[Treatment of ascites by ultrafiltration and reinjection of the proteins].

Report on 14 cases of ascites resistant to conservative treatment such as saltless diet, diuretics including spironolactone, and bedrest. 12 cases were due to alcoholic cirrhosis and a further 2 had malignant tumors (1 hepatoma, 1 adenocarcinoma of the pancreas). 14 patients underwent dialysis in which, after puncture of the ascites, the proteins are concentrated by filtration and then reinjected into the circulation. 16 dialyses were performed and all were well tolerated except in one alcoholic woman in very poor general condition who died from acute pulmonary edema. No significant clinical complications or technical problems were encountered. The dialysis-reinjection time lasted 3-28 h and the bodyweights diminished by 2.4-17 kg. Plasma volume, renal output and urinary concentration of electrolytes (Na) increased during dialysis. In 6 cases these effects persisted with spironolactone and low salt diet only, probably because of better renal perfusion and re-established sensitivity to the diuretic treatment. One year follow up revealed 4 cases out of 13 without relapse. Rapid emptying of the peritoneal cavity permitted two laparoscopies, which revealed the tumoral origin of the ascites in two cases, and one laparotomy for porto-caval shunt in bleeding esophageal varices at the earliest possible juncture. This method of treating cirrhotic ascites is simple and well tolerated. It considerably shortens the hospitalization and may rapidly improve general conditions of life in these chronic patients.