The effect of thermal baths on oedema of the lower limbs might be explained by physical mechanisms of hydrostatic pressure resulting from the use of a deep bath and a centripetal underwater jet, by which the veins and lymph ducts are drained every day. The purpose of this experiment is to demonstrate the existence of hormonal mechanisms which would account for the diuretic effect of thermal baths. One of the effects observed with hydrotherapy is the physiological diuresis that follows each bath, this diuresis would appear to depend at least in part on the atrial natriuretic factor (ANF). The criteria by which assessment can be made essentially biological: ANF level and its biological effects on blood and urine; aldosterone level; plasma renin activity (PRA); creatinine clearance; hematocrit; proteinemia; and blood and urine electrolyte balance. The inclusion criteria are: subjects selected at random and willing cooperate. The criteria for exclusion are disease states which modify ANF kinesis: congestive heart failure, cardiac rhythm disorders, decompensated cirrhosis of liver, obesity, treatment antihypertensive drugs. METHODS: Thirty patients were put through the same experimental sequence, as follows: emptying of the bladder and ingestion of 200 cc of water; seated rest fort 30 mn, after which (to): blood sample; urine sample; ingestion of 200 cc of water; deep bath for 20 mn, i.e. the basic hydro treatment in phlebology at Barbotan. The deep bath is specific to Barbotan and the patient is subjected to maximum immersion in water at a mesothermal temperature of 34.5 degrees C, followed by (t1): blood and urine sample; ingestion of 200 cc of water; supine rest for 90 mn, followed by (t2): blood and urine sample. RESULTS: Data from twenty-eight patients were usable. In this protocol, we use variance analysis with repeated measurements and a 95% confidence limit. The mean value of the principal parameters studies are set out in the following table; these value are accompanied by the degree of significance of the modification at (t1) and (t2). Our experimentation with thirty patients showed that the big thermal bath at Barbotan produces a highly significant increase in ANF secretion, resulting in the diuresis observed after the use of the bath. The antagonist effect of AFN on the renin--angiotensin-aldosterone system was corroborated: we found decreased aldosterone, PRA and creatinine clearance, and increased diuresis and natriuresis. The renal and cardiovascular effects observed after extended immersion in the Barbotan bath (increased diuresis, tachycardia and hypotension, transitory venous vasoplegia and ephemeral vasodilatation of the surface capillaries) are the result of increased ANF secretion. [formula: see text] Supine rest immediately after the bath is essential. This sustains the enhanced ANF and thus reinforces its renal effects, while reducing adverse cardiovascular effects such as the orthostatic hypotension and venous vasoplegia that are normally observed after use of the bath. Moreover, by reducing venular and lymphatic pressure, clinostatism facilitate interstitial to intravascular tissue fluid exchanges and thus helps to drain oedema from the legs. It is striking to note that the hydrotherapy prescribed at Barbotan les Thermes has always included the three most potent factors for ANF release: deep immersion in the big bath, immediate supine rest, and walking. Physiological diuresis has thus been induced empirically as an essential part of the treatment of lower limb phlebopathies.

A total of 480 day-old broiler chicks were divided randomly into 4 equal groups, each of 4 replicates, and reared for two weeks. To their rations, which contained sodium chloride at 2.5% ascorbic acid was added at the rate of 0, 150, 300 and 450 mg/kg for groups 1, 2, 3 and 4 respectively. Incidences of ascites cases were 20.8, 10.8, 7.5 and 7.5% for the groups 1, 2, 3 and 4 respectively. When vitamin C was added to their rations body weights were increased significantly, but feed consumption remained unchanged. There were no significant differences in water consumption or body moisture. The total serum protein was significantly increased. The packed cell volume was only increased in the chicks that had received 450 mg vitamin C/kg of feed and there were no significant differences in the ascorbic acid content of the plasma. It was concluded that the addition of vitamin C to the chicks' rations reduces the incidence of ascites caused by toxic dietary levels of sodium chloride.

Decreased effective circulating blood volume is an important factor in ascites formation in liver cirrhosis. We designed a "body compression" apparatus as a means to restore effective blood volume and investigated its effectiveness in reducing ascites formation in cirrhotics in terms of its effect on parameters of ascites formation noted below. The subjects, eight cirrhotics with ascites and eight cirrhotics without ascites were given spironolactone (50-75 mg/day) and furosemide (40-80 mg/day) while they received a diet containing 85 mEq of sodium per day. All four limbs and the lower abdomen were compressed with constant pressure [height (cm) divided by 13.6 mmHg] once, for 3h, using stroke rehabilitation splints, while patients lay supine. In cirrhotics both with and without ascites, urine volume, urinary sodium excretion, and creatinine clearance during the body compression were greater than values during control (non-compression) periods (urine volume, means 285 vs 169 ml/3h; P<0.001, urinary sodium excretion 15.8 vs 9.5 mEq/3h; p<0.001, creatinine clearance 74 vs 59 ml/min, P<0.001, respectively). The increased basal plasma renin activity, angiotensin II, aldosterone, and norepinephrine levels in all cirrhotics were significantly decreased by the body compression. In another group of six cirrhotics who received no diuretics or albumin, repeat body compression alleviated ascites in three with well preserved renal function, but was ineffective in three with markedly impaired renal function. These results suggest that the improvement in renal function brought about by the body compression is attributable to an increase in effective circulating blood volume. This maneuver may be a useful complementary therapy in patients with cirrhotic ascites with well preserved renal function.

BACKGROUND: Head-out water immersion has been proposed as an adjuvant treatment in refractory ascites and hepatorenal syndrome. We undertook this study to present the results of management of patients with refractory ascites. METHODS: We included 10 patients with diagnosis of hepatic cirrhosis and refractory ascites. Variables were measured in four stages: stage I (basal); II (at the end of water immersion); III (72 h after water immersion); IV (1 week after water immersion concludes). Clinical and laboratory variables were measured and included general exams and renal function tests. Friedman test was used for statistics to establish differences between variables at the end of stage IV. We considered statistical significance when p<0.05. RESULTS: Median age was 53.8 years, corresponding to seven men and three women with a Child's classification of B or C. Statistically significant variables were weight (p=0.02) and abdominal circumference (p=0.003), as a result of an increased urine output (p=0.03) and glomerular filtration rate (p<0.002). Renal plasma rate increased until stage III, returning to basal level in stage IV. Serum potassium levels decreased but the difference was marginal (p=0.052). During follow-up, two patients died as a consequence of liver insufficiency. CONCLUSIONS: Head-out water immersion showed a decrease in weight and abdominal circumference, which means reduction of ascites. There was a transitory improvement in renal function. No collateral events were reported. Water immersion could be proposed as an adjuvant treatment in patients with refractory ascites and liver cirrhosis.