S3-Leitlinie „Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom”

I. Diagnostik des Aszites I.1. Einleitung: Ursachen des Aszites I.2. Wann soll eine diagnostische Aszitespunktion durchgeführt werden? I.3. Technik, Komplikationen und Kontraindikationen der Aszitespunktion I.3.1 Sollen Gerinnungsfaktoren vor einer Aszitespunktion substituiert werden? I.3.2 Welche Kontraindikationen zur Aszitespunktion bestehen? I.4. Diagnostik bei Aszitespunktion I.4.1 Welche Untersuchungen sind obligater Bestandteil der initialen Aszitespunktion? I.4.2 Welche Untersuchungen sind optionaler Bestandteil einer Aszitespunktion? I.4.3 Welche zytologischen Untersuchungen sollen durchgeführt werden? I.5. Spezifische Diagnostik bei Patienten mit Aszites bedingt durch ein Budd-Chiari-Syndrom (BCS) oder sinusoidales Obstruktionssyndrom I.6. Welche Parameter weisen auf eine sekundäre bakterielle Peritonitis hin? II. Therapie des Aszites II.1. Wann bedarf ein Patient mit Aszites einer Therapie? II.2. Was ist die Rolle der nicht medikamentösen Basistherapie? II.3. Wie wird die medikamentöse Therapie des Aszites durchgeführt? II.4. Wie wird der therapierefraktäre und rezidivierende Aszites behandelt? III. Spontan bakterielle Peritonitis III.1. Einleitung: Definition, Inzidenz und Prognose einer spontanbakteriellen Peritonitis (SBP) bzw. eines Bakteraszites III.2. Wann und wie sollte eine Primärprophylaxe einer SBP durchgeführt werden? III.3. Wie sollte eine SBP behandelt werden? III.4. Wie sollte die Sekundärprophylaxe und Nachsorge einer SBP aussehen ? IV. Hepatorenales Syndrom IV.1. Einleitung: Definition IV.2. Welchen Stellenwert hat die Albumingabe in der Therapie des HRS? IV.3. Welchen Stellenwert haben Vasokonstriktoren in der Therapie des HRS? IV.4. Gibt es einen Stellenwert des transjugulären intrahepatischen portosystemischen Shunts (TIPS) bei HRS? IV.5. Wann ist ein Nierenersatzverfahren beim HRS indiziert und welchen Stellenwert haben Leberersatzverfahren? IV.6. Wie beeinflusst das HRS die Indikation zur und den Verlauf nach Lebertransplantation? V. Hepatischer Hydrothorax V.1. Einleitung: Definition V.2. Welche Untersuchungen sind zur Abklärung eines hepatischen Hydrothoraxes notwendig? V.3. Wie sollten Patienten mit hepatischem Hydrothorax therapiert werden? V.4. Wie sollten Patienten mit rezidivierendem hepatischem Hydrothorax therapiert werden? V.5. Spontan bakterielles Empyem (SBEM) V.5.1 Wie wird ein spontan bakterielles Empyem (SBEM) diagnostiziert und therapiert? Abkürzungsverzeichnis Literatur

Die vorliegende Leitlinie wurde erstellt durch die Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (Leitung: Prof. Dr. med. A. L. Gerbes, Medizinische Klinik und Poliklinik II, Klinikum der Universität München Großhadern; Prof. Dr. T. Sauerbruch, Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn) in Zusammenarbeit mit folgenden Fachgesellschaften/Organisationen:

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) Deutsche Gesellschaft für Ernährungsmedizin (DGEM) Deutsche Gesellschaft für Infektiologie (DGI) Deutsche Gesellschaft für Nephrologie (DGfN) Deutsche Gesellschaft für Pathologie (DGP) Deutsche Röntgengesellschaft (DRG) Lebertransplantierte Deutschland e. V.

Literatur

• 1 Runyon B A. Management of adult patients with ascites due to cirrhosis.  Hepatology. 2004;  39 841-856
• 2 Arroyo V, Fernandez-Esparrach G, Gines P. Diagnostic approach to the cirrhotic patient with ascites.  J Hepatol. 1996;  25 (Suppl 1) 35-40
• 3 Cardenas A, Chopra S. Chylous ascites.  Am J Gastroenterol. 2002;  97 1896-1900
• 4 Almakdisi T, Massoud S, Makdisi G. Lymphomas and chylous ascites: review of the literature.  Oncologist. 2005;  10 632-635
• 5 Runyon B A. Early events in spontaneous bacterial peritonitis.  Gut. 2004;  53 782-784
• 6 Castellote J. Spontaneous bacterial peritonitis and reagent strips.  Hepatology. 2007;  46 1667-1668 ; author reply 1669 – 1670
• 7 Jeffries M A, Stern M A, Gunaratnam N T et al. Unsuspected infection is infrequent in asymptomatic outpatients with refractory ascites undergoing therapeutic paracentesis.  Am J Gastroenterol. 1999;  94 2972-2976
• 8 Evans L T, Kim W R, Poterucha J J et al. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites.  Hepatology. 2003;  37 897-901
• 9 Romney R, Mathurin P, Ganne-Carrie N et al. Usefulness of routine analysis of ascitic fluid at the time of therapeutic paracentesis in asymptomatic outpatients. Results of a multicenter prospective study.  Gastroenterol Clin Biol. 2005;  29 275-279
• 10 Robert Koch-Institut . Anforderungen der Hygiene bei Operationen und anderen invasiven Eingriffen – Mitteilung der Kommission für Krankenhaushygiene und Infektionsprävention am Robert Koch-Institut.  Bundesgesundheitsblatt. 2000;  43 644-648
• 11 Schlottmann K, Gelbmann C, Grune S et al. A new paracentesis needle for ascites and pleural effusion compared with the venous indwelling catheter. A prospective, randomized study.  Med Klin. 2001;  96 321-324
• 12 Gines P, Arroyo V, Rodes J. Treatment of ascites and renal failure in cirrhosis.  Baillieres Clin Gastroenterol. 1989;  3 165-186
• 13 Shaheen N J, Grimm I S. Comparison of the Caldwell needle/cannula with Angiocath needle in large volume paracentesis.  Am J Gastroenterol. 1996;  91 1731-1733
• 14 Boccia S, Rollo V, Accorsi L et al. Paracentesis: a new needle for an old technique.  Endoscopy. 1991;  23 83-84
• 15 Nazeer S R, Dewbre H, Miller A H. Ultrasound-assisted paracentesis performed by emergency physicians vs. the traditional technique: a prospective, randomized study.  Am J Emerg Med. 2005;  23 363-367
• 16 Sakai H, Sheer T A, Mendler M H et al. Choosing the location for non-image guided abdominal paracentesis.  Liver Int. 2005;  25 984-986
• 17 Cattau Jr E L, Benjamin S B, Knuff T E et al. The accuracy of the physical examination in the diagnosis of suspected ascites.  JAMA. 1982;  247 1164-1166
• 18 Irshad A, Ackerman S J, Anis M et al. Can the smallest depth of ascitic fluid on sonograms predict the amount of drainable fluid?.  J Clin Ultrasound. 2009;  37 440-444
• 19 De Gottardi A, Thevenot T, Spahr L et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study.  Clin Gastroenterol Hepatol. 2009;  7 906-909
• 20 Martinet O, Reis E D, Mosimann F. Delayed hemoperitoneum following large-volume paracentesis in a patient with cirrhosis and ascites.  Dig Dis Sci. 2000;  45 357-358
• 21 Arnold C, Haag K, Blum H E et al. Acute hemoperitoneum after large-volume paracentesis.  Gastroenterology. 1997;  113 978-982
• 22 Grabau C M, Crago S F, Hoff L K et al. Performance standards for therapeutic abdominal paracentesis.  Hepatology. 2004;  40 484-488
• 23 Pache I, Bilodeau M. Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease.  Aliment Pharmacol Ther. 2005;  21 525-529
• 24 Lin C H, Shih F Y, Ma M H et al. Should bleeding tendency deter abdominal paracentesis?.  Dig Liver Dis. 2005;  37 946-951
• 25 Mallory A, Schaefer J W. Complications of diagnostic paracentesis in patients with liver disease.  JAMA. 1978;  239 628-630
• 26 Webster S T, Brown K L, Lucey M R et al. Hemorrhagic complications of large volume abdominal paracentesis.  Am J Gastroenterol. 1996;  91 366-368
• 27 Minocha A. A fatal case of paracentesis.  Am J Gastroenterol. 1999;  94 856
• 28 McVay P A, Toy P T. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities.  Transfusion. 1991;  31 164-171
• 29 Runyon B A. Paracentesis of ascitic fluid. A safe procedure.  Arch Intern Med. 1986;  146 2259-2261
• 30 Mannucci P M. Abnormal hemostasis tests and bleeding in chronic liver disease: are they related? No.  J Thromb Haemost. 2006;  4 721-723
• 31 Angeloni S, Nicolini G, Merli M et al. Validation of automated blood cell counter for the determination of polymorphonuclear cell count in the ascitic fluid of cirrhotic patients with or without spontaneous bacterial peritonitis.  Am J Gastroenterol. 2003;  98 1844-1848
• 32 Rimola A, Garcia-Tsao G, Navasa M et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club.  J Hepatol. 2000;  32 142-153
• 33 Albillos A, Cuervas-Mons V, Millan I et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis.  Gastroenterology. 1990;  98 134-140
• 34 Jones S R. The absolute granulocyte count in ascites fluid. An aid to the diagnosis of spontaneous bacterial peritonitis.  West J Med. 1977;  126 344-346
• 35 Runyon B A. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis.  Gastroenterology. 1986;  91 1343-1346
• 36 Llach J, Rimola A, Navasa M et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration.  Hepatology. 1992;  16 724-727
• 37 Guarner C, Sola R, Soriano G et al. Risk of a first community-acquired spontaneous bacterial peritonitis in cirrhotics with low ascitic fluid protein levels.  Gastroenterology. 1999;  117 414-419
• 38 Canete N, Erice E, Bargallo A et al. Natural history of spontaneous bacterial peritonitis: A longitudinal study in 263 cirrhotic patients after the first ascites decompensation.  J Hepatol. 2007;  46 S90-S91
• 39 Pare P, Talbot J, Hoefs J C. Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites.  Gastroenterology. 1983;  85 240-244
• 40 Runyon B A, Montano A A, Akriviadis E A et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites.  Ann Intern Med. 1992;  117 215-220
• 41 Dittrich S, Yordi L M, Mattos A A. The value of serum-ascites albumin gradient for the determination of portal hypertension in the diagnosis of ascites.  Hepatogastroenterology. 2001;  48 166-168
• 42 Runyon B A, Canawati H N, Akriviadis E A. Optimization of ascitic fluid culture technique.  Gastroenterology. 1988;  95 1351-1355
• 43 Castellote de J, Xiol X, Verdaguer R et al. Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis.  Am J Gastroenterol. 1990;  85 1605-1608
• 44 Bobadilla M, Sifuentes J, Garcia-Tsao G. Improved method for bacteriological diagnosis of spontaneous bacterial peritonitis.  J Clin Microbiol. 1989;  27 2145-2147
• 45 Caly W R, Strauss E. A prospective study of bacterial infections in patients with cirrhosis.  J Hepatol. 1993;  18 353-358
• 46 Kuiper J J, Buuren H R, Man de R A. Limited role for routine ascites culture as a diagnostic tool for spontaneous bacterial peritonitis in the era of prophylactic antibiotics.  J Hepatol. 2007;  46 S96
• 47 Butani R C, Shaffer R T, Szyjkowski R D et al. Rapid diagnosis of infected ascitic fluid using leukocyte esterase dipstick testing.  Am J Gastroenterol. 2004;  99 532-537
• 48 Castellote van J, Lopez C, Gornals J et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips.  Hepatology. 2003;  37 893-896
• 49 Sapey T, Kabissa D, Fort E et al. Instant diagnosis of spontaneous bacterial peritonitis using leukocyte esterase reagent strips: Nephur-Test vs. MultistixSG.  Liver Int. 2005;  25 343-348
• 50 Thevenot T, Cadranel J F, Nguyen-Khac E et al. Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients by use of two reagent strips.  Eur J Gastroenterol Hepatol. 2004;  16 579-583
• 51 Vanbiervliet G, Rakotoarisoa C, Filippi J et al. Diagnostic accuracy of a rapid urine-screening test (Multistix8SG) in cirrhotic patients with spontaneous bacterial peritonitis.  Eur J Gastroenterol Hepatol. 2002;  14 1257-1260
• 52 Campillo B, Richardet J P, Dupeyron C. Diagnostic value of two reagent strips (Multistix 8 SG and Combur 2 LN) in cirrhotic patients with spontaneous bacterial peritonitis and symptomatic bacterascites.  Gastroenterol Clin Biol. 2006;  30 446-452
• 53 Nousbaum J B, Cadranel J F, Nahon P et al. Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis.  Hepatology. 2007;  45 1275-1281
• 54 Nguyen-Khac E, Cadranel J F, Thevenot T et al. Review article: the utility of reagent strips in the diagnosis of infected ascites in cirrhotic patients.  Aliment Pharmacol Ther. 2008;  28 282-288
• 55 Runyon B A, Hoefs J C, Morgan T R. Ascitic fluid analysis in malignancy-related ascites.  Hepatology. 1988;  8 1104-1109
• 56 Decker D, Stratmann H, Springer W et al. Benign and malignant cells in effusions: diagnostic value of image DNA cytometry in comparison to cytological analysis.  Pathol Res Pract. 1998;  194 791-795
• 57 Jungst D, Gerbes A L, Martin R et al. Value of ascitic lipids in the differentiation between cirrhotic and malignant ascites.  Hepatology. 1986;  6 239-243
• 58 Gerbes A L, Xie Y N, Mezger J et al. Ascitic fluid concentrations of fibronectin and cholesterol: comparison of differential diagnostic value with the conventional protein determination.  Liver. 1990;  10 152-157
• 59 Gerbes A L, Jungst D, Xie Y N et al. Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites. Proposal of a diagnostic sequence.  Cancer. 1991;  68 1808-1814
• 60 Gulyas M, Kaposi A D, Elek G et al. Value of carcinoembryonic antigen (CEA) and cholesterol assays of ascitic fluid in cases of inconclusive cytology.  J Clin Pathol. 2001;  54 831-835
• 61 Boyer T D, Kahn A M, Reynolds T B. Diagnostic value of ascitic fluid lactic dehydrogenase, protein, and WBC levels.  Arch Intern Med. 1978;  138 1103-1105
• 62 Scholmerich J, Volk B A, Kottgen E et al. Fibronectin concentration in ascites differentiates between malignant and nonmalignant ascites.  Gastroenterology. 1984;  87 1160-1164
• 63 Runyon B A. Elevated ascitic fluid fibronectin concentration. A non-specific finding.  J Hepatol. 1986;  3 219-222
• 64 Chen S J, Wang S S, Lu C W et al. Clinical value of tumour markers and serum-ascites albumin gradient in the diagnosis of malignancy-related ascites.  J Gastroenterol Hepatol. 1994;  9 396-400
• 65 Khandwalla H E, Fasakin Y, El-Serag H B. The utility of evaluating low serum albumin gradient ascites in patients with cirrhosis.  Am J Gastroenterol. 2009;  104 1401-1405
• 66 Böcking A, Motherby H, Pomjanski N. Treffsicherheit der Ergusszytologie samt adjuvanten Untersuchungsmethoden.  Dtsch Ärztebl. 2000;  97 A-2626
• 67 Feichter G, Dalquen P. Zytopathologie. Berlin: Springer; 2000
• 68 Motherby H, Nadjari B, Friegel P et al. Diagnostic accuracy of effusion cytology.  Diagn Cytopathol. 1999;  20 350-357
• 69 Rohn B L. Verbesserung der Treffsicherheit der Ergusszytologie mittels AgNOR-Analyse als adjuvante Untersuchungsmethode. Düsseldorf: Institut für Cytopathologie. Medizinische Fakultät der Heinrich-Heine Universität; 2004: 45
• 70 Moore K P, Aithal G P. Guidelines on the management of ascites in cirrhosis.  Gut. 2006;  55 (Suppl 6) vi1-12
• 71 Böcking A. DNA measurements: When and why?. In: Wied G L, Keebler C M, Rosenthal D L, eds Compendium on quality assurance, proficiency testing, and workload limitations. Tutorials of Cytology 1995.. Chicago IL; 1995: 170-188
• 72 Schlake W, Kreipe H. Mitteilungen Deutsche Gesellschaft für Pathologie. Erklärung zur Zytopathologie.  . Unter Mitarbeit von: A. Böcking, R. Bollmann, S. Falk, V. Fritzsche, A. Wellmann. Pathologe. 2007;  28 393
• 73 Spriggs A I, Boddington M M. The Cytology of Effusions in the Pleural, Pericardial and Peritoneal Cavities and of Cerebrospinal Fluid. 2nd ed. London: Heinemann; 1968
• 74 Giroud F, Haroske G, Reith A et al. 1997 ESACP consensus report on diagnostic DNA image cytometry. Part II: Specific recommendations for quality assurance. European Society for Analytical Cellular Pathology.  Anal Cell Pathol. 1998;  17 201-208
• 75 Haroske G, Giroud F, Reith A et al. 1997 ESACP consensus report on diagnostic DNA image cytometry. Part I: basic considerations and recommendations for preparation, measurement and interpretation. European Society for Analytical Cellular Pathology.  Anal Cell Pathol. 1998;  17 189-200
• 76 Motherby H, Nadjari B, Remmerbach T et al. Static DNA cytometry as a diagnostic aid in effusion cytology: II. DNA aneuploidy for identification of neoplastic cells in equivocal effusions.  Anal Quant Cytol Histol. 1998;  20 162-168
• 77 Pomjanski N, Motherby H, Buckstegge B et al. Early diagnosis of mesothelioma in serous effusions using AgNOR analysis.  Anal Quant Cytol Histol. 2001;  23 151-160
• 78 Darwish Murad S, Plessier A, Hernandez-Guerra M et al. Etiology, management, and outcome of the Budd-Chiari syndrome.  Ann Intern Med. 2009;  151 167-175
• 79 Valla D C. Budd-Chiari syndrome and veno-occlusive disease/sinusoidal obstruction syndrome.  Gut. 2008;  57 1469-1478
• 80 Darwish Murad S, Valla D C, Groen P C et al. Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome.  Hepatology. 2004;  39 500-508
• 81 Menon K V, Shah de V, Kamath P S. The Budd-Chiari syndrome.  N Engl J Med. 2004;  350 578-585
• 82 Ludwig J, Hashimoto E, McGill D B et al. Classification of hepatic venous outflow obstruction: ambiguous terminology of the Budd-Chiari syndrome.  Mayo Clin Proc. 1990;  65 51-55
• 83 Okuda K, Kage M, Shrestha S M. Proposal of a new nomenclature for Budd-Chiari syndrome: hepatic vein thrombosis versus thrombosis of the inferior vena cava at its hepatic portion.  Hepatology. 1998;  28 1191-1198
• 84 Hoekstra J, Leebeek F W, Plessier A et al. Paroxysmal nocturnal hemoglobinuria in Budd-Chiari syndrome: findings from a cohort study.  J Hepatol. 2009;  51 696-706
• 85 Bolondi L, Gaiani S, Li Bassi S et al. Diagnosis of Budd-Chiari syndrome by pulsed Doppler ultrasound.  Gastroenterology. 1991;  100 1324-1331
• 86 Miller W J, Federle M P, Straub W H et al. Budd-Chiari syndrome: imaging with pathologic correlation.  Abdom Imaging. 1993;  18 329-335
• 87 Janssen H L, Garcia-Pagan J C, Elias E et al. Budd-Chiari syndrome: a review by an expert panel.  J Hepatol. 2003;  38 364-371
• 88 Valla D, Casadevall N, Lacombe C et al. Primary myeloproliferative disorder and hepatic vein thrombosis. A prospective study of erythroid colony formation in vitro in 20 patients with Budd-Chiari syndrome.  Ann Intern Med. 1985;  103 329-334
• 89 Valla D. Hepatic venous outflow tract obstruction etiopathogenesis: Asia versus the West.  J Gastroenterol Hepatol. 2004;  19 S204-S211
• 90 Shulman H M, Fisher L B, Schoch H G et al. Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms.  Hepatology. 1994;  19 1171-1181
• 91 Soriano G, Castellote J, Alvarez C et al. Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management.  J Hepatol. 2010;  52 39-44
• 92 Caralis P V, Sprung C L, Schiff E R. Secondary bacterial peritonitis in cirrhotic patients with ascites.  South Med J. 1984;  77 579-583
• 93 Runyon B A, Hoefs J C. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid.  Hepatology. 1984;  4 447-450
• 94 Akriviadis E A, Runyon B A. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis.  Gastroenterology. 1990;  98 127-133
• 95 Garrison R N, Cryer H M, Howard D A et al. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis.  Ann Surg. 1984;  199 648-655
• 96 Wu S S, Lin O S, Chen Y Y et al. Ascitic fluid carcinoembryonic antigen and alkaline phosphatase levels for the differentiation of primary from secondary bacterial peritonitis with intestinal perforation.  J Hepatol. 2001;  34 215-221
• 97 Mullen K D. Review of the final report of the 1998 Working Party on definition, nomenclature and diagnosis of hepatic encephalopathy.  Aliment Pharmacol Ther. 2007;  25 Suppl 1 11-16
• 98 Moreau R, Lebrec D. Diagnosis and treatment of acute renal failure in patients with cirrhosis.  Best Pract Res Clin Gastroenterol. 2007;  21 111-123
• 99 D’Amico G, Morabito A, Pagliaro L et al. Survival and prognostic indicators in compensated and decompensated cirrhosis.  Dig Dis Sci. 1986;  31 468-475
• 100 Guardiola J, Baliellas C, Xiol X et al. External validation of a prognostic model for predicting survival of cirrhotic patients with refractory ascites.  Am J Gastroenterol. 2002;  97 2374-2378
• 101 Planas R, Montoliu S, Balleste B et al. Natural history of patients hospitalized for management of cirrhotic ascites.  Clin Gastroenterol Hepatol. 2006;  4 1385-1394
• 102 Gines P, Cardenas A, Arroyo V et al. Management of cirrhosis and ascites.  N Engl J Med. 2004;  350 1646-1654
• 103 Llovet J M, Planas R, Morillas R et al. Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study.  Am J Gastroenterol. 1993;  88 388-392
• 104 Peng S, Plank L D, McCall J L et al. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study.  Am J Clin Nutr. 2007;  85 1257-1266
• 105 Prijatmoko D, Strauss B J, Lambert J R et al. Early detection of protein depletion in alcoholic cirrhosis: role of body composition analysis.  Gastroenterology. 1993;  105 1839-1845
• 106 Cabre E, Gonzalez-Huix F, Abad-Lacruz A et al. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial.  Gastroenterology. 1990;  98 715-720
• 107 Kearns P J, Young H, Garcia G et al. Accelerated improvement of alcoholic liver disease with enteral nutrition.  Gastroenterology. 1992;  102 200-205
• 108 Caregaro L, Alberino F, Amodio P et al. Malnutrition in alcoholic and virus-related cirrhosis.  Am J Clin Nutr. 1996;  63 602-609
• 109 Selberg O, Bottcher J, Tusch G et al. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients.  Hepatology. 1997;  25 652-657
• 110 Pirlich M, Schutz T, Spachos T et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites.  Hepatology. 2000;  32 1208-1215
• 111 Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis.  Eur J Appl Physiol. 2002;  86 509-516
• 112 Plauth M, Cabre E, Riggio O et al. ESPEN Guidelines on Enteral Nutrition: Liver disease.  Clin Nutr. 2006;  25 285-294
• 113 Plauth M, Cabre E, Campillo B et al. ESPEN Guidelines on Parenteral Nutrition: hepatology.  Clin Nutr. 2009;  28 436-444
• 114 Plauth M, Schutz T, Buckendahl D P et al. Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism.  J Hepatol. 2004;  40 228-233
• 115 Plank L D, Gane E J, Peng S et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial.  Hepatology. 2008;  48 557-566
• 116 Zillikens M C, Berg J W, Wattimena J L et al. Nocturnal oral glucose supplementation. The effects on protein metabolism in cirrhotic patients and in healthy controls.  J Hepatol. 1993;  17 377-383
• 117 Cordoba van den J, Lopez-Hellin J, Planas M et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study.  J Hepatol. 2004;  41 38-43
• 118 Madden A M, Bradbury W, Morgan M Y. Taste perception in cirrhosis: its relationship to circulating micronutrients and food preferences.  Hepatology. 1997;  26 40-48
• 119 Soulsby C T, Madden A M, Morgan M Y. The effect of dietary sodium restriction on energy and protein intake in patients with cirrhosis (Abstract).  Hepatology. 1997;  26 382A
• 120 Chobanian A V, Bakris G L, Black H R et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Hypertension. 2003;  42 1206-1252
• 121 Mancia G, De Backer G, Dominiczak A et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).  J Hypertens. 2007;  25 1105-1187
• 122 Reynolds T B, Lieberman F L, Goodman A R. Advantages of treatment of ascites without sodium restriction and without complete removal of excess fluid.  Gut. 1978;  19 549-553
• 123 Gauthier A, Levy V G, Quinton A et al. Salt or no salt in the treatment of cirrhotic ascites: a randomised study.  Gut. 1986;  27 705-709
• 124 Bernardi M, Laffi G, Salvagnini M et al. Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis: a randomized controlled clinical trial comparing two diets with different sodium content.  Liver. 1993;  13 156-162
• 125 Ring-Larsen H, Henriksen J H, Wilken C et al. Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture.  Br Med J (Clin Res Ed). 1986;  292 1351-1353
• 126 Angeli P, Wong F, Watson H et al. Hyponatremia in cirrhosis: Results of a patient population survey.  Hepatology. 2006;  44 1535-1542
• 127 Biggins S W, Kim W R, Terrault N A et al. Evidence-based incorporation of serum sodium concentration into MELD.  Gastroenterology. 2006;  130 1652-1660
• 128 Hecker R, Sherlock S. Electrolyte and circulatory changes in terminal liver failure.  Lancet. 1956;  271 1121-1125
• 129 Kim W R, Biggins S W, Kremers W K et al. Hyponatremia and mortality among patients on the liver-transplant waiting list.  N Engl J Med. 2008;  359 1018-1026
• 130 Abbasoglu O, Goldstein R M, Vodapally M S et al. Liver transplantation in hyponatremic patients with emphasis on central pontine myelinolysis.  Clin Transplant. 1998;  12 263-269
• 131 Sterns R H. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases.  Ann Intern Med. 1987;  107 656-664
• 132 Runyon B A. Management of adult patients with ascites due to cirrhosis: an update.  Hepatology. 2009;  49 2087-2107
• 133 Descos L, Gauthier A, Levy V G et al. Comparison of six treatments of ascites in patients with liver cirrhosis. A clinical trial.  Hepatogastroenterology. 1983;  30 15-20
• 134 Fogel M R, Sawhney V K, Neal E A et al. Diuresis in the ascitic patient: a randomized controlled trial of three regimens.  J Clin Gastroenterol. 1981;  3 (Suppl 1) 73-80
• 135 Perez-Ayuso R M, Arroyo V, Planas R et al. Randomized comparative study of efficacy of furosemide versus spironolactone in nonazotemic cirrhosis with ascites. Relationship between the diuretic response and the activity of the renin-aldosterone system.  Gastroenterology. 1983;  84 961-968
• 136 Santos J, Planas R, Pardo A et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety.  J Hepatol. 2003;  39 187-192
• 137 Pockros P J, Reynolds T B. Rapid diuresis in patients with ascites from chronic liver disease: the importance of peripheral edema.  Gastroenterology. 1986;  90 1827-1833
• 138 Bernardi M, Servadei D, Trevisani F et al. Importance of plasma aldosterone concentration on the natriuretic effect of spironolactone in patients with liver cirrhosis and ascites.  Digestion. 1985;  31 189-193
• 139 Gatta A, Angeli P, Caregaro L et al. A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients.  Hepatology. 1991;  14 231-236
• 140 Angeli P, Fasolato S, Mazza E et al. Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis: results of an open randomised clinical trial.  Gut. 2010;  59 98-104
• 141 Daskalopoulos G, Laffi G, Morgan T et al. Immediate effects of furosemide on renal hemodynamics in chronic liver disease with ascites.  Gastroenterology. 1987;  92 1859-1863
• 142 Sawhney V K, Gregory P B, Swezey S E et al. Furosemide disposition in cirrhotic patients.  Gastroenterology. 1981;  81 1012-1016
• 143 Stanley M M, Ochi S, Lee K K et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites.  N Engl J Med. 1989;  321 1632-1638
• 144 Runyon B A. Care of patients with ascites.  N Engl J Med. 1994;  330 337-342
• 145 Abecasis R, Guevara M, Miguez C et al. Long-term efficacy of torasemide compared with frusemide in cirrhotic patients with ascites.  Scand J Gastroenterol. 2001;  36 309-313
• 146 Fiaccadori F, Pedretti G, Pasetti G et al. Torasemide versus furosemide in cirrhosis: a long-term, double-blind, randomized clinical study.  Clin Investig. 1993;  71 579-584
• 147 Gerbes A L, Bertheau-Reith U, Falkner C et al. Advantages of the new loop diuretic torasemide over furosemide in patients with cirrhosis and ascites. A randomized, double blind cross-over trial.  J Hepatol. 1993;  17 353-358
• 148 Angeli P, Dalla Pria M, De Bei E et al. Randomized clinical study of the efficacy of amiloride and potassium canrenoate in nonazotemic cirrhotic patients with ascites.  Hepatology. 1994;  19 72-79
• 149 Ginsberg D J, Saad A, Gabuzda G J. Metabolic Studies with the Diuretic Triamterene in Patients with Cirrhosis and Ascites.  N Engl J Med. 1964;  271 1229-1235
• 150 Knauf H, Mutschler E. Liver cirrhosis with ascites: pathogenesis of resistance to diuretics and long-term efficacy and safety of torasemide.  Cardiology. 1994;  84 (Suppl 2) 87-98
• 151 McHutchison J G, Pinto P C, Reynolds T B. Hydrochlorothiazide as a third diuretic in cirrhosis with refractory ascites (Abstract).  Hepatology. 1989;  10 719
• 152 Pitt B, Remme W, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.  N Engl J Med. 2003;  348 1309-1321
• 153 Gines P, Wong F, Watson H et al. Effects of satavaptan, a selective vasopressin V(2) receptor antagonist, on ascites and serum sodium in cirrhosis with hyponatremia: a randomized trial.  Hepatology. 2008;  48 204-213
• 154 Rosemurgy A S, Zervos E E, Clark W C et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial.  Ann Surg. 2004;  239 883-889 ; discussion 889 – 891
• 155 Gines A, Fernandez-Esparrach G, Monescillo A et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis.  Gastroenterology. 1996;  111 1002-1010
• 156 Gines P, Tito L, Arroyo V et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis.  Gastroenterology. 1988;  94 1493-1502
• 157 Pozzi M, Osculati G, Boari G et al. Time course of circulatory and humoral effects of rapid total paracentesis in cirrhotic patients with tense, refractory ascites.  Gastroenterology. 1994;  106 709-719
• 158 Lebrec D, Giuily N, Hadengue A et al. Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists.  J Hepatol. 1996;  25 135-144
• 159 Wong F, Sniderman K, Liu P et al. Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites.  Ann Intern Med. 1995;  122 816-822
• 160 Gines P, Uriz J, Calahorra B et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis.  Gastroenterology. 2002;  123 1839-1847
• 161 Rossle M, Ochs A, Gulberg V et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites.  N Engl J Med. 2000;  342 1701-1707
• 162 Salerno F, Camma C, Enea M et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data.  Gastroenterology. 2007;  133 825-834
• 163 Sanyal A J, Genning C, Reddy K R et al. The North American Study for the Treatment of Refractory Ascites.  Gastroenterology. 2003;  124 634-641
• 164 Salerno F, Merli M, Riggio O et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites.  Hepatology. 2004;  40 629-635
• 165 Gulberg V, Liss I, Bilzer M et al. Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts.  Digestion. 2002;  66 127-130
• 166 Bureau C, Garcia-Pagan J C, Otal P et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study.  Gastroenterology. 2004;  126 469-475
• 167 Albillos A, Banares R, Gonzalez M et al. A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites.  J Hepatol. 2005;  43 990-996
• 168 D’Amico G, Luca A, Morabito A et al. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis.  Gastroenterology. 2005;  129 1282-1293
• 169 Deltenre P, Mathurin P, Dharancy S et al. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis.  Liver Int. 2005;  25 349-356
• 170 Riggio O, Ridola L, Angeloni S et al. Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: results of a randomized controlled trial.  J Hepatol. 2010;  53 267-272
• 171 Rossle M, Mullen K D. Long-term patency is expected with covered TIPS stents: this effect may not always be desirable!.  Hepatology. 2004;  40 495-497
• 172 Rossle M, Gerbes A L. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update.  Gut. 2010;  59 988-1000
• 173 Chalasani N, Clark W S, Martin L G et al. Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting.  Gastroenterology. 2000;  118 138-144
• 174 Rajan D K, Haskal Z J, Clark T W. Serum bilirubin and early mortality after transjugular intrahepatic portosystemic shunts: results of a multivariate analysis.  J Vasc Interv Radiol. 2002;  13 155-161
• 175 Gerbes A L, Gulberg V. Benefit of TIPS for patients with refractory or recidivant ascites: serum bilirubin may make the difference.  Hepatology. 2005;  41 217
• 176 Cazzaniga M, Salerno F, Pagnozzi G et al. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt.  Gut. 2007;  56 869-875
• 177 Runyon B A. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis.  Hepatology. 1990;  12 710-715
• 178 Fernandez J, Navasa M, Gomez J et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis.  Hepatology. 2002;  35 140-148
• 179 Castellote J, Girbau A, Maisterra S et al. Spontaneous bacterial peritonitis and bacterascites prevalence in asymptomatic cirrhotic outpatients undergoing large-volume paracentesis.  J Gastroenterol Hepatol. 2008;  23 256-259
• 180 Conn H O, Fessel J M. Spontaneous bacterial peritonitis in cirrhosis: variations on a theme.  Medicine. 1971;  50 161-197
• 181 Gines P, Rimola A, Planas R et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial.  Hepatology. 1990;  12 716-724
• 182 Tito L, Rimola A, Gines P et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors.  Hepatology. 1988;  8 27-31
• 183 Hsieh W J, Lin H C, Hwang S J et al. The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding.  Am J Gastroenterol. 1998;  93 962-966
• 184 Pauwels A, Mostefa-Kara N, Debenes B et al. Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection.  Hepatology. 1996;  24 802-806
• 185 Rolachon A, Cordier L, Bacq Y et al. Ciprofloxacin and long-term prevention of spontaneous bacterial peritonitis: results of a prospective controlled trial.  Hepatology. 1995;  22 1171-1174
• 186 Soriano G, Guarner C, Teixido M et al. Selective intestinal decontamination prevents spontaneous bacterial peritonitis.  Gastroenterology. 1991;  100 477-481
• 187 Terg R, Fassio E, Guevara M et al. Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: a randomized, placebo-controlled study.  J Hepatol. 2008;  48 774-779
• 188 Obstein K L, Campbell M S, Reddy K R et al. Association between model for end-stage liver disease and spontaneous bacterial peritonitis.  Am J Gastroenterol. 2007;  102 2732-2736
• 189 Bajaj J S, Zadvornova Y, Heuman D M et al. Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites.  Am J Gastroenterol. 2009;  104 1130-1134
• 190 Appenrodt B, Grunhage F, Gentemann M G et al. Nucleotide-binding oligomerization domain containing 2 (NOD2) variants are genetic risk factors for death and spontaneous bacterial peritonitis in liver cirrhosis.  Hepatology. 2010;  51 1327-1333
• 191 Chu C M, Chang K Y, Liaw Y F. Prevalence and prognostic significance of bacterascites in cirrhosis with ascites.  Dig Dis Sci. 1995;  40 561-565
• 192 Follo A, Llovet J M, Navasa M et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis.  Hepatology. 1994;  20 1495-1501
• 193 Nobre S R, Cabral J E, Gomes J J et al. In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model.  Eur J Gastroenterol Hepatol. 2008;  20 1176-1181
• 194 Pinzello G, Simonetti R G, Craxi A et al. Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic patients.  Hepatology. 1983;  3 545-549
• 195 Thuluvath P J, Morss S, Thompson R. Spontaneous bacterial peritonitis--in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998.  Am J Gastroenterol. 2001;  96 1232-1236
• 196 Toledo C, Salmeron J M, Rimola A et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime.  Hepatology. 1993;  17 251-257
• 197 Andreu M, Sola R, Sitges-Serra A et al. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites.  Gastroenterology. 1993;  104 1133-1138
• 198 Silvain C, Besson I, Ingrand P et al. Prognosis and long-term recurrence of spontaneous bacterial peritonitis in cirrhosis.  J Hepatol. 1993;  19 188-189
• 199 Terg R, Levi D, Lopez P et al. Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease.  Dig Dis Sci. 1992;  37 1499-1504
• 200 Altman C, Grange J D, Amiot X et al. Survival after a first episode of spontaneous bacterial peritonitis. Prognosis of potential candidates for orthotopic liver transplantation.  J Gastroenterol Hepatol. 1995;  10 47-50
• 201 Almdal T P, Skinhoj P. Spontaneous bacterial peritonitis in cirrhosis. Incidence, diagnosis, and prognosis.  Scand J Gastroenterol. 1987;  22 295-300
• 202 Weinstein M P, Iannini P B, Stratton C W et al. Spontaneous bacterial peritonitis. A review of 28 cases with emphasis on improved survival and factors influencing prognosis.  Am J Med. 1978;  64 592-598
• 203 Terg R, Gadano A, Cartier M et al. Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study.  Liver Int. 2009;  29 415-419
• 204 Franca A V, De Souza J B, Silva C M et al. Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone.  J Clin Gastroenterol. 2001;  33 295-298
• 205 Kamani L, Mumtaz K, Ahmed U S et al. Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study.  BMC Gastroenterol. 2008;  8 59
• 206 Cho J H, Park K H, Kim S H et al. Bacteremia is a prognostic factor for poor outcome in spontaneous bacterial peritonitis.  Scand J Infect Dis. 2007;  39 697-702
• 207 Alvarez R F, Mattos A A, Correa E B et al. Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis.  Arq Gastroenterol. 2005;  42 256-262
• 208 Singh N, Gayowski T, Yu V L et al. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial.  Ann Intern Med. 1995;  122 595-598
• 209 Novella M, Sola R, Soriano G et al. Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin.  Hepatology. 1997;  25 532-536
• 210 Fernandez J, Navasa M, Planas R et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis.  Gastroenterology. 2007;  133 818-824
• 211 Grange J D, Roulot D, Pelletier G et al. Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial.  J Hepatol. 1998;  29 430-436
• 212 Loomba R, Wesley R, Bain A et al. Role of fluoroquinolones in the primary prophylaxis of spontaneous bacterial peritonitis: meta-analysis.  Clin Gastroenterol Hepatol. 2009;  7 487-493
• 213 Saab S, Hernandez J C, Chi A C et al. Oral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis.  Am J Gastroenterol. 2009;  104 993-1001 ; quiz 1002
• 214 Krag A, Wiest R, Gluud L L. Fluoroquinolones in the primary prophylaxis of spontaneous bacterial peritonitis.  Am J Gastroenterol. 2010;  105 1444 ; author reply 1444 – 1445
• 215 Lo R, Austin A S, Freeman J G. Antibiotic prophylaxis for the primary prevention of spontaneous bacterial peritonitis in cirrhotic patients with low ascitic protein: A meta-analysis.  J Hepatol. 2009;  50 S82
• 216 Ortiz J, Vila M C, Soriano G et al. Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients.  Hepatology. 1999;  29 1064-1069
• 217 Bajaj J S, Ananthakrishnan A N, Hafeezullah M et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: A national and tertiary center perspective.  Am J Gastroenterol. 2010;  105 106-113
• 218 Runyon B A. A pill a day can improve survival in patients with advanced cirrhosis.  Gastroenterology. 2007;  133 1029-1031
• 219 Wade J J, Rolando N, Hayllar K et al. Bacterial and fungal infections after liver transplantation: an analysis of 284 patients.  Hepatology. 1995;  21 1328-1336
• 220 Lontos S, Gow P J, Vaughan R B et al. Norfloxacin and trimethoprim-sulfamethoxazole therapy have similar efficacy in prevention of spontaneous bacterial peritonitis.  J Gastroenterol Hepatol. 2008;  23 252-255
• 221 Terg R, Llano K, Cobas S M et al. Effects of oral ciprofloxacin on aerobic gram-negative fecal flora in patients with cirrhosis: results of short- and long-term administration, with daily and weekly dosages.  J Hepatol. 1998;  29 437-442
• 222 Goulis J, Patch D, Burroughs A K. Bacterial infection in the pathogenesis of variceal bleeding.  Lancet. 1999;  353 139-142
• 223 Bernard B, Cadranel J F, Valla D et al. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study.  Gastroenterology. 1995;  108 1828-1834
• 224 Goulis J, Armonis A, Patch D et al. Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal hemorrhage.  Hepatology. 1998;  27 1207-1212
• 225 Bernard B, Grange J D, Khac E N et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis.  Hepatology. 1999;  29 1655-1661
• 226 Chaves-Tapia N C, Barrientos-Gutierres T, Tellez-Avila F I et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding.  Cochrane Database Syst Rev. 2010 Sep 8;  (9) CD002907
• 227 Franchis de R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension.  J Hepatol. 2005;  43 167-176
• 228 Tuncer I, Topcu N, Durmus A et al. Oral ciprofloxacin versus intravenous cefotaxime and ceftriaxone in the treatment of spontaneous bacterial peritonitis.  Hepatogastroenterology. 2003;  50 1426-1430
• 229 Navasa M, Follo A, Llovet J M et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis.  Gastroenterology. 1996;  111 1011-1017
• 230 Angeli P, Guarda S, Fasolato S et al. Switch therapy with ciprofloxacin vs. intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis: similar efficacy at lower cost.  Aliment Pharmacol Ther. 2006;  23 75-84
• 231 Taskiran B, Colakoglu O, Sozmen B et al. Comparison of cefotaxime and ofloxacin in treatment of spontaneous bacterial peritonitis.  Turk J Gastroenterol. 2004;  15 34-38
• 232 Terg R, Cobas S, Fassio E et al. Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study.  J Hepatol. 2000;  33 564-569
• 233 Park Y H, Lee H C, Song H G et al. Recent increase in antibiotic-resistant microorganisms in patients with spontaneous bacterial peritonitis adversely affects the clinical outcome in Korea.  J Gastroenterol Hepatol. 2003;  18 927-933
• 234 Singh N, Wagener M M, Gayowski T. Changing epidemiology and predictors of mortality in patients with spontaneous bacterial peritonitis at a liver transplant unit.  Clin Microbiol Infect. 2003;  9 531-537
• 235 Kresken M, Hafner D, Schmitz F J et al. PEG-Resistenzstudie: Resistenzsituation bei klinisch wichtigen Infektionserregern gegenüber Antibiotika in Deutschland und im mitteleuropäischen Raum. Paul-Ehrlich-Gesellschaft für Chemotherapie e.V; 2007
• 236 Kresken M, Hafner D, Schmitz F J et al. PEG-Resistenzstudie: Daten zur Resistenzlage bei klinisch wichtigen Bakterienspezies gegenüber Antibiotika in Mitteleuropa. Paul-Ehrlich-Gesellschaft für Chemotherapie e.V; 2010
• 237 Felisart J, Rimola A, Arroyo V et al. Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections.  Hepatology. 1985;  5 457-462
• 238 Rimola A, Salmeron J M, Clemente G et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study.  Hepatology. 1995;  21 674-679
• 239 Rimola A, Navasa M, Arroyo V. Experience with cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis.  Diagn Microbiol Infect Dis. 1995;  22 141-145
• 240 Gomez-Jimenez J, Ribera E, Gasser I et al. Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients.  Antimicrob Agents Chemother. 1993;  37 1587-1592
• 241 Ricart E, Soriano G, Novella M T et al. Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients.  J Hepatol. 2000;  32 596-602
• 242 Acevedo J C, Fernandez J, Castro M et al. Current efficacy of recommended empirical antibiotic therapy in patients with cirrhosis and bacterial infection (Abstract).  J Hepatol. 2009;  50 S5
• 243 Castellote J, Ariza X, Girbau A et al. Risk factors to cefotaxime-resistant spontaneous bacterial peritonitis (Abstract).  J Hepatol. 2010;  52 S69
• 244 Angeloni S, Leboffe C, Parente A et al. Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice.  World J Gastroenterol. 2008;  14 2757-2762
• 245 Yakar T, Guclu M, Serin E et al. A recent evaluation of empirical cephalosporin treatment and antibiotic resistance of changing bacterial profiles in spontaneous bacterial peritonitis.  Dig Dis Sci. 2010;  55 1149-1154
• 246 Castellote J, Ariza X, Girbau A et al. Antibiotic-resistant bacteria in spontaneous bacterial peritonitis. Is it time to change? (Abstract).  J Hepatol. 2010;  52 S69
• 247 Cheong H S, Kang C I, Lee J A et al. Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis.  Clin Infect Dis. 2009;  48 1230-1236
• 248 Dupeyron C, Mangeney N, Sedrati L et al. Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis.  Antimicrob Agents Chemother. 1994;  38 340-344
• 249 Dupeyron C, Campillo S B, Mangeney N et al. Carriage of Staphylococcus aureus and of gram-negative bacilli resistant to third-generation cephalosporins in cirrhotic patients: a prospective assessment of hospital-acquired infections.  Infect Control Hosp Epidemiol. 2001;  22 427-432
• 250 Campillo B, Dupeyron C, Richardet J P et al. Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: effect of long-term administration of norfloxacin.  Clin Infect Dis. 1998;  26 1066-1070
• 251 Campillo B, Dupeyron C, Richardet J P. Epidemiology of hospital-acquired infections in cirrhotic patients: effect of carriage of methicillin-resistant Staphylococcus aureus and influence of previous antibiotic therapy and norfloxacin prophylaxis.  Epidemiol Infect. 2001;  127 443-450
• 252 Song K H, Jeon J H, Park W B et al. Clinical outcomes of spontaneous bacterial peritonitis due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species: a retrospective matched case-control study.  BMC Infect Dis. 2009;  9 41
• 253 Umgelter A, Reindl W, Miedaner M et al. Failure of current antibiotic first-line regimens and mortality in hospitalized patients with spontaneous bacterial peritonitis.  Infection. 2009;  37 2-8
• 254 Chavez-Tapia N C, Soares-Weiser K, Brezis M et al. Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients.  Cochrane Database Syst Rev. 2009;  CD002232
• 255 Chen T A, Lo G H, Lai K H et al. Single daily amikacin versus cefotaxime in the short-course treatment of spontaneous bacterial peritonitis in cirrhotics.  World J Gastroenterol. 2005;  11 6823-6827
• 256 Rastegar L A, Umrani G, Dehbashi N et al. Evaluation of the therapeutic effect of pefloxacin in comparison with ampicillin and gentamicin in cirrhotic patients with spontaneous bacterial peritonitis.  Hepatogastroenterology. 1998;  45 783-785
• 257 Antillon M R, Runyon B A. Effect of marked peripheral leukocytosis on the leukocyte count in ascites.  Arch Intern Med. 1991;  151 509-510
• 258 Ljubicic N, Spajic D, Vrkljan M M et al. The value of ascitic fluid polymorphonuclear cell count determination during therapy of spontaneous bacterial peritonitis in patients with liver cirrhosis.  Hepatogastroenterology. 2000;  47 1360-1363
• 259 Runyon B A, Hoefs J C. Spontaneous vs secondary bacterial peritonitis. Differentiation by response of ascitic fluid neutrophil count to antimicrobial therapy.  Arch Intern Med. 1986;  146 1563-1565
• 260 Fong T L, Akriviadis E A, Runyon B A et al. Polymorphonuclear cell count response and duration of antibiotic therapy in spontaneous bacterial peritonitis.  Hepatology. 1989;  9 423-426
• 261 Runyon B A, McHutchison J G, Antillon M R et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients.  Gastroenterology. 1991;  100 1737-1742
• 262 Bauer T M, Follo A, Navasa M et al. Daily norfloxacin is more effective than weekly rufloxacin in prevention of spontaneous bacterial peritonitis recurrence.  Dig Dis Sci. 2002;  47 1356-1361
• 263 Arroyo V, Gines P, Gerbes A L et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club.  Hepatology. 1996;  23 164-176
• 264 Salerno F, Gerbes A, Gines P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis.  Gut. 2007;  56 1310-1318
• 265 Solanki P, Chawla A, Garg R et al. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial.  J Gastroenterol Hepatol. 2003;  18 152-156
• 266 Sanyal A J, Boyer T, Garcia-Tsao G et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome.  Gastroenterology. 2008;  134 1360-1368
• 267 Martin-Llahi M, Pepin M N, Guevara M et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study.  Gastroenterology. 2008;  134 1352-1359
• 268 Neri S, Pulvirenti D, Malaguarnera M et al. Terlipressin and albumin in patients with cirrhosis and type I hepatorenal syndrome.  Dig Dis Sci. 2008;  53 830-835
• 269 Ortega R, Gines P, Uriz J et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study.  Hepatology. 2002;  36 941-948
• 270 Saner F, Kavuk I, Lang H et al. Terlipressin and gelafundin: safe therapy of hepatorenal syndrome.  Eur J Med Res. 2004;  9 78-82
• 271 Dart A B, Mutter T C, Ruth C A et al. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function.  Cochrane Database Syst Rev. 2010;  CD007594
• 272 Fabrizi F, Dixit V, Messa P et al. Terlipressin for hepatorenal syndrome: A meta-analysis of randomized trials.  Int J Artif Organs. 2009;  32 133-140
• 273 Gluud L L, Christensen K, Christensen E et al. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome.  Hepatology. 2010;  51 576-584
• 274 Sagi S V, Mittal S, Kasturi K S et al. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta-analysis of randomized controlled trials.  J Gastroenterol Hepatol. 2010;  25 880-885
• 275 Gerbes A L, Huber E, Gulberg V. Terlipressin for hepatorenal syndrome: continuous infusion as an alternative to i. v. bolus administration.  Gastroenterology. 2009;  137 1179 ; author reply 1179 – 1181
• 276 Hadengue A, Gadano A, Moreau R et al. Beneficial effects of the 2-day administration of terlipressin in patients with cirrhosis and hepatorenal syndrome.  J Hepatol. 1998;  29 565-570
• 277 Gerbes A L, Gulberg V, Waggershauser T et al. Renal effects of transjugular intrahepatic portosystemic shunt in cirrhosis: comparison of patients with ascites, with refractory ascites, or without ascites.  Hepatology. 1998;  28 683-688
• 278 Guevara M, Gines P, Bandi J C et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems.  Hepatology. 1998;  28 416-422
• 279 Brensing K A, Textor J, Perz J et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study.  Gut. 2000;  47 288-295
• 280 Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome.  Hepatology. 2004;  40 55-64
• 281 Testino G, Ferro C, Sumberaz A et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation.  Hepatogastroenterology. 2003;  50 1753-1755
• 282 Witzke O, Baumann M, Patschan D et al. Which patients benefit from hemodialysis therapy in hepatorenal syndrome?.  J Gastroenterol Hepatol. 2004;  19 1369-1373
• 283 Mitzner S R, Stange J, Klammt S et al. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial.  Liver Transpl. 2000;  6 277-286
• 284 Wong F, Raina N, Richardson R. Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment.  Gut. 2010;  59 381-386
• 285 Bannares R, Nevens F, Larsen F S et al. Extracorporeal liver support with the molecular adsorbent recirculating system (MARS) in patients with acute-on-chronic liver failure (AOCLF). The RELIEF trail (Abstract).  J Hepatol. 2010;  52 S459-S460
• 286 Rifai K, Ernst T, Kretschmer U et al. Prometheus – a new extracorporeal system for the treatment of liver failure.  J Hepatol. 2003;  39 984-990
• 287 Rifai K, Kribben A, Gerken G et al. Extracorporeal liver support by fractionated plasma separation and adsorption (Prometheus) in patients with acute-on-chronic liver failure (HELIOS study): A prospective randomized controlled multicenter study (Abstract).  J Hepatol. 2010;  52 S3
• 288 Gonwa T A, Poplawski S, Paulsen W et al. Pathogenesis and outcome of hepatorenal syndrome in patients undergoing orthotopic liver transplant.  Transplantation. 1989;  47 395-397
• 289 Seu P, Wilkinson A H, Shaked A et al. The hepatorenal syndrome in liver transplant recipients.  Am Surg. 1991;  57 806-809
• 290 Lafayette R A, Pare G, Schmid C H et al. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation.  Clin Nephrol. 1997;  48 159-164
• 291 Restuccia T, Ortega R, Guevara M et al. Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case-control study.  J Hepatol. 2004;  40 140-146
• 292 Bundesärztekammer . Richtlinien zur Organtransplantation gem. § 16 Abs.1 S.1 Nrn. 2, 4 u. 5 TPG.  Dtsch Ärztebl. 2010;  107 A1532-1541
• 293 Davis C L, Feng S, Sung R et al. Simultaneous liver-kidney transplantation: evaluation to decision making.  Am J Transplant. 2007;  7 1702-1709
• 294 Lieberman F L, Hidemura R, Peters R L et al. Pathogenesis and treatment of hydrothorax complicating cirrhosis with ascites.  Ann Intern Med. 1966;  64 341-351
• 295 Malagari K, Nikita A, Alexopoulou E et al. Cirrhosis-related intrathoracic disease. Imaging features in 1038 patients.  Hepatogastroenterology. 2005;  52 558-562
• 296 Kinasewitz G T, Keddissi J I. Hepatic hydrothorax.  Curr Opin Pulm Med. 2003;  9 261-265
• 297 Kiafar C, Gilani N. Hepatic hydrothorax: current concepts of pathophysiology and treatment options.  Ann Hepatol. 2008;  7 313-320
• 298 Halank M, Strassburg C P, Hoeper M M. Pulmonary complications of liver cirrhosis: hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax.  Internist. 2010;  51 (Suppl 1) 255-263
• 299 Cardenas A, Arroyo V. Management of ascites and hepatic hydrothorax.  Best Pract Res Clin Gastroenterol. 2007;  21 55-75
• 300 Cardenas A, Kelleher T, Chopra S. Review article: hepatic hydrothorax.  Aliment Pharmacol Ther. 2004;  20 271-279
• 301 Huang P M, Chang Y L, Yang C Y et al. The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding.  J Thorac Cardiovasc Surg. 2005;  130 141-145
• 302 Rubinstein D, McInnes I E, Dudley F J. Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management.  Gastroenterology. 1985;  88 188-191
• 303 Xiol X, Castellote J, Cortes-Beut R et al. Usefulness and complications of thoracentesis in cirrhotic patients.  Am J Med. 2001;  111 67-69
• 304 Reissig A, Heyne J P, Kroegel C. Ancillary lung parenchymal findings at spiral CT scanning in pulmonary embolism. Relationship to chest sonography.  Eur J Radiol. 2004;  49 250-257
• 305 Kocijancic I, Vidmar K, Ivanovi-Herceg Z. Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions.  J Clin Ultrasound. 2003;  31 69-74
• 306 Kohan J M, Poe R H, Israel R H et al. Value of chest ultrasonography versus decubitus roentgenography for thoracentesis.  Am Rev Respir Dis. 1986;  133 1124-1126
• 307 Light R W. Clinical practice. Pleural effusion.  N Engl J Med. 2002;  346 1971-1977
• 308 Castellote J, Xiol X, Cortes-Beut R et al. Complications of thoracentesis in cirrhotic patients with pleural effusion.  Rev Esp Enferm Dig. 2001;  93 566-575
• 309 Jones P W, Moyers J P, Rogers J T et al. Ultrasound-guided thoracentesis: is it a safer method?.  Chest. 2003;  123 418-423
• 310 Gordon C E, Feller-Kopman D, Balk E M et al. Pneumothorax following thoracentesis: a systematic review and meta-analysis.  Arch Intern Med. 2010;  170 332-339
• 311 Romero S, Candela A, Martin C et al. Evaluation of different criteria for the separation of pleural transudates from exudates.  Chest. 1993;  104 399-404
• 312 Burgess L J, Maritz F J, Taljaard J J. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates.  Chest. 1995;  107 1604-1609
• 313 Light R W, Macgregor M I, Luchsinger P C et al. Pleural effusions: the diagnostic separation of transudates and exudates.  Ann Intern Med. 1972;  77 507-513
• 314 Mittal B R, Maini A, Das B K. Peritoneopleural communication associated with cirrhotic ascites: scintigraphic demonstration.  Abdom Imaging. 1996;  21 69-70
• 315 Bhattacharya A, Mittal B R, Biswas T et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax.  J Gastroenterol Hepatol. 2001;  16 317-321
• 316 Ajmi S, Hassine H, Guezguez M et al. Isotopic exploration of hepatic hydrothorax: ten cases.  Gastroenterol Clin Biol. 2004;  28 462-466
• 317 Huang P M, Han Y Y, Kuo S W et al. Color Doppler ultrasonography in detecting transdiaphragmatic flow of hepatic hydrothorax: correlation with thoracoscopic findings.  J Thorac Cardiovasc Surg. 2009;  138 1251-1252
• 318 Tamano M, Hashimoto T, Kojima K et al. Diagnosis of hepatic hydrothorax using contrast-enhanced ultrasonography with intraperitoneal injection of Sonazoid.  J Gastroenterol Hepatol. 2010;  25 383-386
• 319 Takayama T, Kurokawa Y, Kaiwa Y et al. A new technique of thoracoscopic pleurodesis for refractory hepatic hydrothorax.  Surg Endosc. 2004;  18 140-143
• 320 Lin D J, Zhang M, Gao G X et al. Thoracoscopy for diagnosis and management of refractory hepatic hydrothorax.  Chin Med J. 2006;  119 430-434
• 321 Xiol X, Castellvi J M, Guardiola J et al. Spontaneous bacterial empyema in cirrhotic patients: a prospective study.  Hepatology. 1996;  23 719-723
• 322 D"Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.  J Hepatol. 2006;  44 217-231
• 323 Kaplan L M, Epstein S K, Schwartz S L et al. Clinical, echocardiographic, and hemodynamic evidence of cardiac tamponade caused by large pleural effusions.  Am J Respir Crit Care Med. 1995;  151 904-908
• 324 Angueira C E, Kadakia S C. Effects of large-volume paracentesis on pulmonary function in patients with tense cirrhotic ascites.  Hepatology. 1994;  20 825-828
• 325 Heller B J, Grathwohl M K. Contralateral reexpansion pulmonary edema.  South Med J. 2000;  93 828-831
• 326 Feller-Kopman D, Berkowitz D, Boiselle P et al. Large-volume thoracentesis and the risk of reexpansion pulmonary edema.  Ann Thorac Surg. 2007;  84 1656-1661
• 327 Liu L U, Haddadin H A, Bodian C A et al. Outcome analysis of cirrhotic patients undergoing chest tube placement.  Chest. 2004;  126 142-148
• 328 Colombato L. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension.  J Clin Gastroenterol. 2007;  41 (Suppl 3) S344-S351
• 329 Strauss R M, Martin L G, Kaufman S L et al. Transjugular intrahepatic portal systemic shunt for the management of symptomatic cirrhotic hydrothorax.  Am J Gastroenterol. 1994;  89 1520-1522
• 330 Chalasani N, Gitlin N. TIPS for patients with refractory hepatic hydrothorax: what is the take-home message?.  Am J Gastroenterol. 1997;  92 2129-2130
• 331 Gordon F D, Anastopoulos H T, Crenshaw W et al. The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt.  Hepatology. 1997;  25 1366-1369
• 332 Degawa M, Hamasaki K, Yano K et al. Refractory hepatic hydrothorax treated with transjugular intrahepatic portosystemic shunt.  J Gastroenterol. 1999;  34 128-131
• 333 Conklin L D, Estrera A L, Weiner M A et al. Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax.  Ann Thorac Surg. 2000;  69 609-611
• 334 Siegerstetter V, Deibert P, Ochs A et al. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients.  Eur J Gastroenterol Hepatol. 2001;  13 529-534
• 335 Spencer E B, Cohen D T, Darcy M D. Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax.  J Vasc Interv Radiol. 2002;  13 385-390
• 336 Wilputte J Y, Goffette P, Zech F et al. The outcome after transjugular intrahepatic portosystemic shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction: a long-term study in 28 patients.  Acta Gastroenterol Belg. 2007;  70 6-10
• 337 Dhanasekaran R, West J K, Gonzales P C et al. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis.  Am J Gastroenterol. 2010;  105 635-641
• 338 Ikard R W, Sawyers J L. Persistent hepatic hydrothorax after peritoneojugular shunt.  Arch Surg. 1980;  115 1125-1127
• 339 Ghandour E, Carter J, Feola M et al. Management of hepatic hydrothorax with a peritoneovenous (Denver) shunt.  South Med J. 1990;  83 718-719
• 340 Falchuk K R, Jacoby I, Colucci W S et al. Tetracycline-induced pleural symphysis for recurrent hydrothorax complicating cirrhosis. A new approach to treatment.  Gastroenterology. 1977;  72 319-321
• 341 Milanez Campos J R, Filho L O, Campos Werebe de E et al. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax.  Chest. 2000;  118 13-17
• 342 Ferrante D, Arguedas de M R, Cerfolio R J et al. Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax.  Am J Gastroenterol. 2002;  97 3172-3175
• 343 Cerfolio R J, Bryant A S. Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax.  Ann Thorac Surg. 2006;  82 457-459
• 344 Huang P M, Kuo S W, Lee J M. Thoracoscopic diaphragmatic repair for refractory hepatic hydrothorax: application of pleural flap and mesh onlay reinforcement.  Thorac Cardiovasc Surg. 2006;  54 47-50
• 345 Xiol X, Tremosa G, Castellote J et al. Liver transplantation in patients with hepatic hydrothorax.  Transpl Int. 2005;  18 672-675
• 346 Serste T, Moreno C, Francoz C et al. The impact of preoperative hepatic hydrothorax on the outcome of adult liver transplantation.  Eur J Gastroenterol Hepatol. 2010;  22 207-212
• 347 Sese E, Xiol X, Castellote J et al. Low complement levels and opsonic activity in hepatic hydrothorax: its relationship with spontaneous bacterial empyema.  J Clin Gastroenterol. 2003;  36 75-77
• 348 Ackerman Z, Reynolds T B. Evaluation of pleural fluid in patients with cirrhosis.  J Clin Gastroenterol. 1997;  25 619-622
• 349 Xiol X, Castellote J, Baliellas C et al. Spontaneous bacterial empyema in cirrhotic patients: analysis of eleven cases.  Hepatology. 1990;  11 365-370
• 350 Castellote J, Lopez C, Gornals J et al. Use of reagent strips for the rapid diagnosis of spontaneous bacterial empyema.  J Clin Gastroenterol. 2005;  39 278-281
• 351 Hoffken G, Lorenz J, Kern W et al. Epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults. Guidelines of the Paul-Ehrlich-Society for Chemotherapy, the German Respiratory Society, the German Society for Infectiology and the Competence Network CAPNETZ Germany.  Pneumologie. 2009;  63 e1-68
• 352 Maskell N A, Davies C W, Nunn A J et al. U.K. Controlled trial of intrapleural streptokinase for pleural infection.  N Engl J Med. 2005;  352 865-874