiotonic Agents; Digoxin; Diuretics; Female; Heart Septal Defects, Atrial; Humans; Ultrasonography

The objective of this study was to determine the relations between the hallmark circulatory finding of decompensated cirrhosis, a reduced systemic vascular resistance (SVR), and the indices of hepatic decompensation, the accumulation of ascites, and the concentrations of various vasoactive substances. At a university-affiliated teaching hospital, eighteen hospitalized patients with cirrhosis and 18 age- and sex-matched healthy subjects were used. This was a case-control study. Measurements included cardiac dimensions and indices derived from echocardiograms and Doppler studies, abdominal ultrasound estimates of ascites, indices of hepatic function, and various serum (S) and urinary (U) substances. Results showed that cirrhotics had increased left atrial and left ventricular dimensions, left ventricular mass, heart rate, cardiac output (CO), transvalvular velocities, and a decreased SVR. SVR was related to hepatic dysfunction, as reflected by an abnormal prothrombin time ratio (r = -0.64, p = 0.006), and also related to overall severity of liver disease as estimated by the Child-Pugh score (r = -0.53, p = 0.044). Although cirrhotics with ascites generally had a reduced SVR, estimates of ascites were directly related to SVR (r = 0.57, p = 0.03) and inversely related to CO (r = -0.53, p = 0.04). Concentrations of S and U digoxin-like immunoreactive substance (DLIS) were also increased, but the concentrations of S glucagon and estradiol were not elevated. The accumulations of S and U DLIS, S glucagon, and S estradiol were all related to hepatic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Ascites; Blood Proteins; Cardenolides; Digoxin; Echocardiography; Echocardiography, Doppler; Estradiol; Female; Glucagon; Hemodynamics; Hepatic Encephalopathy; Humans; Liver Cirrhosis, Alcoholic; Liver Function Tests; Male; Middle Aged; Saponins; Vascular Resistance; Vasodilation; Ventricular Function, Left; Water-Electrolyte Balance

Endogenous digitalis-like factor (EDLF), an inhibitor of membrane Na+/K(+)-ATPase, is discussed to be involved in the pathogenesis of cirrhogenic portal hypertension, ascites formation and development of functional hepatorenal failure. Therefore, we investigated the serum content of this mediator in patients with liver cirrhosis Child-Pugh stage A, B, and C (n = 27) by means of enzyme immunoassay with a specific digoxin antibody. Furthermore, a correlation analysis was performed in order to find out correlations between signs of cell injury, cholestasis, synthetic cell function, ascites formation, and hepatorenal failure. Our results demonstrate that EDLF is significantly elevated in Child C cirrhosis (0.61 +/- 0.15 ng/ml) in comparison to Child A cirrhosis (0.013 +/- 0.2 ng/ml) and is also higher than in Child B cirrhosis (0.23 +/- 0.25 ng/ml). In patients without ascites EDLF (0.056 +/- 0.19 ng/ml) differs significantly from that of patients with non-complicated ascites (0.156 +/- 0.176 ng/ml) and from that of patients with therapy refractory ascites (0.66 +/- 0.17 ng/ml) or hepatorenal failure (1.56 ng/ml). There are no correlations between EDLF and renal function. Significant correlations were demonstrated for cholestasis (serum bilirubin), synthesis function (serum protein, Quick's value, cholinesterase, fibrinogen, albumin), and the degree of portasystemic encephalopathy (number connection test). We conclude that EDLF may act as a mediator in the process of progressive portal hypertension and its complications due to cirrhosis. This process of progression is caused by the inhibition of Na+/K(+)-ATPase, vasoconstriction, and endothelin secretion.

Topics: Adult; Ascites; Bilirubin; Blood Proteins; Cardenolides; Digoxin; Enzyme Inhibitors; Female; Hepatic Encephalopathy; Hepatorenal Syndrome; Humans; Hypertension, Portal; Immunoenzyme Techniques; Kidney Function Tests; Liver; Liver Cirrhosis; Liver Function Tests; Male; Prothrombin Time; Saponins; Serum Albumin; Sodium-Potassium-Exchanging ATPase

Presented is a case story of a patient with highly elevated serum levels of the tumour marker CA 125 (Cancer Antigen 125). The patient was thought to have ovarian cancer, but eventually the source of the elevated serum CA 125 levels became clear: cardiac failure caused by thyrotoxicosis. Benign and malignant causes of elevated serum levels of CA 125 are described briefly.

Topics: Aged; Aged, 80 and over; Antigens, Tumor-Associated, Carbohydrate; Ascites; Cardiac Output, Low; Coagulants; Diagnosis, Differential; Diet, Sodium-Restricted; Digoxin; Diuretics; Female; Humans; Thyrotoxicosis; Thyrotropin; Thyroxine

The ability of urine extracts to inhibit sodium and potassium-activated ATPase, cross-react with antidigoxin antibodies and induce natriuresis in rats was investigated in 10 healthy subjects, 10 cirrhotic patients without ascites (compensated cirrhotics), 27 nonazotemic cirrhotic patients with ascites and 10 cirrhotic patients with ascites and functional renal failure to assess whether reduced activity of natriuretic hormone contributes to sodium retention in cirrhosis. No significant differences were seen between healthy subjects and compensated cirrhotic patients in any of these parameters (sodium and potassium-activated ATPase inhibition = 178.5 +/- 19.8 vs. 247.4 +/- 48.7 nmol equivalent of ouabain/day; digoxinlike activity = 43.9 +/- 6.1 vs. 48.0 +/- 5.6 ng equivalent of digoxin/day; natriuretic activity = 0.36 +/- 0.15 vs. 0.63 +/- 0.27 mumol/min). Cirrhotic patients with ascites with and without functional renal failure showed significantly higher values of sodium and potassium-activated ATPase inhibition (708.1 +/- 94.0 and 529.2 +/- 53.9 nmol equivalent of ouabain/day, respectively), digoxinlike activity (136.9 +/- 7.2 and 116.3 +/- 7.9 ng equivalent of digoxin/day) and natriuretic activity (1.78 +/- 0.48 and 1.93 +/- 0.37 mumol/min) than healthy subjects and compensated cirrhotic patients. We saw no significant differences between these two groups of cirrhotic patients with ascites with respect to these parameters. In the cirrhotic patients studied, sodium and potassium-activated ATPase inhibition and antidigoxin antibodies directly correlated with the degree of impairment of hepatic and renal function, plasma renin activity and plasma levels of aldosterone and norepinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Animals; Antibodies; Ascites; Biological Assay; Digoxin; Female; Humans; Hypertension, Portal; Kidney; Liver Cirrhosis; Male; Middle Aged; Natriuresis; Natriuretic Agents; Rats; Rats, Inbred Strains; Sodium; Sodium-Potassium-Exchanging ATPase; Sodium, Dietary

In a fetus with supraventricular tachycardia (SVT) and cardiac failure, normal sinus rhythm (NSR) was restored with maternal digoxin therapy at 26 weeks' gestation. The diagnosis of cardiac failure was based on ultrasound evidence of ascites and scalp edema. Cardiac failure was attributed to the persistent SVT. The infant remained in NSR and was delivered at 36 weeks' gestation because of persistent ascites. Intracardiac anatomy was normal. This case confirms the usefulness of prenatal ultrasound examinations in the diagnosis of fetal SVT and cardiac failure and illustrates the effectiveness and safety of transplacental digoxin therapy in the management of fetal SVT.

Topics: Adult; Ascites; Cesarean Section; Digoxin; Edema; Female; Fetal Diseases; Fetal Heart; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Polyhydramnios; Pregnancy; Tachycardia

Digoxin has been successfully used to treat fetal supraventricular tachycardia. When therapy with digoxin fails, alternative therapies have met with equivocal success. In this report, successful fetal therapy with maternally administered digoxin and quinidine is presented in three consecutive patients with fetal supraventricular tachycardia. The arrhythmia was eliminated in each instance. Fetal ascites, present in two fetuses, was completely reversed. Intrapartum fetal distress was not observed. The rationale of this therapy and a review of pertinent literature are also presented.

Topics: Administration, Oral; Adolescent; Adult; Ascites; Digoxin; Drug Therapy, Combination; Echocardiography; Female; Fetal Diseases; Humans; Pregnancy; Quinidine; Tachycardia; Wolff-Parkinson-White Syndrome

Intrauterine supraventricular tachycardia is an uncommon cardiac arrhythmia that presents difficult problems in diagnosis and management, especially in the very preterm infant. Serial ultrasound examinations were used to follow the course of fetal ascites and the maternal administration of digoxin to induce cardioversion. Higher maternal doses of digoxin than administered to the nonpregnant patient may be necessary to achieve adequate digitalization of the fetus. As many infants with supraventricular tachycardia require continued medical management, they should be delivered in a facility with neonatal intensive care capabilities.

Topics: Adult; Ascites; Digoxin; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Pregnancy; Tachycardia; Ultrasonography

Six examples of intrauterine supraventricular tachycardia together with 31 previously reported cases are described and analyzed. Among the 37 infants, structural heart disease was present in only four (11%), three of whom died. Males comprised 68% of the group without identifiable heart disease or pre-excitation. Congestive heart failure was evident in 62% of the infants at birth or shortly thereafter; ascites was the predominant finding in three (8%). Neither the duration of SVT nor heart rate was predictive of the clinical status at birth. Infants without underlying heart disease or conduction abnormalities had a benign course after the neonatal period. Thirty-eight percent of the babies converted to sinus rhythm during or shortly after delivery without medication, and most of the others converted after digitalization. The failure of maternal digitalization to convert SVT to sinus rhythm in two of our infants was perhaps related to subtherapeutic maternal and fetal digoxin levels. Newborn infants presenting with unexplained ascites or congestive heart failure should have an ECG to determine whether pre-excitation is present, and their cardiac rhythm should be monitored for several days.

Topics: Ascites; Cardiomegaly; Digoxin; Female; Fetal Diseases; Heart Defects, Congenital; Heart Failure; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia

Topics: Ascites; Digoxin; Edrophonium; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Pregnancy; Propranolol; Tachycardia

Topics: Animals; Antigen-Antibody Complex; Ascites; Charcoal; Digoxin; Half-Life; Humans; Immune Sera; Ketosteroids; Lactones; Pregnadienes; Rabbits; Radioimmunoassay; Sheep; Spironolactone; Tritium

Topics: Animals; Ascites; Digoxin; Diuretics; Dog Diseases; Dogs; Hemangioma; Liver; Male; Pleural Neoplasms; Radiography

Topics: Adrenalectomy; Ascites; Blood Transfusion; Chlorothiazide; Digoxin; Diuretics; Edema; Ethacrynic Acid; Geriatrics; Heart Failure; Humans; Injections, Intravenous; Liver Cirrhosis; Pulmonary Edema