... Get Tested? To help diagnose the cause of peritonitis, an inflammation of the membrane lining the abdomen, ... fever and your healthcare practitioner suspects you have peritonitis or ascites Sample Required? A peritoneal fluid sample ...
Culture - peritoneal fluid ... sent to the laboratory for Gram stain and culture. The sample is checked to see if bacteria ... The peritoneal fluid culture may be negative, even if you have ... diagnosis of peritonitis is based on other factors, in addition ...
Zweers, M. M.; Splint, L. J.; Krediet, R. T.; Struijk, D. G.
OBJECTIVE: Hemoconcentration may influence peritoneal permeability parameters in anesthetized animals without fluid supplementation. Therefore, the aim of this study was to investigate the effects of fluid supplementation on peritoneal permeability in an acute peritoneal dialysis model in
The aim of the study was to determine if direct inoculation of peritoneal fluid into Bactec blood culture bottles would improve the positive bacteriological yield compared with conventional techniques in continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis. All patients presenting with suspected peritonitis ...
Full Text Available Peritoneal dialysis (PD is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes.
Ramanathan, Kumaresan; Padmanabhan, Giri; Vijayaraghavan, Bhooma
Severe peritonitis causing death is one of the most devastating complications of peritoneal dialysis (PD). Since the predictive value of C-reactive protein (CRP) in PD fluid has not been assessed, the objective of the present study is to evaluate its predictive value and clinical correlation in patients on PD with peritonitis. One hundred and twenty patients on continuous ambulatory PD (CAPD) were enrolled and their serum and fluid CRP (Fl. CRP) were evaluated at the start of CAPD. All patients who developed peritonitis were further evaluated for serum and fluid CRP. The patients were categorized into four groups, namely: normal patients (control group), patients with peritonitis, patients with peritonitis leading to catheter removal, and death due to peritonitis. Sixty-five patients developed peritonitis of whom, catheter removal was performed in eight patients. Five patients died due to peritonitis-related complications. Fl. CRP showed a significant difference among the three groups, unlike S. CRP. Estimation of CRP in the peritoneal fluid may be a useful marker to monitor the onset of peritonitis.
Optimization of peritoneal dialysis schedule and dialysis fluid composition needs, among others, methods for quantitative assessment of fluid and solute transport. Furthermore, an integrative quantitative description of physiological processes within the tissue, which contribute to the net transfer of fluid and solutes, is necessary for interpretation of the data and for predictions of the outcome of possible intervention into the peritoneal transport system. The current pro...
Full Text Available During peritoneal dialysis (PD, the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87 years; median time on PD 19 (3–100 months underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS, fraction of ultrasmall pores (αu, osmotic conductance for glucose (OCG, and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters. Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.
Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia
During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane. PMID:26989432
Full Text Available Background: Despite a high prevalence of endometriosis, there still exist many challenges indiagnosing the disease. This study aims to evaluate non-invasive and practical diagnostic methodsby measuring serum and peritoneal fluid CA 125 levels in patients with endometriosis. A secondaryaim is to determine the correlation between these markers with the stage of disease as well as therelationship of the two markers with each other.Materials and Methods: This is a cross-sectional study of 60 women who underwent laparoscopyfor benign conditions. Based on laparoscopic findings and biopsy results, patients were divided to twogroups; one group included patients with pelvic endometriosis (35 patients and the second enrolledpatients free from endometriosis (25 patients. Serum and peritoneal fluid specimens were provided at thetime of laparoscopy and CA125 levels were then assessed by electrochemiluminescence immunoassay.Results: Mean serum and peritoneal fluid CA125 levels were significantly higher in women withendometriosis as compared to the control group (26.42 ± 24.34 IU/ml versus 12.64 ± 6.87 IU/mlin serum and 2203.54 + 993.19 IU/ml versus 1583.42 ± 912.51 IU/ml in peritoneal fluid, p<0.05.CA 125 levels also varied proportionally with the stage of endometriosis; but showed a significantdifference only in higher stages of the disease, both in serum and peritoneal fluid. We calculatedthe cut-off value suggesting a diagnosis of pelvic endometriosis as 14.70 IU/ml for serum and1286.5 IU/ml for peritoneal fluid CA125. A linear correlation between CA 125 levels in serum andperitoneal fluid in patients with pelvic endometriosis has also been observed.Conclusion: Serum and peritoneal fluid CA 125 levels are simple and non-surgical tools fordiagnosing and staging pelvic endometriosis. These markers are of greater diagnostic value inhigher stages of the disease.
Polak, Grzegorz; Wertel, Iwona; Tarkowski, Rafał; Kotarski, Jan
Endometriosis is characterized by a cyclic hemorrhage within the peritoneal cavity. Accumulating data suggests that iron homeostasis in the peritoneal cavity may be disrupted by endometriosis. The aim of our study was to evaluate iron levels in peritoneal fluid (PF) of women with and without endometriosis. Seventy-five women were studied: 50 women with endometriosis and, as a reference group, 25 patients with functional follicle ovarian cysts. Iron concentrations in the PF were measured using a commercially available colorimetric assay kit. Iron concentrations were significantly higher in PF from women with endometriosis as compared to the reference group. Patients with stages III/IV endometriosis had significantly higher PF iron concentrations than women with stages I/II of the disease. Disrupted iron homeostasis in the peritoneal cavity of women with endometriosis plays a role in the pathogenesis of the disease.
Agrawal, Karan; Ebel, Joseph G; Bischoff, Karyn
Most antidoping method development in the equine industry has been for plasma and urine, though there has been recent interest in the analysis of synovial fluid for evidence of doping by intra-articular corticosteroid injection. Published methods for corticosteroid analysis in synovial fluid are primarily singleplex methods, do not screen for all corticosteroids of interest and are not adequately sensitive. The purpose of this study is to develop a rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) screening method for the detection of four of the most common intra-articularly administered corticosteroids--betamethasone, methylprednisolone, methylprednisolone acetate and triamcinolone acetonide. Sample preparation consisted of protein precipitation followed by a basified liquid-liquid extraction. LC-MS-MS experiments consisted of a six-min isocratic separation using a Phenomenex Polar-RP stationary phase and a mobile phase consisting of 35% acetonitrile, 5 mM ammonium acetate and 0.1% formic acid in nanopure water. The detection system used was a triple quadrupole mass analyzer with thermospray ionization, and compounds were identified using selective reaction monitoring. The method was validated to the ISO/IEC 17025 standard, and real synovial fluid samples were analyzed to demonstrate the application of the method in an antidoping context. The method was highly selective for the four corticosteroids with limits of detection of 1-3 ng/mL. The extraction efficiency was 50-101%, and the matrix effects were 14-31%. These results indicate that the method is a rapid and sensitive screen for the four corticosteroids in equine synovial fluid, fit for purpose for equine antidoping assays.
Reddingius, R. E.; Schröder, C. H.; Willems, J. L.; Lelivelt, M.; Kohler, B. E.; Krediet, R. T.; Monnens, L. A.
Fluid kinetics were studied in children treated with continuous ambulatory peritoneal dialysis (CAPD) aged between 2 and 15 years. Dextran 70 was used as a volume marker. A 4-h dwell was studied with a dwell volume of 40 mg/kg. Transcapillary ultrafiltration was measured as well as marker clearance,
Full Text Available Background: Endoglin is a specific angiogenic factor suspected to involve in the pathogenesis of endometriosis. The aim of this study was to evaluate the significance of endoglin concentration in the peritoneal fluid of patients with endometriosis.Methods: This pilot study was performed between March 2011 and July 2012 at Dr. Wahidin Sudirohusodo Hospital and another private hospital in Makassar, Indonesia. This was an observational, cross-sectional study. All patients undergoing laparoscopy for infertility and other cases with suitable inclusion criteria were asked to answer a questionnaire and had a 5 cc peritoneal fluid sample taken for measurement of peritoneal endoglin concentration using ELISA. Endometriosis stage was classified using ASRM criteria and divided into two groups, mild and severe. All data were analyed using Excel and Spearman correlation analysis.Results: In the endometriosis group peritoneal endoglin concentration ranged between 14.43- 15.65 ng/mL (median 15.04 ng/mL which is higher than control group 7.42-10.26 ng/mL (median 8.84 ng/mL. A peritoneal endoglin concentration equal to or higher than 11 ng/mL could be used to predict endometriosis.Conclusion: Endoglin concentrations increased proportionally with the severity of endometriosis, and many be used as predictive factor of endometriosis cases. (Med J Indones. 2013;22:88-91Keywords: Endoglin, endometriosis, peritoneum
Hipp, Heather; Loucks, Tammy L; Nezhat, Ceana; Sidell, Neil; Session, Donna R
Anti-Müllerian hormone (AMH) has potential local effects on ovarian function and endometrial tissue, including endometriosis, but its presence in peritoneal fluid is not fully understood. This is a cross-sectional study evaluating AMH in peritoneal fluid and plasma from women with endometriosis (N = 61) and from control women without endometriosis (N = 36). There was a significant correlation between AMH in plasma and peritoneal fluid from both patients with endometriosis (r(2) = .767 [P peritoneal fluid in women with and without endometriosis. There were no differences in the plasma or peritoneal fluid AMH in women with endometriosis versus control women. The strong relationship between plasma and peritoneal fluid may allow plasma AMH to be a marker for peritoneal AMH in studies evaluating the local effects of AMH. © The Author(s) 2015.
Bianchessi, Marta; Chen, Yuwen; Durgam, Sushmitha; Pondenis, Holly; Stewart, Matthew
Mesenchymal stem cells have been identified in the synovial fluid of several species. This study was conducted to characterize chondroprogenitor (CP) cells in equine synovial fluid (SF) and to determine the effect of fibroblast growth factor 2 (FGF-2) on SF-CP monolayer proliferation and subsequent chondrogenesis. We hypothesized that FGF-2 would stimulate SF-CP proliferation and postexpansion chondrogenesis. SF aspirates were collected from adult equine joints. Colony-forming unit (CFU) assa...
Cebra, Christopher K; Tornquist, Susan J; Reed, Shannon K
To describe a technique for abdominocentesis in camelids and report peritoneal fluid biochemical and cytologic findings from healthy llamas and alpacas. Prospective study. Animals-17 adult llamas and 5 adult alpacas. Right paracostal abdominocentesis was performed. Peritoneal fluid was collected by gravity flow into tubes containing potassium-EDTA for cell count and cytologic evaluation and lithium heparin for biochemical analysis. Blood samples were collected via jugular venipuncture into heparinized tubes at the same time. Cytologic components were quantified. Fluid pH and concentrations of total carbon dioxide, sodium, potassium, chloride, lactate, and glucose were compared between peritoneal fluid and venous blood. All but 3 camelids had peritoneal fluid cell counts of or = 2.5 g/dL. Peritoneal fluid of camelids generally contained slightly less glucose, lactate, and sodium and roughly equal concentrations of potassium and chloride as venous blood. Peritoneal fluid was collected safely from healthy camelids. Compared with blood, peritoneal fluid usually had a low cell count and protein concentration, but some individuals had higher values. Electrolyte concentrations resembled those found in blood. High cell counts and protein concentrations found in peritoneal fluid of some healthy camelids may overlap with values found in diseased camelids, complicating interpretation of peritoneal fluid values.
Sajjad, M.; Khan, Z.A.; Khan, M.S.
Objective: To determine the frequency and compare the culture yield of bacterial isolation by conventional and blood culture BACTEC bottle techniques in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Study Design: Cross-sectional comparative study. Place and Duration of Study: Pathology Department, Bannu Medical College, Bannu, KPK, from January 2012 to December 2013. Methodology: Paracentesis of 20 ml of ascitic fluid tapped from cirrhotic patients with SBP was carried out by a single technologist. The analysis included differential leukocyte count (DLC), while 5 ml each of the fluid was inoculated into conventional culture media and BACTEC blood culture bottle. All the data were analysed on (SPSS) version 16 to determine frequencies with percentages and mean values with standard deviation. Chi-square test was used for comparing the yield of conventional and blood culture bottle methods. P-value was considered significant if < 0.05. Results: In 105 cases of ascitic fluid analyses, 27 (25.72 percent) had positive ascitic fluid culture whereas 78 (74.28 percent) had negative ascitic fluid culture. Ascitic fluid culture was positive in 6 cases by conventional culture media and in 27 cases by BACTEC culture bottle media (p < 0.001). Bacterial isolation was obtained by both culture methods in 6 cases (p < 0.001). Conclusion: Direct bedside inoculation of ascitic fluid by BACTEC culture bottle method has better yield as compared to conventional culture method. (author)
... complication of colonoscopy or endoscopy. A ruptured appendix, stomach ulcer or perforated colon. Any of these conditions can ... risk of developing peritonitis: cirrhosis, appendicitis, Crohn's disease, stomach ulcers, diverticulitis and pancreatitis. History of peritonitis. Once you' ...
Pihl, Tina Holberg; Andersen, Pia Haubro; Kjelgaard-Hansen, Mads
BACKGROUND: Peritoneal fluid (PF) analysis is a valuable diagnostic tool in equine medicine. Markers such as serum amyloid A (SAA) and haptoglobin (Hp) could facilitate the diagnosis of inflammatory abdominal conditions. OBJECTIVES: The objectives were to (1) establish reference intervals (RI......) for SAA and Hp in serum and PF in healthy horses, (2) compare SAA and Hp concentrations between healthy horses and horses with colic, and (3) to assess the correlation between serum and PF concentrations. METHODS: Serum amyloid A and Hp concentrations were determined by automated assays in prospectively...... enrolled healthy reference horses and horses with colic. RIs were calculated, group concentrations were compared by Student's t-test, and Pearson's correlation for serum and PF concentrations were determined. RESULTS: In healthy horses (n = 62) the measurements for SAA were below the detection limit (0...
Mild derangements of acid-base status are common features in peritoneal dialysis patients, metabolic acidosis being the most frequent alteration. One of the main tasks of dialysis is to correct these derangements and the target is the normalization of the acid-base parameters since they affect several organs and functions. Since factors affecting acid-base homeostasis are intrinsic characteristics of the individual patient (metabolic acid production, distribution space for bicarbonate, dialytic prescription, etc.), it is not surprising that only relatively few patients achieve the normal range. Only a certain modulation of buffer infusion by using different buffer concentrations in the dialysis fluid may ensure a good correction in a large percentage of patients.
Full Text Available The benefits of long-term peritoneal dialysis (PD in patients with end-stage renal failure are short-lived due to structural and functional changes in the peritoneal membrane. In this report, we provide evidence for the in vitro and in vivo participation of the renin-angiotensin-aldosterone system (RAAS in the signaling pathway leading to peritoneal fibrosis during PD. Exposure to high-glucose PD fluids (PDFs increases damage and fibrosis markers in both isolated rat peritoneal mesothelial cells and in the peritoneum of rats after chronic dialysis. In both cases, the addition of the RAAS inhibitor aliskiren markedly improved damage and fibrosis markers, and prevented functional modifications in the peritoneal transport, as measured by the peritoneal equilibrium test. These data suggest that inhibition of the RAAS may be a novel way to improve the efficacy of PD by preventing inflammation and fibrosis following peritoneal exposure to high-glucose PDFs.
Full Text Available The peritoneal fluid from six female health donkeys was evaluated. In each animal, it was carried out eight abdominocentesis with 40x12 needles, at 72-hour intervals. All animals presented clinical changes, and there was higher frequency of yellow-tinged fluid with turbidity aspect. Means, and respective standard deviations, for cytology and protein concentration were: erythrocytes, 24.7±11.7x10³/mm³; leukocytes, 15.8±6.79x10³/mm³; mesothelial cells, 3.85±1.30x10³/mm³; neutrophils, 10.9±4.51x10³/mm³; lymphocytes, 1.41±0.51x10³/mm³; macrophages, 0.98±0.55x10³/mm³; eosinophils, 2.48±1.36x10³/mm³, and total proteins, 1.97±0.31 g/dl.
Full Text Available The article describes the peritoneal calcification in peritoneal carcinomatosis, as well as its possible role in the development of carcinomatosis within the frames of the authors’ alternative theory. The analysis of the "serous-lymph hatches" condition of the intact peritoneum and peritoneum in carcinomatosis was carried out. Also the elemental quantitative calcium determination in the intact peritoneum and the peritoneum in peritoneal carcinomatosis was carried out using the atomic emission spectrometry.
Dziuk, E.; Siekierzynski, M.; Jedrzejczak, W.
The peritoneal dialysis has become more and more popular in treating some diseases of the kidneys. In the standard technique, the dialization fluid is fed intermittently through a single catheter introduced into the peritoneal cavity. The efficiency of the procedure can be increased by using a continuous fluid flow. In 17 rabbits a continuous mode of peritoneal dialyses was employed by using two catheters introduced by a single injection. The studies were made on two groups of animals using a different distance between the catheter ends. The dialization fluid contained 131 I labelled albumin. By determining the amount of the isotope in the outflowing fluid the degree of the fluid intermixing in the peritoneal cavity was evaluated. An open one-compartamental model was found to be useful in the estimation of the dynamics of the fluid flow during the continuous peritoneal dialysis. When the distance between both catheter ends was larger the fluid was better intermixed in the peritoneal cavity. This made it possible to obtain a high gradient of the concentrations of various substances between the blood and the dialization fluid. (author)
van Westrhenen, Roos; Zweers, Machteld M.; Kunne, Cindy; de Waart, Dirk R.; van der Wal, Allard C.; Krediet, Raymond T.
BACKGROUND: Conventional lactate-buffered peritoneal dialysis (PD) fluids containing glucose and glucose degradation products are believed to contribute to the development of fibrosis and angiogenesis in the dialyzed peritoneum. To reduce potential negative effects of lactate, pyruvate was
Full Text Available Early detection of free air in the peritoneal cavity is vital in diagnosis of life-threatening emergencies, and can play a significant role in expediting treatment. We present a series of cases in which bedside ultrasound (US in the emergency department accurately identified evidence of free intra-peritoneal air and echogenic (dirty free fluid consistent with a surgical final diagnosis of a perforated hollow viscus. In all patients with suspected perforated viscus, clinicians were able to accurately identify the signs of pneumoperitoneum including enhanced peritoneal stripe sign (EPSS, peritoneal stripe reverberations, and focal air collections associated with dirty shadowing or distal multiple reflections as ring down artifacts. In all cases, hollow viscus perforation was confirmed surgically. It seems that, performing US in patients with suspected perforated viscus can accurately identify presence of intra-peritoneal echogenic or “dirty” free fluid as well as evidence of free air, and may expedite patient management.
Vivian Ferreira do Amaral
Full Text Available CONTEXT AND OBJECTIVE: One of the diagnostic markers of endometriosis is CA-125, and elevated levels of this are caused by high concentrations in the ectopic endometrium. The objective of this study was to correlate CA-125 levels in serum and peritoneal fluid from women with and without pelvic endometriosis. DESIGN AND SETTING: This was a prospective, cross-sectional, controlled study of consecutive pa-tients undergoing laparoscopy for infertility, pelvic pain or tubal ligation, during early follicular phase, at the university hospital of Faculdade de Medicina de Ribeirão Preto. METHODS: Fifty-two patients were divided into two groups: endometriosis group, consisting of 35 patients with biopsy-confirmed pelvic endometriosis, and control group, consisting of 17 patients without endometriosis. CA-125 levels in serum samples and peritoneal fluid were determined by chemiluminescence. RESULTS: CA-125 levels in serum and peritoneal fluid were higher in patients with advanced pelvic endometriosis (means of 39.1 ± 45.8 U/ml versus 10.5 ± 5.9 U/ml in serum, p < 0.005; 1,469.4 ± 1,350.4 U/ml versus 888.7 ± 784.3 U/ml in peritoneal fluid, p < 0.05, and showed a positive correlation between each other (correlation coefficient (r = 0.4880. Women with more advanced degrees of endometriosis showed higher CA-125 levels in both serum and peritoneal fluid (p = 0.0001. CONCLUSION: There is a positive correlation between serum and peritoneal fluid values of CA-125 in women with and without endometriosis, and their levels are higher in peritoneal fluid. Advanced endometriosis is related to higher levels in both serum and peritoneal fluid.
Wu, Hong-Ming; Tzeng, Chii-Ruey; Chen, Chi-Hung; Chen, Pi-Hua
This study investigated the occurrence of peritoneal fluid in women undergoing intrauterine insemination (IUI) and its correlation with the stage of pelvic endometriosis and its influence on pregnancy outcomes. A retrospective case-control design was used to recruit 272 infertile women with pelvic endometriosis. The treatment protocol consisted of controlled ovarian hyperstimulation with downregulation and gonadotropin for IUI treatment following ultrasound and laparoscopic intervention. The amount and color of the peritoneal fluid were determined during laparoscopy. The mean amount of peritoneal fluid with pelvic endometriosis that was detected using transvaginal ultrasound was ~ 15.1 mL. Women whose cycles contained more peritoneal fluid had significantly lower pregnancy rates (17.2% and 31.3%, respectively). The total clinical pregnancy rate was not significantly different between the two groups with reddish and yellowish peritoneal fluid who had pelvic endometriosis. Pelvic endometriosis and peritoneal fluid, detected through vaginal ultrasound, have negative effects on the pregnancy outcome of IUI treatment. Copyright © 2013. Published by Elsevier B.V.
Polak, Grzegorz; Wertel, Iwona; Barczyński, Bartłomiej; Kwaśniewski, Wojciech; Bednarek, Wiesława; Kotarski, Jan
To evaluate 8-hydroxy-2-deoxyguanosine (8-OHdG) and 8-isoprostane levels in the peritoneal fluid (PF) of women with endometriosis. One hundred and ten women with laparoscopically and histopathologically confirmed endometriosis and, as reference groups, 119 patients with simple serous (n=78) and dermoid (n=41) ovarian cysts were studied. Peritoneal fluid 8-OHdG and 8-isoprostane concentrations were evaluated by enzyme-linked immunosorbent assays. 8-OHdG and 8-isoprostane levels in peritoneal fluid were significantly higher in patients with endometriosis compared with the reference groups. Higher PF 8-OHdG and 8-isoprostane concentrations were observed in patients with advanced stages of endometriosis. A statistically significant positive correlation was found between 8-OHdG and 8-isoprostane levels in peritoneal fluid. Endometriosis induces greater oxidative stress and frequent DNA mutations in peritoneal fluid than nonendometriotic ovarian cysts. The most severe oxidative stress occurs in the peritoneal cavity of women with more advanced stages of the disease. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Lee, In Kyu; Kim, Do Hyoung; Gorden, D Lee; Lee, Yoon Suk; Sung, Na Young; Park, Gyeoung-Sin; Kim, Hyung Jin; Kang, Won Kyung; Park, Jong Kyung; Ahn, Chang Hyeok; Kim, Jun-Gi; Jeon, Hae Myung; Oh, Seong Taek
Early diagnosis and management of peritoneal metastases from colorectal cancer patients are difficult clinical challenges. The aims of this study were to evaluate the clinical significance of tumor markers and cytology in peritoneal effusions (PE) and peritoneal irrigation fluid (PI) and to determine their value as prognostic indicators in this disease. Two hundred thirty-four consecutive patients who underwent abdominal surgery for colorectal cancer from January 2006 to December 2007 were included, and tumor markers and cytology in PE and PI were analyzed prospectively. The incidence of free cancer cells retrieved from peritoneal samples was 7.9%. Cytology was positive in 40.0% by Papanicolaou and Giemsa staining, 73.3% by hematoxylin and eosin staining of cell blocks, and 66.7% by carcinoembryonic antigen (CEA) and calretinin immunohistochemistry. Multivariate analysis revealed that peritoneal CEA and cancer antigen (CA) 19-9 in PI were correlated with peritoneal metastasis and cytology. Level of peritoneal fluid CEA was statistically significantly correlated with recurrence and peritoneal metastatic recurrence in patients with negative peritoneal cytology. Cytology, peritoneal CEA, and peritoneal CA 19-9 showed correlations with cancer-free survival and overall survival. These correlations demonstrate the importance of continuous follow-up of peritoneal metastasis if there is positive cytology or an increase in CEA and CA 19-9 in peritoneal fluid.
Noh, Seung Moo
The accurate pH range of peritoneal fluid is clinically valuable for the evaluation of some pathological conditions of the body, however, it is not easy to measure in healthy individuals. The aim of this study was to measure; pH, pCO2, pO2, Na+, K++, Ca++, HCO3-, and O2 saturation of the peritoneal fluid in patients with non-serosal invasive gastric cancer. One hundred and thirty four patients (86 men and 48 women), ranging in age from 24 to 91 years were enrolled in this study. After opening the abdominal wall, the probe of a portable pH meter was placed in the peritoneal fluid in the subhepatic space. In addition, I collected the peritoneal fluid from the subhepatic space to measure, pH, pCO2, pO2, Na+, K++, Ca++, HCO3-, and O2 saturation using an autoanalyzer. The pHs of the peritoneal fluids tested has a mean of 7.73 (range 7.46 - 8.10), and the other parameters were pCO2, 22.81 mmHg; pO2, 136.49 mmHg; Na+, 146.57 mmol/L; K++, 4.80 mmol/L; Ca++, 0.89 mmol/L; HCO3-, 30.54 mmol/L, and O2 saturation, 99.74%. This study describes a practical method of measuring the pH of peritoneal fluid. The result obtained reflects the normal adult peritoneal pH value, which I propose as a reference value.
Liu, Haiping; Wang, Jianye; Wang, Haiyu; Tang, Ning; Li, Yunfei; Zhang, Yan; Hao, Tianyu
Enzyme matrix metalloproteinase-9 is a member of the matrix metalloproteinase family, which is critical to normal tissue remodelling during embryogenesis and wound healing. In patients with endometriosis, increased expression and activity of matrix metalloproteinase-9 have been observed in ectopic endometrium, but the plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 in patients with endometriosis and their relation to disease severity have not been clear. The aim of the study was to investigate the concentrations of matrix metalloproteinase-9 in plasma and peritoneal fluid of patients with endometriosis. A prospective case-control study was conducted in Jinan Military General Hospital between January 2010 and December 2013. Fifty patients with proven endometriosis and 26 endometriosis-free controls were enrolled in this study. Patients with endometriosis were evaluated and divided into moderate/severe endometriosis group (stage I-II, n = 26) and minimal/mild endometriosis group (stage III-IV, n = 24) according to the revised criteria of the American Society for Reproductive Medicine. Blood samples and peritoneal fluid were obtained from both patients and controls. Matrix metalloproteinase-9 was measured using enzyme-linked immunosorbent assay in plasma and peritoneal fluid. The concentration of matrix metalloproteinase-9 between different groups was compared and its correlation to disease severity was analysed. Plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 in patients with endometriosis were higher than that in controls. In addition, those patients with moderate/severe endometriosis had significantly higher plasma and peritoneal fluid concentrations of matrix metalloproteinase-9 compared to those with minimal/mild endometriosis. Matrix metalloproteinase-9 concentrations in plasma and peritoneal fluid were both positively correlated with severity of endometriosis and plasma matrix metalloproteinase-9
Polak, Grzegorz; Mazurek, Diana; Rogala, Ewelina; Nowicka, Aldona; Derewianka-Polak, Magdalena; Kotarski, Jan
Proinflammatory and prooxidative environment in the peritoneal cavity may be involved in the pathogenesis of endometriosis. Imbalance between reactive oxygen species levels and the antioxidant capacity leads to oxidation of low-density lipoproteins (LDL). The importance of oxidized LDL (Ox-LDL) in the development of atherosclerosis is well recognized. The aim of our study was to evaluate for the presence of ox-LDL in the peritoneal fluid (PF) of women with and without endometriosis. A total of 60 women who underwent laparoscopy were divided into groups: endometriosis sufferers with minimal to mild (n 20) and moderate to severe (n 20) stages, and the reference group (n 20) with functional follicle ovarian cysts. Oxidized LDL levels were determined in the PF using enzyme immunoassay Oxidized LDL levels were detectable in all peritoneal fluid samples. Significantly increased levels of ox-LDL were observed in PF of women with stage III/IV endometriosis compared to the reference group (p = 0.03). However peritoneal fluid ox-LDL concentrations did not differ significantly between patients with minimal/mild and women with moderate/severe stage of the disease (p = 0.2). No significant difference in the PF ox-LDL concentrations was also found between women with stage I/II endometriosis and patients with follicle cysts (p = 0.3). Increased peritoneal fluid ox-LDL levels observed in women with advanced-stage endometriosis suggest the important role of oxidative stress in the pathogenesis of the disease.
Gogacz, Marek; Gałczyński, Krzysztof; Romanek-Piva, Katarzyna; Winkler, Izabela; Rechberger, Tomasz; Adamiak-Godlewska, Aneta
Endometriosis is a sex hormone-dependent and successively progressing gynecological disease, characterized by the presence of endometrial tissue outside the uterus. The etiology of endometriosis is known to be multifactorial, and its growth depends on immunological, hormonal, genetic and environmental factors. Angiogenesis plays a key role in implantation and growth of endometriotic lesions, as well as in adhesion formation. Physiologically angiogenesis is responsible for neoangiogenesis and recruitment of new capillaries from the already existing capillaries. It is well-documented that altered angiogenesis provokes improper follicular maturation, infertility recurrent miscarriages, ovarian hyperstimulation syndrome, and carcinogenesis. Factors stimulating angionesis include angiogenin, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). The aim of the study was to analyze angiogenic factor concentration (angiogenin, VEGF, FGF) in blood serum and peritoneal fluid in patients with diagnosed endometriosis and idiopathic infertility. A total of 39 patients were recruited for the study including 19 patients (study group) diagnosed with endometriosis during the laparoscopic procedure and 20 patients (control group) with idiopathic infertility and no morphologic changes within the pelvis revealed during the laparoscopic procedure. All patients underwent laparoscopy during the follicular phase of the menstrual cycle. Vein blood sample was obtained before the procedure and during laparoscopy the entire peritoneal fluid was aspirated for further measurement of VEGF, FGF and angiogenin concentrations. Angiogenin concentration in peritoneal fluid was statistically higher in patient with idiopathic infertility in comparison to endometriosis (pendometriosis, but no statistical significance was found. VEGF and FGF concentration in blood serum and peritoneal fluid was similar in both groups (p>0.05). There were no significant differences between serum
Zappella, N; Desmard, M; Chochillon, C; Ribeiro-Parenti, L; Houze, S; Marmuse, J-P; Montravers, P
Postoperative peritonitis (POP) is a common surgical complication after bariatric surgery (BS). We assessed the importance of positive fungal cultures in these cases of POP admitted to the intensive care unit. Clinical features and outcome were compared in 25 (41%) Candida-positive patients (6 (22%) fluconazole-resistant Candida glabrata) and 36 patients without Candida infection. Candida infections were more commonly isolated in late-onset peritonitis and were often associated with multidrug-resistant bacteria. Risk factors for intensive care unit mortality (19.6%) were diabetes and superobesity. Candida infections, including fluconazole-resistant strains, are common in POP after BS. These data encourage the empirical use of a broad-spectrum antifungal agent. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Full Text Available Ultrafiltration decline is a progressive issue for patients on chronic peritoneal dialysis (PD and can be caused by peritoneal angiogenesis induced by PD fluids. A recent pediatric trial suggests better preservation of ultrafiltration with bicarbonate versus lactate buffered fluid; underlying molecular mechanisms are unknown.Angiogenic cytokine profile, tube formation capacity and Receptor Tyrosine Kinase translocation were assessed in primary human umbilical vein endothelial cells following incubation with bicarbonate (BPDF and lactate buffered (LPDF, pH neutral PD fluid with low glucose degradation product content and lactate buffered, acidic PD fluid with high glucose degradation product content (CPDF. Peritoneal biopsies from age-, PD-vintage- and dialytic glucose exposure matched, peritonitis-free children on chronic PD underwent automated histomorphometry and immunohistochemistry.In endothelial cells angiopoietin-1 mRNA and protein abundance increased 200% upon incubation with BPDF, but decreased by 70% with LPDF as compared to medium control; angiopoietin-2 remained unchanged. Angiopoietin-1/Angiopoietin-2 protein ratio was 15 and 3-fold increased with BPDF compared to LPDF and medium. Time-lapse microscopy with automated network analysis demonstrated less endothelial cell tube formation with BPDF compared to LPDF and CPDF incubation. Receptor Tyrosine Kinase translocated to the cell membrane in BPDF but not in LPDF or CPDF incubated endothelial cells. In children dialyzed with BPDF peritoneal vessels were larger and angiopoietin-1 abundance in CD31 positive endothelium higher compared to children treated with LPDF.Bicarbonate buffered PD fluid promotes vessel maturation via upregulation of angiopoietin-1 in vitro and in children on dialysis. Our findings suggest a molecular mechanism for the observed superior preservation of ultrafiltration capacity with bicarbonate buffered PD fluid with low glucose degradation product content.
Rab, S.T.; Alazraki, N.P.; Guertler-Krawczynska, E.
On SPECT thallium images, myocardial left ventricular (LV) anterior wall attenuation due to breast tissue is common in women. In contrast, in men, inferior wall counts are normally decreased compared to anterior counts. The purpose of this report is to describe cases of inferior wall attenuation of counts in women caused by peritoneal fluid, not myocardial disease. Twelve consecutive SPECT thallium myocardial studies performed in women on peritoneal dialysis, being evaluated for kidney transplant, were included in this study. For all studies, 3.5 mCi 201Tl were injected intravenously. Thirty-two images were acquired over 180 degrees (45 degrees RAO progressing to 45 degrees LPO) at 40 sec per stop. SPECT images were reviewed in short axis, horizontal long and vertical long axes. Data were also displayed in bullseye format with quantitative comparison to gender-matched normal files. Ten of 12 female patients studied had inferior wall defects on images, confirmed by bullseye display. All patients had approximately 2 liters of peritoneal fluid. Review of planar rotational views showed diaphragm elevation and fluid margin attenuations affecting left ventricular inferior wall. Thus, peritoneal fluid is a cause of inferior attenuation on 201Tl cardiac imaging
Sobiecka, Danuta; Waniewski, Jacek; Weryński, Andrzej; Lindholm, Bengt
Continuous ambulatory peritoneal dialysis (CAPD) patients with high peritoneal solute transport rate often have inadequate peritoneal fluid transport. It is not known whether this inadequate fluid transport is due solely to a too rapid fall of osmotic pressure, or if the decreased effectiveness of fluid transport is also a contributing factor. To analyze fluid transport parameters and the effectiveness of dialysis fluid osmotic pressure in the induction of fluid flow in CAPD patients with different small solute transport rates. 44 CAPD patients were placed in low (n = 6), low-average (n = 13), high-average (n = 19), and high (n = 6) transport groups according to a modified peritoneal equilibration test (PET). The study involved a 6-hour peritoneal dialysis dwell with 2 L 3.86% glucose dialysis fluid for each patient. Radioisotopically labeled serum albumin was added as a volume marker.The fluid transport parameters (osmotic conductance and fluid absorption rate) were estimated using three mathematical models of fluid transport: (1) Pyle model (model P), which describes ultrafiltration rate as an exponential function of time; (2) model OS, which is based on the linear relationship of ultrafiltration rate and overall osmolality gradient between dialysis fluid and blood; and (3) model G, which is based on the linear relationship between ultrafiltration rate and glucose concentration gradient between dialysis fluid and blood. Diffusive mass transport coefficients (K(BD)) for glucose, urea, creatinine, potassium, and sodium were estimated using the modified Babb-Randerson-Farrell model. The high transport group had significantly lower dialysate volume and glucose and osmolality gradients between dialysate and blood, but significantly higher K(BD) for small solutes compared with the other transport groups. Osmotic conductance, fluid absorption rate, and initial ultrafiltration rate did not differ among the transport groups for model OS and model P. Model G yielded
Full Text Available Peritonitis and ultrafiltration failure remain serious complications of chronic peritoneal dialysis (PD. Dysfunctional cellular stress responses aggravate peritoneal injury associated with PD fluid exposure, potentially due to peritoneal glutamine depletion. In this randomized cross-over phase I/II trial we investigated cytoprotective effects of alanyl-glutamine (AlaGln addition to glucose-based PDF.In a prospective randomized cross-over design, 20 stable PD outpatients underwent paired peritoneal equilibration tests 4 weeks apart, using conventional acidic, single chamber 3.86% glucose PD fluid, with and without 8 mM supplemental AlaGln. Heat-shock protein 72 expression was assessed in peritoneal effluent cells as surrogate parameter of cellular stress responses, complemented by metabolomics and functional immunocompetence assays.AlaGln restored peritoneal glutamine levels and increased the primary outcome heat-shock protein expression (effect 1.51-fold, CI 1.07-2.14; p = 0.022, without changes in peritoneal ultrafiltration, small solute transport, or biomarkers reflecting cell mass and inflammation. Further effects were glutamine-like metabolomic changes and increased ex-vivo LPS-stimulated cytokine release from healthy donor peripheral blood monocytes. In patients with a history of peritonitis (5 of 20, AlaGln supplementation decreased dialysate interleukin-8 levels. Supplemented PD fluid also attenuated inflammation and enhanced stimulated cytokine release in a mouse model of PD-associated peritonitis.We conclude that AlaGln-supplemented, glucose-based PD fluid can restore peritoneal cellular stress responses with attenuation of sterile inflammation, and may improve peritoneal host-defense in the setting of PD.
Santulli, Pietro; Chouzenoux, Sandrine; Fiorese, Mauro; Marcellin, Louis; Lemarechal, Herve; Millischer, Anne-Elodie; Batteux, Frédéric; Borderie, Didier; Chapron, Charles
Are protein oxidative stress markers [thiols, advanced oxidation protein products (AOPP), protein carbonyls and nitrates/nitrites] in perioperative peritoneal fluid higher in women with histologically proven endometriosis when compared with endometriosis-free controls? Protein oxidative stress markers are significantly increased in peritoneal fluids from women with deep infiltrating endometriosis with intestinal involvement when compared with endometriosis-free controls. Endometriosis is a common gynaecologic condition characterized by an important inflammatory process. Various source of evidence support the role of oxidative stress in the development of endometriosis. We conducted a prospective laboratory study in a tertiary-care university hospital between January 2011 and December 2012, and included 235 non-pregnant women, younger than 42 year old, undergoing surgery for a benign gynaecological condition. After complete surgical exploration of the abdomino-pelvic cavity, 150 women with histologically proven endometriosis and 85 endometriosis-free controls women were enrolled. Women with endometriosis were staged according to a surgical classification in three different phenotypes of endometriosis: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) and deeply infiltrating endometriosis (DIE). Perioperative peritoneal fluids samples were obtained from all study participants. Thiols, AOPP, protein carbonyls and nitrates/nitrites were assayed in all peritoneal samples. Concentrations of peritoneal AOPP were significantly higher in endometriosis patients than in the control group (median, 128.9 µmol/l; range, 0.3-1180.1 versus median, 77.8 µmol/l; range, 0.8-616.1; P peritoneal nitrates/nitrites were higher in endometriosis patients than in the control group (median, 24.8 µmol/l; range, 1.6-681.6 versus median, 18.5 µmol/l; range, 1.6-184.5; P peritoneal fluids protein AOPP and nitrates/nitrites were significantly increased only in DIE samples
Rakhila, Halima; Al-Akoum, Mahera; Bergeron, Marie-Eve; Leboeuf, Mathieu; Lemyre, Madeleine; Akoum, Ali; Pouliot, Marc
Studies have long sought specific cytokines that could characterize endometriosis. Either due to variations between study designs regarding the assessment criteria for the cytokine or to low power resulting from small sample size, no factor proved to be sufficiently specific to endometriosis. In other clinical fields, a combination of several markers proved to be more powerful than a single-molecule approach. As well, in the context of endometriosis, simultaneous assessment of several cytokines present in the peritoneal fluid might help in unveiling patho-physiological processes, thus contributing to a better understanding of the condition. Therefore, the objective of this study was to investigate peritoneal fluid cytokines-derived of endometriotic women. For this retrospective case-control study, peritoneal fluid samples were obtained at laparoscopy and assessed by multiplex. Our data showed distinct patterns of peritoneal fluid cytokine concentrations in endometriotic women most notably a marked increase in EGF, FGF-2, IL-1α, MIP-1β, TGFα, PDGF-AA, PDGF-BB, MCP-3, sCD40L, Gro Pan, IL-17α, MDC and Rantes. The overall effect of fertility status revealed a significant difference for only one cytokine, namely MDC. Furthermore, FLT-3L and IP-10 levels were decreased in endometriosis patients, the former in both menstrual cycle phases and the latter in the secretory phase. A significant inverse Pearson correlation (pendometriosis patients at stages III-IV and in the secretory phase. These changes may exacerbate the local peritoneal angiogenic and proliferative reaction observed in women with endometriosis, and contributes to its pathophysiology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Background: Evaluation of contrast-induced changes in the peritoneal area may reveal the effects of their permeation followed by gastrointestinal perforation. This study aims to compare the radiographic changes and hematological and biochemical parameters of peritoneal fluid and blood after intraperitoneal injection of barium sulfate and gastrografin to the rabbit.Materials and Methods: In this clinical trial, 15 healthy male rabbits were randomly divided into 3 groups. Respectively to each group 10 ml/kg barium sulfate 30%, 10 ml/kg gastrografin, and 10 ml/kg saline was intraperitoneally injected. Before injection and 24 hours after injection, blood samples and peritoneal fluid were collected to measure glucose, total protein, WBC count and pH. Lateral and dorsal-ventral radiography was provided 20 min and 24 hours after contrast injection.Results: After injection of barium sulfate, serum glucose decreased, cell count and blood neutrophil percentage increased, glucose and the percentage of peritoneal fluid lymphocytes decreased (p<0.05. The amount of total protein, cell count and peritoneal fluid neutrophil percentage increased (p<0.05. Gastrografin injection only increased peritoneal fluid total protein (p=0.04. Other blood factors and peritoneal fluid showed no significant changes. In radiographies, barium sulfate remained in abdominal area and rapid absorption of gastrografin was observed.Conclusion: The use of gastrografin has fewer side effects than barium sulfate and is recommended in patients suspected with gastrointestinal perforation.
Full Text Available Mesenchymal stem cells have been identified in the synovial fluid of several species. This study was conducted to characterize chondroprogenitor (CP cells in equine synovial fluid (SF and to determine the effect of fibroblast growth factor 2 (FGF-2 on SF-CP monolayer proliferation and subsequent chondrogenesis. We hypothesized that FGF-2 would stimulate SF-CP proliferation and postexpansion chondrogenesis. SF aspirates were collected from adult equine joints. Colony-forming unit (CFU assays were performed during primary cultures. At first passage, SF-cells were seeded at low density, with or without FGF-2. Following monolayer expansion and serial immunophenotyping, cells were transferred to chondrogenic pellet cultures. Pellets were analyzed for chondrogenic mRNA expression and cartilage matrix secretion. There was a mean of 59.2 CFU/mL of SF. FGF-2 increased the number of population doublings during two monolayer passages and halved the population doubling times. FGF-2 did not alter the immunophenotype of SF-CPs during monolayer expansion, nor did FGF-2 compromise chondrogenesis. Hypertrophic phenotypic markers were not expressed in control or FGF-2 groups. FGF-2 did prevent the development of a “fibroblastic” cell layer around pellet periphery. FGF-2 significantly accelerates in vitro SF-CP expansion, the major hurdle to clinical application of this cell population, without detrimentally affecting subsequent chondrogenic capacity.
Musi, Barbara; Braide, Magnus; Carlsson, Ola; Wieslander, Anders; Albrektsson, Ann; Ketteler, Markus; Westenfeld, Ralf; Floege, Jürgen; Rippe, Bengt
Long-term peritoneal dialysis (PD) leads to structural and functional changes in the peritoneum. The aim of the present study was to investigate the long-term effects of PD fluid components, glucose and glucose degradation products (GDP), and lactate-buffered solution on morphology and transport characteristics in a nonuremic rat model. Rats were subjected to two daily intraperitoneal injections (20 mL/day) during 12 weeks of one of the following: commercial PD fluid (Gambrosol, 4%; Gambro AB, Lund, Sweden), commercial PD fluid with low GDP levels (Gambrosol trio, 4%; Gambro AB), sterile-filtered PD fluid (4%) without GDP, or a glucose-free lactate-buffered PD fluid. Punctured and untreated controls were used. Following exposure, the rats underwent a single 4-hour PD dwell (30 mL, 4% glucose) to determine peritoneal function. Additionally, submesothelial tissue thickness, percentage of high mesothelial cells (perpendicular diameter > 2 microm), vascular density, vascular endothelial growth factor (VEGF), and transforming growth factor (TGF) beta1 mRNA expression were determined. Submesothelial collagen concentration was estimated by van Gieson staining. Submesothelial tissue thickness and vascular density, mediated by VEGF and TGFbeta production, in the diaphragmatic peritoneum increased significantly in rats exposed to any PD fluid. Gambrosol induced a marked increased fibrosis of the hepatic peritoneum. A significant increase in high mesothelial cells was observed in the Gambrosol group only. Net ultrafiltration was reduced in the Gambrosol and in the glucose-free groups compared to untreated controls. Small solute transport was unchanged, but all groups exposed to fluids showed significantly increased lymph flow. Our results show that long-term exposure to different components of PD fluids leads to mesothelial cell damage, submesothelial fibrosis, and neoangiogenesis. Mesothelial cell damage could be connected to the presence of GDP; the other changes were
Bhusal, Prabhat; Rahiri, Jamie Lee; Sua, Bruce; McDonald, Jessica E; Bansal, Mahima; Hanning, Sara; Sharma, Manisha; Chandramouli, Kaushik; Harrison, Jeff; Procter, Georgina; Andrews, Gavin; Jones, David S; Hill, Andrew G; Svirskis, Darren
An understanding of biological fluids at the site of administration is important to predict the fate of drug delivery systems in vivo. Little is known about peritoneal fluid; therefore, we have investigated this biological fluid and compared it to phosphate-buffered saline, a synthetic media commonly used for in vitro evaluation of intraperitoneal drug delivery systems. Human peritoneal fluid samples were analysed for electrolyte, protein and lipid levels. In addition, physicochemical properties were measured alongside rheological parameters. Significant inter-patient variations were observed with regard to pH (p < 0.001), buffer capacity (p < 0.05), osmolality (p < 0.001) and surface tension (p < 0.05). All the investigated physicochemical properties of peritoneal fluid differed from phosphate-buffered saline (p < 0.001). Rheological examination of peritoneal fluid demonstrated non-Newtonian shear thinning behaviour and predominantly exhibited the characteristics of an entangled network. Inter-patient and inter-day variability in the viscosity of peritoneal fluid was observed. The solubility of the local anaesthetic lidocaine in peritoneal fluid was significantly higher (p < 0.05) when compared to phosphate-buffered saline. Interestingly, the dissolution rate of lidocaine was not significantly different between the synthetic and biological media. Importantly, and with relevance to intraperitoneal drug delivery systems, the sustained release of lidocaine from a thermosensitive gel formulation occurred at a significantly faster rate into peritoneal fluid. Collectively, these data demonstrate the variation between commonly used synthetic media and human peritoneal fluid. The differences in drug release rates observed illustrate the need for bio-relevant media, which ultimately would improve in vitro-in vivo correlation.
Polak, Grzegorz; Barczyński, Bartłomiej; Bednarek, Wiesława; Kwaśniewski, Wojciech; Wertell, Iwona; Derewianka-Polak, Magdalena; Makara-Studzińska, Marta; Kotarski, Jan
Most investigators agree that endometriosis is associated with a state of subclinical, non-infectious peritoneal inflammation. The objective of the study was to assess concentrations of two markers of the acute inflammatory phase proteins, haptoglobin and ceruloplasmin, in peritoneal fluid of endometriotic women. 229 women who underwent diagnostic or therapeutic laparoscopy were included in the study Minimal, mild, moderate and severe endometriosis according to ASRM was confirmed in 119 women (study groups), whereas 110 patients suffered from simple serous or dermoid ovarian cysts (reference groups). Haptoglobin and ceruloplasmin concentrations in the peritoneal fluid samples aspirated during laparoscopy were measured using commercially available radial immunodiffusion kits. The concentration of haptoglobin in the peritoneal fluid of women with endometriosis was significantly higher as compared to patients with serous and dermoid ovarian cysts. Significantly higher haptoglobin level was observed in patients with severe and moderate endometriosis as compared to women from both reference groups. No significant difference in the peritoneal fluid ceruloplasmin levels was found between patients with endometriosis and women from reference groups. However, it was noted that ceruloplasmin levels are higher in the subgroup of patients with severe endometriosis as compared to both reference groups and women with mild disease. Our results support the hypothesis that endometriosis is associated with subclinical inflammation within the peritoneal cavity It may be speculated that pro-inflammatory stimuli strong enough to cause an increase in acute inflammatory phase proteins peritoneal fluid concentrations are observed only in the advanced stages of the disease.
Wu, Hong-Ming; Tzeng, Chii-Ruey; Chen, Chi-Hung; Chen, Pi-Hua
Objective: This study investigated the occurrence of peritoneal fluid in women undergoing intrauterine insemination (IUI) and its correlation with the stage of pelvic endometriosis and its influence on pregnancy outcomes. Materials and Methods: A retrospective case–control design was used to recruit 272 infertile women with pelvic endometriosis. The treatment protocol consisted of controlled ovarian hyperstimulation with downregulation and gonadotropin for IUI treatment following ultrasoun...
D. I. Sokolov
Full Text Available Abstract. Endometriosis is a disease accompanied by development of heterotopic endometrial foci at the peritoneum, proliferation of endothelial cells, and inflammatory reaction. Aiming to specify the dynamics of inflammatory process in endometriosis of different severity, as well as significance of chemokines and cytokines in angiogenesis and inflammation, we determined concentrations of RANTES, IL-8, IP-10, MIG, MCP-1 chemokines, as well as IL-4, IL-6 and IL-10 cytokines in peritoneal fluid from patients by endometriosis. Forty women at reproductive age with an endometriosis have been observed. Among them, endometriosis grade I-II was registered in 20 cases, whereas grade III-IV has been confirmed in 20 women. Twenty-two women without evidence of endometriosis referred to diagnostic laparoscopy for pregnancy planning, comprised a control group. Diagnosis of endometriosis was based upon endoscopic findings and results of histological research. Severity grade of endometriosis was estimated according to R-AFS classification. Sampling of peritoneal fluid was carried out when performing surgical laparoscopies. Concentrations of chemokines and cytokines were determined by flow cytometry techniques, using BD Cytometric Bead Array test kits and FACStrack flow cytometer. The amounts of RANTES in peritoneal fluid were higher in grade I-II endometriosis, in comparison with grade III-IV endometriosis and control samples. Concentrations of IP-10, IL-8, МСР-1, MIG, IL-6, and IL-4 were higher than in control group and correlated with severity of the disease. IL-10 was not detectable in peritoneal fluid of the patients with endometriosis. These results suggest a significant role of the mentioned cytokines and chemokines that may promote invasion of endometrial cells, growth of heterotopic endometrioid locuses, development of vascular bed and induction of inflammatory processes, in development and progression of endometriosis.
Zuo Liandong; Zheng Hui; Li Hongyi
To investigate whether the Interleukin-6 (IL-6) concentration in peritoneal fluid of patients with endometriosis (EM) is higher than that of healthy, synthetic quantitative analysis was used to study international literatures on IL-6 in peritoneal fluid of women with EM by means of Meta-analysis. The results showed that IL-6 levels of ELISA in the women with EM were -0.472-3.974 times of standard deviation higher than those in the healthy control group. Regardless of measurement methods, -0.73-3.45 times of standard deviation was higher. Both results could not generally think that the IL-6 in peritoneal fluid of EM patient was higher than that of normal persons. However, when EM was diagnosed at the time of laparoscopy or surgery and staged according to AFS, I-II stage were attributed to EM1, III-IV stage were EM2. It was found by Meta-analysis that the elevated IL-6 levels had a mutual relation with the severity of EM: The levels of EM1 were -4.807-5.608 times of standard deviation higher than those of then healthy, with no significant difference (P>0.05), whereas those of EM2 were 0.54-5.34 times or 1.13-5.46 times of standard deviation higher than those of EM1 or healthy, respectively, both with significant difference. The higher the IL-6 levels of the patients had in peritoneal fluid, the more serious EM were. The dysregulation of IL-6 responses might play a role in the pathophysiology of EM
TEDJA DANUDJA OEPOMO
Full Text Available The aim of this research was to expose the relation between tumor necrosis factor alpha (TNF-α in the peritoneal fluid and in the serum of endometriosis patients. It was conducted at Dr. Muwardi Hospital Surakarta. Twenty patients undergoing laparoscopic operation because of endometriosis indication (Endometriosis Group, 20 women (aged 23 to 40 who undergo interval sterilization by means of laparoscopic technique. During laparoscopic operation, peritoneal fluid is taken to examine TNF-α by ELISA technique. At the same time, the serum is also taken to examine TNF-α by the same technique. The research result indicated that by independent sample t-test, the TNF-α concentration in the Endometriosis Group is quite different from the control group (P=0.00. The simple linear regression test shows a strong positive one-way correlative relation between TNF-α concentration in the peritoneal fluid and TNF-α concentration in the serum in the Endometriosis Group. The research result indicated that the TNF-α concentration in the serum can be used as a reflection of endometriosis. A statistical test is done to find the limit value based on sensitivity and specification.
O'Daly, Brendan J
BACKGROUND: Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. METHODS: We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002-2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. RESULTS: Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan (n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15-7.84). CONCLUSION: The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery.
Maleeva, A.; Milanov, S.; Kekhajova, M.
LH, FSH, estradiol, progesterone and corisol concentrations in periotoneal fluid of 64 women with histologically verified endometriosis were determined by a personally developed radioimmunologic method. A significant raise in estradiol and progesterone concentrations was observed, exceeding the plasma levels 9 times (estradiol) and 15 times (progesterone). Reliable diagnostic criteria for confirming a diagnosis of endometriosis, based on the hormonal link between endometriosis and the ovulatory processes, have for the first time been found
Full Text Available Sixteen adult horses were randomly divided into four equal groups of four animals and each group was injected intraperitoneally with one of the following suspension: Group I, 100×10(7 colony-forming units (CFU of E. coli diluted in 500ml of 0.9% saline; Group II, 100×10(7 CFU of Bacteroides fragilis in 500ml of 0.9% saline; Group III, 100×10(7 CFU of E. coli in combination with 100×10(7 CFU of B. fragilis in 500ml of 0.9% saline; Group IV, 500ml of 0.9% saline. A significant increase in leukocyte number was observed in the peritoneal fluid by four hours after the inoculations in animals of Group I and II, and by eight hours in animals of Group III. The highest cell count observed was 516×10³ leukocytes/mm³. Significant increases in peritoneal fluid fibrinogen (1g/dl and total protein (9.1% concentrations were also observed. Horses inoculated with pure cultures of either E. coli or B. fragilis demonstrated mild and self-limiting peritonitis, while those inoculated with a combination of both bacteria demonstrated laboratory findings of higher intensity and duration.Dezesseis eqüinos adultos foram aleatoriamente divididos em quatro grupos de quatro animais que receberam inoculação intraperitoneal das seguintes suspenções: grupo I, 100×10(7 unidades formadoras de colônias (CFU de E. coli diluídas em 500ml de solução salina a 0,9%; grupo II, 100×10(7 CFU de Bacteroides fragilis em 500ml de solução salina a 0,9%; grupo III, 100×10(7 CFU de E. coli combinados com 100×10(7 CFU de B. fragilis em 500ml de solução salina a 0,9%; grupo IV, 500ml de solução salina a 0,9%. Observou-se aumento significativo do número de leucócitos no líquido peritoneal quatro horas após as inoculações dos animais dos grupos I e II, e oito horas após as inoculações dos animais do grupo III. A contagem mais elevada foi de 516×10³ leucócitos/mm³. Aumentos significativos nas concentrações de fibrinogênio (1g/dl e proteína total (9
Herzog, Rebecca; Kuster, Lilian; Becker, Julia; Gluexam, Tobias; Pils, Dietmar; Spittler, Andreas; Bhasin, Manoj K; Alper, Seth L; Vychytil, Andreas; Aufricht, Christoph; Kratochwill, Klaus
Peritonitis remains a major cause of morbidity and mortality during chronic peritoneal dialysis (PD). Glucose-based PD fluids reduce immunological defenses in the peritoneal cavity. Low concentrations of peritoneal extracellular glutamine during PD may contribute to this immune deficit. For these reasons we have developed a clinical assay to measure the function of the immune-competent cells in PD effluent from PD patients. We then applied this assay to test the impact on peritoneal immune-competence of PD fluid supplementation with alanyl-glutamine (AlaGln) in 6 patients in an open-label, randomized, crossover pilot trial (EudraCT 2012-004004-36), and related the functional results to transcriptome changes in PD effluent cells. Ex-vivo stimulation of PD effluent peritoneal cells increased release of interleukin (IL) 6 and tumor necrosis factor (TNF) α. Both IL-6 and TNF-α were lower at 1 h than at 4 h of the peritoneal equilibration test but the reductions in cytokine release were attenuated in AlaGln-supplemented samples. AlaGln-supplemented samples exhibited priming of IL-6-related pathways and downregulation of TNF-α upstream elements. Results from measurement of cytokine release and transcriptome analysis in this pilot clinical study support the conclusion that suppression of PD effluent cell immune function in human subjects by standard PD fluid is attenuated by AlaGln supplementation.
Kearney, C M; Buckley, C T; Jenner, F; Moissonnier, P; Brama, P A J
Selection of suture material in equine surgery is often based on costs or subjective factors, such as the surgeon's personal experience, rather than objective facts. The amount of objective data available on durability of suture materials with regard to specific equine physiological conditions is limited. To evaluate the effect of various equine physiological and pathological fluids on the rate of degradation of a number of commonly used suture materials. In vitro material testing. Suture materials were exposed in vitro to physiological fluid, followed by biomechanical analysis. Three absorbable suture materials, glycolide/lactide copolymer, polyglactin 910 and polydioxanone were incubated at 37°C for 7, 14 or 28 days in phosphate-buffered saline, equine serum, equine urine and equine peritoneal fluid from an animal with peritonitis. Five strands of each suture material type were tested to failure in a materials testing machine for each time point and each incubation medium. Yield strength, strain and Young's modulus were calculated, analysed and reported. For all suture types, the incubation time had a significant effect on yield strength, percentage elongation and Young's modulus in all culture media (Ptype was also shown significantly to influence changes in each of yield strength, percentage elongation and Young's modulus in all culture media (Ptype of fluid have significant effects on the biomechanical properties of various suture materials. These findings are important for evidence-based selection of suture material in clinical cases. © 2013 EVJ Ltd.
Impact of experimental endogenous gram-negative peritonitis on the pancreas of the rat as evaluated by cationic trypsin-like immunoreactivity in peritoneal fluid and serum and by electron microscopy of pancreatic tissue
Florholmen, J.; Almdahl, S.M.; Myklebust, R.; Burhol, P.G.; Malm, D.; Riepl, R.; Giercksky, K.E.
Endogenous gram-negative peritonitis leading to septic shock was induced in rats by a defined perforation of the coecum. Cationic trypsin-like immunoreactivity (CTLI) was measured in peritoneal fluid and serum by a radioimmunoassay method. 5, 10 and 15 h after the coecal perforation, CTLI in peritoneal fluid was significantly higher than before the coecal perforation and also higher than in the corresponding control rats. Moreover, CTLI in serum was under the same conditions significantly higher 10 and 15 h after the induction of peritonitis. Gel chromatography of peritoneal fluid and serum during peritonitis showed free CTLI and CTLI bound to both alpha-1-antitrypsin and alpha-2-macroglobulin, wheras only free CTLI could be detected in serum from control rats. These findings were accompanied by local ultrastructural changes in the acinar cells as evaluated by electron microscopy. The pathophysiologic implications of the findings are discussed
Müller-Krebs, Sandra; Nissle, Katharina; Tsobaneli, Julia; Zeier, Martin; Kihm, Lars Philipp; Kender, Zoltan; Fleming, Thomas; Nawroth, Peter Paul; Reiser, Jochen; Schwenger, Vedat
In peritoneal dialysis (PD), residual renal function (RRF) fundamentally contributes to improved quality of life and patient survival. High glucose and advanced glycation end-products (AGE) contribute locally to peritoneal and systemically to renal damage. Integrity of podocyte structure and function is of special importance to preserve RRF. Benfotiamine could counteract the glucose and AGE-mediated toxicity by blocking hyperglycemia-associated podocyte damage via the pentose-phosphate pathway. A human differentiated podocyte cell line was incubated with control solution (control), 2.5% glucose solution (glucose), and 2.5% peritoneal dialysis fluid (PDF) for 48 h either ±50 μM benfotiamine. Podocyte damage and potential benefit of benfotiamine were analyzed using immunofluorescence, western blot analysis, and a functional migration assay. For quantitation, a semiquantitative score was used. When incubating podocytes with benfotiamine, glucose, and PDF-mediated damage was reduced, resulting in lower expression of AGE and intact podocin and ZO-1 localization. The reorganization of the actin cytoskeleton was restored in the presence of benfotiamine as functional podocyte motility reached control level. Decreased level of inflammation could be shown as well as reduced podocyte apoptosis. These data suggest that benfotiamine protects podocytes from glucose and PDF-mediated dysfunction and damage, in particular, with regard to cytoskeletal reorganization, motility, inflammation, and podocyte survival.
Full Text Available A patient with alcoholic cirrhosis of the liver, portal hypertension with hepatic encephalopathy and spontaneous bacterial peritonitis (SBP was admitted in an obtunded condition. Attempts at delineating the aetiology of the SBP using conventional cultures as well as automated systems were not successful. The use of non-anionic surfactant agents such as Tween 80-incorporated blood agar and Triton X treatment of the specimens facilitated the growth of Klebsiella pneumoniae from the ascitic fluid, which otherwise would have been concluded to represent culture-negative neutrocytic ascites. Thus, the use of the aforementioned agents could be explored in elucidating the aetiology of body cavity infections when conventional methods fail.
Ushenko, Yuriy A.; Koval, Galina D.; Ushenko, Alexander G.; Dubolazov, Olexander V.; Ushenko, Vladimir A.; Novakovskaia, Olga Yu.
This research presents investigation results of the diagnostic efficiency of an azimuthally stable Mueller-matrix method of analysis of laser autofluorescence of polycrystalline films of dried uterine cavity peritoneal fluid. A model of the generalized optical anisotropy of films of dried peritoneal fluid is proposed in order to define the processes of laser autofluorescence. The influence of complex mechanisms of both phase (linear and circular birefringence) and amplitude (linear and circular dichroism) anisotropies is taken into consideration. The interconnections between the azimuthally stable Mueller-matrix elements characterizing laser autofluorescence and different mechanisms of optical anisotropy are determined. The statistical analysis of coordinate distributions of such Mueller-matrix rotation invariants is proposed. Thereupon the quantitative criteria (statistic moments of the first to the fourth order) of differentiation of polycrystalline films of dried peritoneal fluid, group 1 (healthy donors) and group 2 (uterus endometriosis patients), are determined.
Jørgensen, Hilde; Hill, Abby S; Beste, Michael T; Kumar, Manu P; Chiswick, Evan; Fedorcsak, Peter; Isaacson, Keith B; Lauffenburger, Douglas A; Griffith, Linda G; Qvigstad, Erik
Our aim was to characterize peritoneal cytokine profiles in patients with infertility, with and without endometriosis, to illuminate potential differences in immune profiles that may reflect mechanistic differences between these two patient populations. Cross-sectional study. University hospital and research center. Women undergoing laparoscopy for infertility investigation (n = 107). Peritoneal fluid was collected during surgery. Clinical characteristics were registered preoperatively. We determined the concentration of 48 different cytokines from the peritoneal fluid with multiplex immunoassays. Associations between cytokines and clinical findings were assessed with logistic regression and partial least squares discriminant analyses (PLS-DA). Concentrations of SCGF-β, IL-8, HGF, and MCP-1 were significantly higher, while IL-13 was significantly lower in the endometriosis group compared with the group without endometriosis. Multiple stepwise logistic regression identified a combination of SCGF-β, IL-13, and G-CSF concentrations that predicted the presence of endometriosis with 86% sensitivity and 67% specificity. PLS-DA identified a class of 11 cytokines (SCGF-β, HGF, IL-13, MCP-1, CTACK, MCP-3, M-CSF, LIF, IL-5, IL-9, and IFN-a2) that were more characteristic of endometriosis than nonendometriosis patients. By combining univariate and multivariate analyses, profiles of cytokines more likely to be enriched or depleted in infertility patients with endometriosis compared with those without endometriosis were identified. These findings may inform future analyses of pathophysiological mechanisms of endometriosis in infertile patients, including dysregulated Th1/Th2 response and mobilization and proliferation of hematopoietic stem cells. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Aminiahidashti, Hamed; Hosseininejad, Seyed Mohammad; Montazer, Hosein; Bozorgi, Farzad; Goli Khatir, Iraj; Jahanian, Fateme; Raee, Behnaz
Spontaneous bacterial peritonitis (SBP) as a monomicrobial infection of ascites fluid is one of the most important causes of morbidity and mortality in cirrhotic patients. This study was aimed to determine the diagnostic accuracy of ascites fluid color in detection of SBP in cirrhotic cases referred to the emergency department. Cirrhotic patients referred to the ED for the paracentesis of ascites fluid were enrolled. For all studied patients, the results of laboratory analysis and gross appearance of ascites fluid registered and reviewed by two emergency medicine specialists. The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ration of the ascites fluid gross appearance in detection of SBP were measured with 95% confidence interval. The present project was performed in 80 cirrhotic patients with ascites (52.5 female). The mean of the subjects' age was 56.25±12.21 years (35-81). Laboratory findings revealed SBP in 23 (29%) cases. Fifty nine (73%) cases had transparent ascites fluid appearance of whom 17 (29%) ones suffered from SBP. From 21 (26%) cases with opaque ascites appearance, 15 (71%) had SBP. The sensitivity and specificity of the ascites fluid appearance in detection of SBP were 46.88% (Cl: 30.87-63.55) and 87.50% (95% Cl: 75.3-94.14), respectively. It seems that the gross appearance of ascites fluid had poor diagnostic accuracy in detection of SBP and considering its low sensitivity, it could not be used as a good screening tool for this propose.
Full Text Available Introduction: Spontaneous bacterial peritonitis (SBP as a monomicrobial infection of ascites fluid is one of the most important causes of morbidity and mortality in cirrhotic patients. This study was aimed to determine the diagnostic accuracy of ascites fluid color in detection of SBP in cirrhotic cases referred to the emergency department. Methods: Cirrhotic patients referred to the ED for the paracentesis of ascites fluid were enrolled. For all studied patients, the results of laboratory analysis and gross appearance of ascites fluid registered and reviewed by two emergency medicine specialists. The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ration of the ascites fluid gross appearance in detection of SBP were measured with 95% confidence interval. Results: The present project was performed in 80 cirrhotic patients with ascites (52.5 female. The mean of the subjects’ age was 56.25±12.21 years (35-81. Laboratory findings revealed SBP in 23 (29% cases. Fifty nine (73% cases had transparent ascites fluid appearance of whom 17 (29% ones suffered from SBP. From 21 (26% cases with opaque ascites appearance, 15 (71% had SBP. The sensitivity and specificity of the ascites fluid appearance in detection of SBP were 46.88% (Cl: 30.87-63.55 and 87.50% (95% Cl: 75.3-94.14, respectively. Conclusion: It seems that the gross appearance of ascites fluid had poor diagnostic accuracy in detection of SBP and considering its low sensitivity, it could not be used as a good screening tool for this propose.
Mosbah, Alaa; Nabiel, Yasmin; Khashaba, Eman
To compare levels of interleukin-6 (IL-6), intracellular adhesion molecule-1 (ICAM-1), and glycodelin A in serum and peritoneal fluid of patients with and without endometriosis, and to correlate levels with disease stage. An observational study was undertaken at Mansoura University Hospital, Egypt, between March 2014 and June 2015. Patients aged 21-48 years laparoscopically diagnosed with endometriosis and those without endometriosis who underwent laparoscopy for tubal ligation were included. Levels of IL-6, ICAM-1, and glycodelin A were measured in samples of serum and peritoneal fluid. Receiver operating characteristic curves were used to evaluate diagnostic accuracy. Forty-eight women with endometriosis and 20 without the disorder were included. IL-6 and glycodelin A levels in serum and peritoneal fluid were higher in the endometriosis group than in the control group (Pperitoneal fluid markers were 85.4% and 89.0%, 60.4% and 50.0%, and 89.6% and 90.0%, respectively. IL-6 and glycodelin A levels in serum and peritoneal fluid increased with disease stage (Pendometriosis and are positively correlated with the disease stage. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Full Text Available Peritoneal metastasis is the most frequent type of recurrence in patients with gastric cancer (GC and is associated with poor prognosis. Peritoneal lavage cytology, used to evaluate the risk of peritoneal metastasis, has low sensitivity. Here, we assessed the diagnostic potential of exosomal miRNA profiles in peritoneal fluid for the prediction of peritoneal dissemination in GC. Total RNA was extracted from exosomes isolated from six gastric malignant ascites (MA samples, 24 peritoneal lavage fluid (PLF samples, and culture supernatants (CM of two human gastric carcinoma cell lines that differ in their potential for peritoneal metastasis. Expression of exosomal miRNAs was evaluated with Agilent Human miRNA microarrays and quantitative reverse transcription polymerase chain reaction (qRT-PCR. The microarray analysis indicated a low variability in the number and signal intensity of miRNAs detected among the samples. In the six MA fluids, miR-21 showed the highest signal intensity. We identified five miRNAs (miR-1225-5p, miR-320c, miR-1202, miR-1207-5p, and miR-4270 with high expression in MA samples, the PLF of serosa-invasive GC, and the CM of a highly metastatic GC cell line; these candidate miRNA species appear to be related to peritoneal dissemination. Differential expression of miR-21, miR-320c, and miR-1225-5p was validated in the PLF of serosa-invasive and non-invasive GC by qRT-PCR and miR-21 and miR-1225-5p were confirmed to be associated with serosal invasion in GC. PLF can be used to profile the expression of exosomal miRNAs. Our findings suggest that miR-21 and miR-1225-5p may serve as biomarkers of peritoneal recurrence after curative GC resection, thus providing a novel approach to early diagnosis of peritoneal dissemination of GC.
Simonelli, Angela; Guadagni, Rossella; De Franciscis, Pasquale; Colacurci, Nicola; Pieri, Maria; Basilicata, Pascale; Pedata, Paola; Lamberti, Monica; Sannolo, Nicola; Miraglia, Nadia
The study aimed to give a first data set of bisphenol A (BPA) levels in the peritoneal fluid of patients suffering from endometriosis and to investigate the relationship between BPA exposure and endometriosis. A questionnaire investigating the occupational context, life environment, and habits was administered to 68 patients suffering from endometriosis and 60 endometriosis-free subjects (control group). Urine and peritoneal fluids samples were collected and analysed by GC/MSMS for BPA dosage. Some of the investigated environmental/lifestyle risk factors (closeness to industries/activities at risk) were associated with an increase in endometriosis; smoking resulted as protective factor; others (use of food plastic boxes) did not seem to influence the onset of pathology. The association between the occupational exposure summarising all examined risk factors (working activity, personal protective equipment, seniority) and endometriosis was statistically significant (χ 2 = 5.252, p = 0.02). Contrasting results were obtained when specific activities were examined. Detectable urinary BPA levels were found in all analysed samples (patients: 1.17-12.68 pg/µl; mean ± SD, 5.31 ± 3.36 pg/µl; control group: 1.28-2.35 pg/µl; mean ± SD, 1.64 ± 0.49 pg/µl; median; 1.46 pg/µl), with a statistically significant difference between patients and controls, showing an association between BPA exposure and endometriosis. Only a few subjects from the control group supplied peritoneal fluid; hence, no comparison test with patients (range 0.39-1.46 pg/µl; mean ± SD, 0.67 ± 0.30 pg/µl; median, 0.58 pg/µl) was carried out. Results highlight the potential association between BPA exposure and endometriosis, as well as the current lack of knowledge regarding occupational exposure to BPA and the need of epidemiological studies focused on single activities/occupations, such as housewives, cleaners, students.
Full Text Available Background:In peritoneal dialysis (PD residual renal function (RRF fundamentally contributes to improved quality of life and patient survival. High glucose and advanced glycation end-products (AGE contribute locally to peritoneal and systemically to renal damage. Integrity of podocyte structure and function is of special importance to preserve RRF. Benfotiamine could counteract the glucose and AGE mediated toxicity by blocking hyperglycemia associated podocyte damage via the pentose phosphate pathway.Methods: A human differentiated podocyte cell line was incubated with control solution (Control, 2.5% glucose solution (Glucose and 2.5% PD fluid (PDF for 48 h either ± 50 μM benfotiamine.Podocyte damage and potential benefit of benfotiamine were analyzed using immunofluorescence, western blot analysis, and a functional migration assay. For quantitation, a semiquantitative score was used. Results:When incubating podocytes with benfotiamine, Glucose and PDF mediated damage was reduced resulting in lower expression of AGE and intact podocin and ZO-1 localization. The reorganization of the actin cytoskeleton was restored in the presence of benfotiamine as functional podocyte motility reached Control level. Decreased level of inflammation could be shown as well as reduced podocyte apoptosis.Conclusions:These data suggest that benfotiamine protects podocytes from Glucose and PDF mediated dysfunction and damage, in particular with regard to cytoskeletal reorganization, motility, inflammation and podocyte survival.
Ives, Edward J; Vanhaesebrouck, An E; Cian, Francesco
A 4-month-old female entire domestic shorthair cat presented with an acute onset of blindness, tetraparesis and subsequent generalised seizure activity. Haematology and serum biochemistry demonstrated a moderate, poorly regenerative anaemia, hypoalbuminaemia and hyperglobulinaemia with a low albumin:globulin ratio. Serology for feline coronavirus antibody was positive with an elevated alpha-1 acid glycoprotein. Analysis of cisternal cerebrospinal fluid (CSF) demonstrated markedly elevated protein and a mixed, predominately neutrophilic pleocytosis. Immunocytochemistry for feline coronavirus was performed on the CSF, with positive staining observed inside macrophages. The cat was subsequently euthanased, and both histopathology and immunohistochemistry were consistent with a diagnosis of feline infectious peritonitis. This is the first reported use of immunocytochemistry for detection of feline coronavirus within CSF macrophages. If this test proves highly specific, as for identification of feline coronavirus within tissue or effusion macrophages, it would be strongly supportive of an ante-mortem diagnosis of feline infectious peritonitis in cats with central nervous system involvement without the need for biopsy.
Ali, N; Nath, N C; Parvin, R; Rahman, A; Bhuiyan, T M; Rahman, M; Mohsin M N
This cross sectional study was carried out in the department of gastroenterology, BIRDEM, Dhaka from January 2010 to May 2011 to determine the role of ascitic fluid ADA and serum CA-125 in the diagnosis of clinically suspected tubercular peritonitis. Total 30 patients (age 39.69 ± 21.26, 18M/12F) with clinical suspicion of tuberculosis peritonitis were included in this study after analyzing selection criteria. Laparoscopic peritoneal biopsy with 'histopathological diagnosis' was considered gold standard against which accuracics of two biomarkers (ADA & CA-125) were compared. Cut off value of ADA and CA-125 are 24 u/l, 35 U/ml respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ADA as a diagnostic modality in tuberculos peritonitis were 87.5%, 83.33%, 95.45%, 62.5% and 86.67% respectively where as CA-125 was found to have 83.33% sensitivity, 50% specificity, 86.9% positive predictive value, 42.85% negative predictive value and 76.6% accuracy. Both biomarkers are simple, non-invasive, rapid and relatively cheap diagnostic test where as laparoscopy is an invasive procedure, costly & requires trained staff and not without risk and also not feasible in all the centre in our country. So ascitic fluid ADA and serum CA-125 are important diagnostic test for peritoneal tuberculosis.
Njoku, Chinedu J.; Saville, William J. A.; Reed, Stephen M.; Oglesbee, Michael J.; Rajala-Schultz, Päivi J.; Stich, Roger W.
Equine protozoal myeloencephalitis (EPM) is a disease of horses that is primarily associated with infection with the apicomplexan Sarcocystis neurona. Infection with this parasite alone is not sufficient to induce the disease, and the mechanism of neuropathogenesis associated with EPM has not been reported. Nitric oxide (NO) functions as a neurotransmitter, a vasodilator, and an immune effector and is produced in response to several parasitic protozoa. The purpose of this work was to determine if the concentration of NO metabolites (NOx−) in the cerebrospinal fluid (CSF) is correlated with the development of EPM. CSF NOx− levels were measured before and after transport-stressed, acclimated, or dexamethasone-treated horses (n = 3 per group) were experimentally infected with S. neurona sporocysts. CSF NOx− levels were also compared between horses that were diagnosed with EPM after natural infection with S. neurona and horses that did not have clinical signs of disease or that showed no evidence of infection with the parasite (n = 105). Among the experimentally infected animals, the mean CSF NOx− levels of the transport-stressed group, which had the most severe clinical signs, was reduced after infection, while these values were found to increase after infection in the remaining groups that had less severe signs of EPM. Under natural conditions, horses with EPM (n = 65) had a lower mean CSF NOx− concentration than clinically normal horses with antibodies (Abs) against S. neurona (n = 15) in CSF, and horses that developed ataxia (n = 81) had a significantly lower mean CSF NOx− concentration than horses that did not have neurologic signs (n = 24). In conclusion, lower CSF NOx− levels were associated with clinical EPM, suggesting that measurement of CSF NOx− levels could improve the accuracy of diagnostic tests that are based upon detection of S. neurona-specific Abs in CSF alone and that reduced NO levels could be causatively related to the development
O, Dorien F; Roskams, Tania; Van den Eynde, Kathleen; Vanhie, Arne; Peterse, Daniëlle P; Meuleman, Christel; Tomassetti, Carla; Peeraer, Karen; D'Hooghe, Thomas M; Fassbender, Amelie
To reinforce Sampson's theory of retrograde menstruation in the pathogenesis of endometriosis, proof should be provided that during menstruation endometrial cells are present in peritoneal fluid (PF). We hypothesize that the prevalence of PF samples containing endometrial cells is higher in patients with endometriosis than in controls without endometriosis during menstruation. We selected from our biobank PF samples of 17 reproductive-age women with (n = 9) or without (n = 8) endometriosis who had received a diagnostic laparoscopy for investigation of pain/infertility. Peritoneal fluid had been collected during laparoscopy in the menstrual phase of the cycle, centrifuged, and the resulting pellet was stored at -80°C. About 5-μm sections of frozen PF pellets were stained using the Dako Envision Flex system with primary antibodies against epithelial cell adhesion molecule (Ep-CAM; endometrial epithelial cells), CD10 (endometrial stromal cells), prekeratin (epithelial/mesothelial cells), vimentin (endometrial/mesothelial/immune cells), calretinin (mesothelial cells), and CD68 (macrophages). The PF cells positive for Ep-CAM were detected in 5 of 9 patients with endometriosis and 6 of 8 controls ( P = .62). CD10 stained positively in 6 of the 9 patients with endometriosis and 3 of the 8 controls ( P = .35). Calretinin and prekeratin staining showed the presence of mesothelial cells in all pellets. Vimentin stained approximately 100% of the PF cells. CD68+ macrophages represented >50% of cells in all pellets. The prevalence of PF samples containing endometrial epithelial and stromal cells was not higher in patients with endometriosis than in controls without endometriosis during menstruation. Our findings question the relevance of endometrial cells in PF for the pathogenesis of endometriosis and support the importance of other mechanisms such as immune dysfunction and/or endometrial stem cells.
Raptopoulos, V.; Gourtsoyiannis, N.
The peritoneum is a mesothelial lining of the abdominal cavity (parietal) and intraperitoneal viscera (visceral). The cavity contains a small amount of fluid, which circulates from cephalad to caudal to cephalad, influenced by negative pressure under the diaphragm during exhalation, gravity, and bowel peristalsis. Peritoneal reflections and mesenteries divide the cavity into various compartments (supramesocolic, inframesocolic, and pelvis). These reflections support the peritoneal organs and provide vascular and nervous connections while within the cavity they influence pathway of intraperitoneal fluid circulation. Capillary force over convex surfaces influence stasis of fluid and promotes peritoneal seeding; thus, there are numerous areas in which peritoneal masses are seen more commonly. These areas include the undersurface of the diaphragm (negative pressure and capillary force), the omentum (bathed in fluid), the right lower quadrant (oblique course from left superior to right inferior of the small bowel mesentery), the left lower quadrant (transverse course of the sigmoid), and the pelvis (gravity). Peritoneal carcinomatosis may be either primary (mesothelioma) or metastatic. The mode of spread is by direct invasion, lymphatic permeation, peritoneal seeding or hematogenous. The imaging patterns include fibronodular stranding, nodules, plaques, and masses. Mesenteric thickening may produce pleated or stellate patterns. Spiral CT is the most useful modality in diagnosis and follow-up of peritoneal tumors. (orig.)
Van Biesen, Wim; Williams, John D.; Covic, Adrian C.; Fan, Stanley; Claes, Kathleen; Lichodziejewska-Niemierko, Monika; Verger, Christian; Steiger, Jurg; Schoder, Volker; Wabel, Peter; Gauly, Adelheid; Himmele, Rainer
Background Euvolemia is an important adequacy parameter in peritoneal dialysis (PD) patients. However, accurate tools to evaluate volume status in clinical practice and data on volume status in PD patients as compared to healthy population, and the associated factors, have not been available so far. Methods We used a bio-impedance spectroscopy device, the Body Composition Monitor (BCM) to assess volume status in a cross-sectional cohort of prevalent PD patients in different European countries. The results were compared to an age and gender matched healthy population. Results Only 40% out of 639 patients from 28 centres in 6 countries were normovolemic. Severe fluid overload was present in 25.2%. There was a wide scatter in the relation between blood pressure and volume status. In a multivariate analysis in the subgroup of patients from countries with unrestricted availability of all PD modalities and fluid types, older age, male gender, lower serum albumin, lower BMI, diabetes, higher systolic blood pressure, and use of at least one exchange per day with the highest hypertonic glucose were associated with higher relative tissue hydration. Neither urinary output nor ultrafiltration, PD fluid type or PD modality were retained in the model (total R2 of the model = 0.57). Conclusions The EuroBCM study demonstrates some interesting issues regarding volume status in PD. As in HD patients, hypervolemia is a frequent condition in PD patients and blood pressure can be a misleading clinical tool to evaluate volume status. To monitor fluid balance, not only fluid output but also dietary input should be considered. Close monitoring of volume status, a correct dialysis prescription adapted to the needs of the patient and dietary measures seem to be warranted to avoid hypervolemia. PMID:21390320
Zao Yuhua; Zhang Juhong; Ma Yunbao
Objective: To investigate the clinical significance of the changes of serum and peritioneal fluid TGF-β, IGF - I , TNF-α and IL-8 levels in patients with endometriosis. Methods: Serum and peritoneal fluid levels of TGF-β, IGF-I, TNF-α and IL-8 were measured with RIA in 30 patients with endometriosis and 30 controls. Results: The levels of TGF-β, IGF-I, TNF-α and IL-8 in serum and peritoneal fluid in endometriosis group were significantly higher than those in the controls (P<0.05), moreover, the levels of the markers in peritoneal fluid were significantly higher than those in serum (P<0.05). Conclusion: It is likely that elevation of serum and peritoneal fluid levels of the markers may play a role in the pathogenesis of endometriosis. (authors)
Full Text Available Background: Endometriosis is known as one of the most common disease in women ofreproductive age. Due to important role of vascular endothelial growth factor (VEGF inneo-vascularization for the implantation of endometrial cell, and also presence of differentstudies reported VEGF level in the serum and peritoneal fluid (PF in endometriosispatients, this study was designed to determine the serum and PF levels of VEGF in endometriosispatients, and to compare with normal subjects.Materials and Methods: In this descriptive study, 179 women subjected to laparoscopyfor the evaluation of infertility or pelvic pain were allocated into the following two groups:group I: different types of endometriosis patients (n=90 and group II: non-endometriosispatients (n=89. The PF from pelvis and venous blood samples were obtained. The VEGFconcentration of the serum and PF were measured using enzyme immunoassay kit and werecompared using t test.Results: The level of VEGF in serum was significantly less than that in PF in both groups(p=0.00. However, endometriosis patients had significantly higher level of VEGF inperitoneal fluid than non-endometriosis patients (p=0.043.Conclusion: According to our findings, endometriosis is not associated with change inthe level of circulating VEGF.
Zhou, Jianhui; Cao, Xueying; Lin, Hongli; Ni, Zhaohui; He, Yani; Chen, Menghua; Zheng, Hongguang; Chen, Xiangmei
Peritoneal dialysis is an important type of renal replacement therapy for uremic patients. In peritoneal dialysis, fluids fill in and flow out of the abdominal cavity three to five times per day. Usually, the fluid is packed in a polyvinyl chloride (PVC) bag. Safety concerns have arisen over di-(2-ethylhexyl) phthalate, which is essential in the formation of PVC materials. In 2011, the National Development and Reform Commission of China released a catalog of industrial structural adjustments, mandating the elimination of PVC bags for intravenous infusion and food containers. Although bags for peritoneal dialysis fluid were not included in the elimination list, several manufacturers began to develop new materials for fluid bags. HUAREN peritoneal dialysis fluid consists of the same electrolytes and buffer agent as in Baxter fluid, but is packed in bags that do not contain PVC. This multicenter randomized controlled trial was designed to compare peritoneal dialysis fluid packed in non-PVC-containing and PVC-containing bags. Further, the study sought to determine the proper dose of peritoneal dialysis fluid and the actual survival rates of Chinese patients undergoing peritoneal dialysis. The study participants are adults undergoing continuous ambulatory peritoneal dialysis for 30 days to 6 months. All eligible patients are randomized (1:1) to peritoneal dialysis with Baxter and HUAREN dialysis fluids (initial dose, 6 l/day), with dosages adjusted according to a unified protocol. The primary outcomes are the 1-, 2-, 3-, 4-, and 5-year overall survival rates. Secondary outcome measures include technique survival rates, reductions in estimated glomerular filtration rate, nutritional status, quality of life, cardiovascular events, medical costs and drop-out rates. Safety outcome measures include adverse events, changes in vital signs and laboratory parameters, peritonitis, allergies, and quality of products. This study is the first to evaluate the long-term safety and
K. A. Syssoev
Full Text Available Abstract. Uterine leiomyoma (UL is a hormone-dependent benign tumor of uterus. Social significance of UL is stipulated by its high rate among fertile females. Scarce data exist about the impact of cytokines in UL progression. Th1/Th2 paradigm is one of crucial points in modern immunology. Evaluation of cytokines involved into either type of immune response is of special significance for studying the diseases accompanied by the changes of extracellular matrix, e.g., leiomyomas. In present study, we analyzed peritoneal fluids from UL patients, with multiplex detection of IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, GM-CSF, IFN-γ and TNF-α (Th1/Th2 panel, by means of a Bio-Plex® instrument (Bio-Rad, USA. Twenty-seven patients were observed in our study (20 patients with UL, and 7 myoma-free women (a group of comparison. The mean age of the patients was 43.5±0.6 years. The duration of UL ranged from 0 to 18 years. As a result, the levels of IL-10, GM-CSF, IFN-γ and TNF-α in patients with long-existing UL (over 5 years were significantly higher (p<0,05 than in group with a disease story of <5 years. IFN-γ values in peritoneal fluid patients with UL did inversely correlate with uterine size. Moreover, the levels of IFN-γ in patients with smaller uterine volume (<8 weeks of pregnancy were increased in relation to the group with larger tumor size. IL-10 contents were increased in the patients with adenomyosis, rapid and slow growth of UL, and in both types of tumor (simple and proliferative. Increased IL-5 levels were observed in the patients with single tumor nodules (as related to the patients bearing multiple nodes, and comparison group. Furthermore, intramural and subserosal location of nodes was characterized by increased levels of IL-5. In the patients free of adenomyosis, IL-5 value was increased against the comparison group. The changes in IL-2, IL-4, IL-12 and IL-13 levels in patients with UL were not statistically significant.
Full Text Available Clinical observations suggest that treatment of Rituximab might be less effective in patients with nephrotic range proteinuria when compared to nonnephrotic patients. It is conceivable that the reason for this is that significant amounts of Rituximab might be lost in the urine in a nephrotic patient and that these patients require a repeated or higher dosage. However, this has not been systematically studied. In this case report we describe two different patients with nephrotic range proteinuria receiving Rituximab. The first patient received Rituximab for therapy resistant cryoglobulinemic membranoproliferative glomerulonephritis and the other for second line treatment of Felty’s syndrome. We employed flow cytometry to determine the amount of Rituximab excretion in both urine and peritoneal fluid specimens in these patients following administration of Rituximab. We found that a significant amount of Rituximab is lost from the circulation by excretion into the urine. Furthermore we saw a close correlation of the excretion of Rituximab to the excretion of IgG molecules suggesting selectivity of proteinuria as the determining factor of Rituximab excretion. Further larger scale clinical studies could have the potential to evaluate an optimal cut-off value of IgG urinary loss before a possible administration of Rituximab therefore contributing to a more individualized treatment approach in patients with nonselective and nephrotic range proteinuria.
Stahl, Klaus; Duong, Michelle; Schwarz, Anke; Wagner, A D; Haller, Hermann; Schiffer, Mario; Jacobs, Roland
Clinical observations suggest that treatment of Rituximab might be less effective in patients with nephrotic range proteinuria when compared to nonnephrotic patients. It is conceivable that the reason for this is that significant amounts of Rituximab might be lost in the urine in a nephrotic patient and that these patients require a repeated or higher dosage. However, this has not been systematically studied. In this case report we describe two different patients with nephrotic range proteinuria receiving Rituximab. The first patient received Rituximab for therapy resistant cryoglobulinemic membranoproliferative glomerulonephritis and the other for second line treatment of Felty's syndrome. We employed flow cytometry to determine the amount of Rituximab excretion in both urine and peritoneal fluid specimens in these patients following administration of Rituximab. We found that a significant amount of Rituximab is lost from the circulation by excretion into the urine. Furthermore we saw a close correlation of the excretion of Rituximab to the excretion of IgG molecules suggesting selectivity of proteinuria as the determining factor of Rituximab excretion. Further larger scale clinical studies could have the potential to evaluate an optimal cut-off value of IgG urinary loss before a possible administration of Rituximab therefore contributing to a more individualized treatment approach in patients with nonselective and nephrotic range proteinuria.
Full Text Available The effect of peritoneal fluid (PF on the human sperm acrosome reaction (AR was tested. Sperm was pre-incubated with PF and the AR was induced by calcium ionophore A23187 and a neoglycoprotein bearing N-acetylglycosamine residues (NGP. The AR induced by calcium ionophore was inhibited 40% by PF from controls (PFc and 50% by PF from the endometriosis (PFe group, but not by PF from infertile patients without endometriosis (PFi. No significant differences were found in the spontaneous AR. When the AR was induced by NGP, pre-incubation with PFc reduced (60% the percentage of AR, while PFe and PFi caused no significant differences. The average rates of acrosome reactions obtained in control, NGP- and ionophore-treated sperm showed that NGP-induced exocytosis differed significantly between the PFc (11% and PFe/PFi groups (17%, and the ionophore-induced AR was higher for PFi (33% than PFc/PFe (25%. The incidence of the NGP-induced AR was reduced in the first hour of pre-incubation with PFc and remained nearly constant throughout 4 h of incubation. The present data indicate that PF possesses a protective factor which prevents premature AR.
Gogacz, Marek; Winkler, Izabela; Bojarska-Junak, Agnieszka; Tabarkiewicz, Jacek; Semczuk, Andrzej; Rechberger, Tomasz; Adamiak, Aneta
Th17 cells are a newly discovered T helper lymphocyte subpopulation, producing interleukin IL-17. Th17 cells are present in blood and peritoneal fluid (PF) at different stages of endometriosis. We aim to establish their potential importance in the pathogenesis and clinical features of the disease. The percentage of Th17 cells among T helper lymphocytes was determined in the PF and peripheral blood (PB) of patients with endometriosis and in the control group by flow cytometry using monoclonal antibodies: anti-CD-4-FITC, anti-CD-3-PE/Cy5, and anti-IL-17A-PE. Th17 percentage is increased in PF in comparison with PB in both endometriotic patients and in the control group. In severe endometriosis, the percentage of Th17 cells in PF was higher than with early (I/II stage) endometriosis. A positive correlation between the percentage of Th17 cells in PF and the white blood cell count in PB was found in patients with endometriosis. Targeting the activity of PF Th17 cells may have an influence on the proliferation of ectopic tissue and clinical manifestations of the disease. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Bungum, Helle Folge; Nygaard, Uffe; Vestergaard, Christian; Martensen, Pia M; Knudsen, Ulla Breth
Previous studies have indicated a higher prevalence of allergic disease among women with endometriosis. It is already well established that type 1 allergies develop in a Th2 cytokine environment. Recent studies have shown, however, that IL-25 induces a Th2 development of naive T lymphocytes and is central in the Th2 response. The aim of this case-control study was to investigate the presence of IL-25 in the peritoneal fluid of women suffering from endometriosis. PF was obtained both from women undergoing laparoscopic surgery due to endometriosis (25 cases) and from women wanting sterilisation (19 controls). IL-25 levels were then investigated by ELISA. Women with endometriosis showed significantly higher levels of IL-25 in their PF (p=0.019) compared to controls. IL-25 levels did not correlate with the stage of endometriosis. Both Th2-cells and mast cells express IL-25, which could favor the development of allergies by perpetuating a hypersensitivity reaction. Further, IL-25 may also hold a role as a diagnostic tool. Copyright © 2016. Published by Elsevier Ireland Ltd.
Saulez, M N; Cebra, C K; Dailey, M
Fifty-six horses with colic were examined over a period of three months. The concentrations of glucose, lactate, sodium, potassium and chloride, and the pH of samples of blood and peritoneal fluid, were determined with a portable clinical analyser and with an in-house analyser and the results were compared. Compared with the in-house analyser, the portable analyser gave higher pH values for blood and peritoneal fluid with greater variability in the alkaline range, and lower pH values in the acidic range, lower concentrations of glucose in the range below 8.3 mmol/l, and lower concentrations of lactate in venous blood in the range below 5 mmol/l and in peritoneal fluid in the range below 2 mmol/l, with less variability. On average, the portable analyser underestimated the concentrations of lactate and glucose in peritoneal fluid in comparison with the in-house analyser. Its measurements of the concentrations of sodium and chloride in peritoneal fluid had a higher bias and were more variable than the measurements in venous blood, and its measurements of potassium in venous blood and peritoneal fluid had a smaller bias and less variability than the measurements made with the in-house analyser.
Mashayekhi, Farhad; Aryaee, Hadis; Mirzajani, Ebrahim; Yasin, Ashraf Ale; Fathi, Abdolsatar
Endometriosis is a gynecological disease defined by the histological presence of endometrial glands and stroma outside the uterine cavity, most commonly implanted over visceral and peritoneal surface within the female pelvis. CD44 is a membrane protein expressed by human endometrial cells, and it has been shown to promote the adhesion of endometrial cells. The aim of this study was to determine the levels of soluble CD44 (sCD44) in the serum and peritoneal fluid (PF) samples of patients with different stages of endometriosis. 39 PF and serum samples from normal healthy and 130 samples from different stages of patients with endometriosis (33 cases of stage I, 38 stage II, 30 stage III and 29 stage IV) were included in this study. Total protein concentration (TPC) and the level of s-cMet in the serum were determined by Bio-Rad protein assay based on the Bradford dye procedure and enzyme-linked immunosorbent assay, respectively. No significant change in the TPC was seen in the serum of patients with endometriosis when compared to normal controls. Results obtained demonstrated that all serum and peritoneal fluid samples, presented sCD44 expression, whereas, starting from stages I to IV endometriosis, a significant increase of sCD44 expression was observed as compared to control group. The results of this study show that a high expression of sCD44 is correlated with advanced stages of endometriosis. It is also concluded that the detection of serum and/or peritoneal fluid sCD44 may be useful in classifying endometriosis.
Harris Dana M
Full Text Available Abstract Background Peptide nucleic acid fluorescent in situ hybridization (PNA-FISH is a rapid and established method for identification of Candida sp., Gram positive, and Gram negative bacteria from positive blood cultures. This study reports clinical experience in the evaluation of 103 positive blood cultures and 17 positive peritoneal fluid cultures from 120 patients using PNA-FISH. Our study provides evidence as to potential pharmaceutical cost savings based on rapid pathogen identification, in addition to the novel application of PNA-FISH to peritoneal fluid specimens. Methods Identification accuracy and elapsed time to identification of Gram positives, Gram negatives, and Candida sp., isolated from blood and peritoneal fluid cultures were assessed using PNA-FISH (AdvanDx, as compared to standard culture methods. Patient charts were reviewed to extrapolate potential pharmaceutical cost savings due to adjustment of antimicrobial or antifungal therapy, based on identification by PNA-FISH. Results In blood cultures, time to identification by standard culture methods for bacteria and Candida sp., averaged 83.6 hours (95% CI 56.7 to 110.5. Identification by PNA-FISH averaged 11.2 hours (95% CI 4.8 to 17.6. Overall PNA-FISH identification accuracy was 98.8% (83/84, 95% CI 93.5% to 99.9% as compared to culture. In peritoneal fluid, identification of bacteria by culture averaged 87.4 hours (95% CI −92.4 to 267.1. Identification by PNA-FISH averaged 16.4 hours (95% CI −57.3 to 90.0. Overall PNA-FISH identification accuracy was 100% (13/13, 95% CI 75.3% to 100%. For Candida sp., pharmaceutical cost savings based on PNA-FISH identification could be $377.74/day. For coagulase-negative staphylococcus (CoNS, discontinuation of vancomycin could result in savings of $20.00/day. Conclusions In this retrospective study, excellent accuracy of PNA-FISH in blood and peritoneal fluids with reduced time to identification was observed, as compared to
M?ller-Krebs, Sandra; Nissle, Katharina; Tsobaneli, Julia; Zeier, Martin; Kihm, Lars Philipp; Kender, Zoltan; Fleming, Thomas; Nawroth, Peter Paul; Reiser, Jochen; Schwenger, Vedat
Background: In peritoneal dialysis (PD), residual renal function (RRF) fundamentally contributes to improved quality of life and patient survival. High glucose and advanced glycation end-products (AGE) contribute locally to peritoneal and systemically to renal damage. Integrity of podocyte structure and function is of special importance to preserve RRF. Benfotiamine could counteract the glucose and AGE-mediated toxicity by blocking hyperglycemia-associated podocyte damage via the pentose-phos...
Himmele, Rainer; Jensen, Lynn; Fenn, Dominik; Ho, Chih-Hu; Sawin, Dixie-Ann; Diaz-Buxo, Jose A.
♦ Background: Conventional peritoneal dialysis fluids (PDFs) consist of ready-to-use solutions with an acidic pH. Sterilization of these fluids is known to generate high levels of glucose degradation products (GDPs). Although several neutral-pH, low-GDP PD solutions have been developed, none are commercially available in the United States. We analyzed pH and GDPs in Delflex Neutral pH (Fresenius Medical Care North America, Waltham, MA, USA), the first neutral-pH PDF to be approved by the US Food and Drug Administration. ♦ Methods: We evaluated whether patients (n = 26; age range: 18 - 78 years) could properly mix the Delflex Neutral pH PDF after standardized initial training. We further analyzed the concentrations of 10 different glucose degradation products in Delflex Neutral pH PDF and compared the results with similar analyses in other commercially available biocompatible PDFs. ♦ Results: All pH measurements (n = 288) in the delivered Delflex Neutral pH solution consistently fell within the labeled range of 7.0 ± 0.4. Analysis of mixing errors showed no significant impact on the pH results. Delflex Neutral pH, Balance (Fresenius Medical Care, Bad Homburg, Germany), BicaVera (Fresenius Medical Care), and Gambrosol Trio (Gambro Lundia AB, Lund, Sweden) exhibited similar low total GDP concentrations, with maximums in the 4.25% solutions of 88 μmol/L, 74 μmol/L, 74 μmol/L, and 79 μmol/L respectively; the concentration in Physioneal (Baxter Healthcare Corporation, Deerfield, IL, USA) was considerably higher at 263.26 μmol/L. The total GDP concentration in Extraneal (Baxter Healthcare Corporation) was 63 μmol/L, being thus slightly lower than the concentrations in the 4.25% glucose solutions, but higher than the concentrations in the 1.5% and 2.5% glucose solutions. ♦ Conclusions: The new Delflex Neutral pH PDF consistently delivers neutral pH with minimal GDPs. PMID:22383632
Full Text Available Endometriosis is a gynecological disease defined by the histological presence of endometrial glands and stroma outside the uterine cavity. Ectopic endometrial cell proliferation and chronic inflammation in endometriosis were shown to be associated with oxidative stress (OS induction. OS is a condition in which reactive oxygen species (ROS overproduction and antioxidant deficiency cause a shift in oxidant/antioxidant balance. Glutathione S-transferases (GSTs comprise a family of eukaryotic and prokaryotic phase II metabolic isozymes best known for their ability to catalyze the conjugation of the reduced form of glutathione (GSH to xenobiotic substrates for the purpose of detoxification. The aim of this project was to study the concentrations of GSTT1 in the serum and peritoneal fluid (PF of patients with different stages of endometriosis. Frothy two PF and serum from normal and 152 from different stages of patients with endometriosis (stage I: n = 30, stage II: n = 39, stage III: n = 43 and stage IV: n = 40 were included in this study. The level of GSTT1 in the serum was determined by enzyme linked immunosorbent assay (ELISA. The results showed the presence of GSTT1 in all serum and peritoneal fluid samples, while, starting from stages I to IV endometriosis, a significant decrease in GSTT1 concentration was seen as compared to controls. It is concluded that levels of GSTT1 is negatively correlated with advanced stages of endometriosis. It is also suggested that the detection of serum and/or peritoneal fluid GSTT1 concentration may be valuable in the classifying of endometriosis.
Vouk, Katja; Ribič-Pucelj, Martina; Adamski, Jerzy; Rižner, Tea Lanišnik
Endometriosis is a complex, polygenic, and estrogen-dependent disease that affects 6% to 10% of women of reproductive age, and 30% to 50% of women with infertility and/or pelvic pain. Surgical diagnosis of endometriosis is still the gold standard, as there are currently no diagnostic biomarkers available. Due to the invasive diagnostics, it can take up to 11 years before affected women are diagnosed and receive the appropriate treatment. We performed a targeted metabolomics study to search for potential semi-invasive biomarkers in peritoneal fluid from endometriosis patients. Our case-control study comprised 29 ovarian endometriosis patients and 36 healthy control women. The 148 metabolites included acylcarnitines, glycerophospholipids, and sphingolipids, which were quantified by electrospray ionization tandem mass spectrometry. The strength of association between the metabolites and the metabolite ratios and disease was assessed using crude and adjusted odds ratios. The best combination of biomarkers was then selected by performing step-wise logistic regression. Our analysis reveals significantly decreased concentrations of 10 metabolites, of carnitine and acylcarnitines (C0, C8:1, C6C4:1 DC, C10:1), phosphatidylcholines (PC aa C38:3, PC aa C38:4, PC aa C40:4, PC aa C40:5), and sphingomyelins (SM C16:1, SM C18:1), and 125 significantly altered metabolite ratios in patients versus control women. The best model includes two ratios: a carnitine to a phosphatidylcholine (C0/PC ae C36:0); and between two phosphatidylcholines (PC aa C30:0/PC ae C32:2). When adjusted for age, this provides sensitivity of 82.8% and specificity of 94.4%, with AUC of 0.944. Our study supports the importance of carnitine, phosphatidylcholine, and sphingomyelin metabolites in the pathophysiology of endometriosis, and confirms the potential for the combination of individual metabolite ratios to provide biomarkers for semi-invasive diagnostics. Copyright © 2016 Elsevier Ltd. All rights
Michaud, Nadège; Al-Akoum, Mahéra; Gagnon, Geneviève; Girard, Karine; Blanchet, Pierre; Rousseau, Julie Anne; Akoum, Ali
Interleukin 1 (IL1) may play an important role in endometriosis-associated pelvic inflammation, and natural specific inhibitors, including soluble IL1 receptor accessory protein (sIL1RAcP) and soluble IL1 receptor type 2 (sIL1R2), are critical for counterbalancing the pleiotropic effects of IL1. The objective of this study was to evaluate the levels of sIL1RAcP, together with those of sIL1R2 and IL1β, in the peritoneal fluid of women with and without endometriosis. Peritoneal fluid samples were obtained at laparoscopy and assessed by ELISA. sIL1RAcP concentrations were reduced in endometriosis stages I-II and III-IV. sIL1R2 concentrations were decreased, and those of IL1β were significantly increased in endometriosis stages I-II. sIL1RAcP and sIL1R2 concentrations were significantly decreased in the secretory phase of the menstrual cycle, and IL1β concentrations were elevated in the proliferative and the secretory phases. sIL1RAcP and sIL1R2 concentrations were reduced in women with endometriosis who were infertile, fertile, suffering from pelvic pain or pain-free. However, IL1β concentrations were significantly reduced in women with endometriosis who were infertile or had pelvic pain. These changes may exacerbate the local peritoneal inflammatory reaction observed in women with endometriosis and contribute to endometriosis pathophysiology and the major symptoms of this disease. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Jun 2, 1971 ... cellular fluid' into the peritoneal cavity allows both the removal of excess fluid ... occur. In adults the maximum peritoneal urea clearance is ob- tained with a dialysis ..... and Records. Pulse and respiration rates, temperature and blood .... diffusion of urea out of the brain cells, with consequent movement of ...
Full Text Available Cirrhotic patients (23 with alcoholic cirrhosis, 5 with posthepatitic cirrhosis and 2 with cryptogenic cirrhosis with ascites and portal hypertension were studied and divided into two groups corresponding to high or low risk to develop spontaneous bacterial peritonitis (SBP related to the concentration of total protein in the ascitic fluid (A-TP: group I (high risk: A-TP£1.5 g/dl and group II (low risk: A-TP>1.5 g/dl. Fibronectin (FN, C3 and C4 concentrations were measured by radial immunodiffusion while total protein was measured by the biuret method. The mean values (group I vs group II of C3 (12.59 ± 4.72 vs 24.53 ± 15.58 mg/dl, C4 (4.26 ± 3.87 vs 7.26 ± 4.14 mg/dl and FN (50.47 ± 12.49 vs 75.89 ± 24.70 mg/dl in the ascitic fluid were significantly lower (P<0.05 in the group considered to be at high risk for SBP. No significant difference was observed in the plasma/ascites fibronectin ratio (3.91 ± 1.21 vs 3.80 ± 1.26 or gradient (131.46 ± 64.01 vs 196.96 ± 57.38 between groups. Fibronectin in ascites was significantly correlated to C3 (r = 0.76, C4 (r = 0.58, total protein (r = 0.73 and plasma FN (r = 0.58 (P<0.05. The data suggest that the FN concentration in ascites is related to the opsonic capacity of this fluid, and that its concentration in the ascitic fluid may be a biochemical risk factor indicator for the development of spontaneous bacterial peritonitis
Full Text Available UNLABELLED: Endometriosis, defined as the presence of endometrium outside the uterus, is one of the most frequent gynecological diseases. It has been suggested that modifications of both endometrial and peritoneal factors could be implicated in this disease. Endometriosis is a multifactorial disease in which angiogenesis and proteolysis are dysregulated. MicroRNAs (miRNAs are small non-coding RNAs that regulate the protein expression and may be the main regulators of angiogenesis. Our hypothesis is that peritoneal fluid from women with endometriosis could modify the expression of several miRNAs that regulate angiogenesis and proteolysis in the endometriosis development. The objective of this study has been to evaluate the influence of endometriotic peritoneal fluid on the expression of six miRNAs related to angiogenesis, as well as several angiogenic and proteolytic factors in endometrial and endometriotic cell cultures from women with endometriosis compared with women without endometriosis. METHODS: Endometrial and endometriotic cells were cultured and treated with endometriotic and control peritoneal fluid pools. We have studied the expression of six miRNAs (miR-16, -17-5p, -20a, -125a, -221, and -222 by RT-PCR and protein and mRNA levels of vascular endothelial growth factor-A, thrombospondin-1, urokinase plasminogen activator and plasminogen activator inhibitor-1 by ELISA and qRT-PCR respectively. RESULTS: Control and endometriotic peritoneal fluid pools induced a significant reduction of all miRNAs levels in endometrial and endometriotic cell cultures. Moreover, both peritoneal fluids induced a significant increase in VEGF-A, uPA and PAI-1 protein levels in all cell cultures without significant increase in mRNA levels. Endometrial cell cultures from patients treated with endometriotic peritoneal fluid showed lower expression of miRNAs and higher expression of VEGF-A protein levels than cultures from controls. In conclusion , this "in vitro
Kratochwill, Klaus; Boehm, Michael; Herzog, Rebecca; Lichtenauer, Anton Michael; Salzer, Elisabeth; Lechner, Michael; Kuster, Lilian; Bergmeister, Konstantin; Rizzi, Andreas; Mayer, Bernd; Aufricht, Christoph
Exposure of mesothelial cells to peritoneal dialysis fluids (PDF) results in cytoprotective cellular stress responses (CSR) that counteract PDF-induced damage. In this study, we tested the hypothesis that the CSR may be inadequate in relevant models of peritoneal dialysis (PD) due to insufficient levels of glutamine, resulting in increased vulnerability against PDF cytotoxicity. We particularly investigated the role of alanyl-glutamine (Ala-Gln) dipeptide on the cytoprotective PDF stress proteome. Adequacy of CSR was investigated in two human in vitro models (immortalized cell line MeT-5A and mesothelial cells derived from peritoneal effluent of uraemic patients) following exposure to heat-sterilized glucose-based PDF (PD4-Dianeal, Baxter) diluted with medium and, in a comparative proteomics approach, at different levels of glutamine ranging from depletion (0 mM) via physiological (0.7 mM) to pharmacological levels (8 mM administered as Ala-Gln). Despite severe cellular injury, expression of cytoprotective proteins was dampened upon PDF exposure at physiological glutamine levels, indicating an inadequate CSR. Depletion of glutamine aggravated cell injury and further reduced the CSR, whereas addition of Ala-Gln at pharmacological level restored an adequate CSR, decreasing cellular damage in both PDF exposure systems. Ala-Gln specifically stimulated chaperoning activity, and cytoprotective processes were markedly enhanced in the PDF stress proteome. Taken together, this study demonstrates an inadequate CSR of mesothelial cells following PDF exposure associated with low and physiological levels of glutamine, indicating a new and potentially relevant pathomechanism. Supplementation of PDF with pharmacological doses of Ala-Gln restored the cytoprotective stress proteome, resulting in improved resistance of mesothelial cells to exposure to PDF. Future work will study the clinical relevance of CSR-mediated cytoprotection.
Mo, Silje; Bendtsen, Flemming; Wiese, Signe Skovgaard
Background: Spontaneous bacterial peritonitis (SBP) is a complication to decompensated cirrhosis. Fluoroquinolones may prevent SBP. However, predictive markers for SBP are wanted. Guidelines suggest that patients with ascitic fluid protein below 15 g/l receive fluoroquinolones to prevent SBP...
Maas, J. W.; Calhaz-Jorge, C.; ter Riet, G.; Dunselman, G. A.; de Goeij, A. F.; Struijker-Boudier, H. A.
OBJECTIVE: To assess the angiogenic activity of peritoneal fluid in women with minimal to mild endometriosis and to investigate the relationship between this activity and the concentration of macrophage-derived angiogenic factors and clinical variables, such as phase of menstrual cycle, type of
Storgaard, J S; Svendsen, Jesper Hastrup; Hegnhøj, J
During a 21-month period, 65 consecutive patients admitted with ascites were included in a prospective study of the incidence of spontaneous bacterial peritonitis, and paracentesis was performed on admission. The ascitic fluid was cultured, ascitic leucocytes were counted and pH was measured....... Bacterial growth was found in five patients with chronic liver disease, who were diagnosed as having spontaneous bacterial peritonitis (SBP), since no intra-abdominal focus could be demonstrated. Thus, the incidence of SBP in this material was 7.7% (95% confidence limits: 2.5-17%). SBP was caused...
Chae, Uisoo; Min, Jin Young; Kim, Sung Hoon; Ihm, Hyo Jin; Oh, Young Sang; Park, So Yun; Chae, Hee Dong; Kim, Chung Hoon; Kang, Byung Moon
Progesterone resistance is thought to be a major factor that contributes to progression of endometriosis. However, it is not clear what causes progesterone resistance in endometriosis. This study aimed to assess whether cytokines or peritoneal fluid can affect progesterone receptor (PR) expression in endometrial cells and to verify whether PR expression is reduced in endometriosis. The PR-B/A ratio was measured via real-time polymerase chain reaction after in vitro culture, in which endometrial cells were treated with either tumor necrosis factor-alpha (TNF-α), interleukin-1 beta, or peritoneal fluid obtained from women with advanced-stage endometriosis. Immunohistochemistry was performed to compare PR-B expression between eutopic and ectopic endometrial tissues from women with and without advanced-stage endometriosis. The PR-B/A ratio was significantly decreased by treatment with either TNF-α (p=0.011) or peritoneal fluid from women with advanced-stage endometriosis (p=0.027). Immunoreactivity of PR-B expression was significantly lower during the secretory phase than during the proliferative phase in endometrial tissues from control subjects (pendometriosis compared with eutopic endometrium tissues from control subjects. Progesterone resistance in endometriosis may be caused by proinflammatory conditions in the pelvic peritoneal microenvironment.
Van de Water, Eline; Oosterlinck, Maarten; Duchateau, Luc; Pille, Frederik
The purpose of this study was to determine whether the scil Vet abc Plus(+) (SCIL Animal Care Company, Altorf, France), an impedance hematology analyzer, can accurately quantify and differentiate nucleated blood cells (NBCs) in equine synovial fluid. Synovial fluid samples (n=242) in different stages of experimentally induced inflammation were analyzed with and without hyaluronidase pretreatment and compared to manual hemocytometer counts and smear reviews. No significant effect of hyaluronidase pretreatment was observed. Total nucleated cell counts of the scil Vet abc Plus(+) were significantly higher compared to the manual method (P=0.02), yet the difference was small and clinically irrelevant (ratio manual/automated count equal to 0.97 with 95% CI [0.95, 1.00]). Differential cell counts of the scil Vet abc Plus(+) were not accurate. In conclusion, the scil Vet abc Plus(+) hematology analyzer is highly accurate for quantification, but not accurate for differentiation of NBCs in equine synovial fluid. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available Mario Bonomini,1,2 Sara Di Silvestre,3,4 Pamela Di Tomo,3,4 Natalia Di Pietro,2,4 Domitilla Mandatori,3,4 Lorenzo Di Liberato,1 Vittorio Sirolli,1,2 Francesco Chiarelli,2,4 Cesare Indiveri,5 Assunta Pandolfi,3,4 Arduino Arduini6 1Unit of Nephrology and Dialysis, 2Department of Medicine and Aging Sciences, 3Department of Medical, Oral and Biotechnological Sciences, 4Aging Research Center and Translational Medicine, CeSI-MeT, University “G. d’Annunzio”, Chieti-Pescara, 5Department DiBEST (Biologia, Ecologia, Scienze della Terra, Unit of Biochemistry and Molecular Biotechnology, University of Calabria, Arcavacata di Rende CS, Italy; 6CoreQuest, Manno, Switzerland Background: The use of glucose as the only osmotic agent in peritoneal dialysis (PD solutions (PDSs is believed to exert local (peritoneal and systemic detrimental actions, particularly in diabetic PD patients. To improve peritoneal biocompatibility, we have developed more biocompatible PDSs containing xylitol and carnitine along with significantly less amounts of glucose and have tested them in cultured Human Vein Endothelial Cells (HUVECs obtained from the umbilical cords of healthy (C and gestational diabetic (GD mothers. Methods: Primary C- and GD-HUVECs were treated for 72 hours with our PDSs (xylitol 0.7% and 1.5%, whereas carnitine and glucose were fixed at 0.02% and 0.5%, respectively and two glucose-based PDSs (glucose 1.36% or 2.27%. We examined their effects on endothelial cell proliferation (cell count, viability (3-(4,5-dimethylthiazolyl-2-2,5-diphenyltetrazolium bromide assay, intracellular nitro-oxidative stress (peroxynitrite levels, Vascular Cell Adhesion Molecule-1 and Intercellular Adhesion Molecule-1 membrane exposure (flow cytometry, and HUVEC-monocyte interactions (U937 adhesion assay. Results: Compared to glucose-based PDSs, our in vitro studies demonstrated that the tested PDSs did not change the proliferative potential both in C- and GD-HUVECs. Moreover, our
Background: The C3 component of complement tends to be reduced in cirrhosis and patients with reduced ascitic fluid C3 concentration and reduced opsonic activities have been shown to be predisposed to SBP. Aim of the work: To compare the level of ascitic fluid C3 concentration in cirrhotic patients with and without ...
Verdugo, Fernando J; Briones, Eduardo; Porte, Lorena; Amaro, José; Fica, Alberto
Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.
Liu, Qi; Ma, Pingchuan; Liu, Lanxia; Ma, Guilei; Ma, Jingjing; Liu, Xiaoxuan; Liu, Yijin; Lin, Wanjun; Zhu, Yingjun
Our study investigated poly(lactic-co-glycolic acid) (PLGA) as protein delivery vehicles encapsulate CTLA-4-antibody (anti-CTLA-4) which is essential for CD4+CD25+Treg cells suppressive function exposing superior potential for inhibiting endometriosis progress in mouse model than single anti-CTLA-4. Anti-CTLA-4 loaded PLGA combined to ligands CTLA-4 in surface of CD4+CD25+Treg cells which distributed in peritoneal fluid of mouse endometriosis model. The particle size, zeta potential of the anti-CTLA-4 loaded nanoparticles was detected by dynamic light scattering. Morphology of nanoparticles was evaluated by transmission electron microscopy (TEM). Confocal laser scanning microscopy (CLSM) indicated distribution of anti-CTLA-4 with PLGA or without in peritoneal fluid. Cumulative anti-CTLA-4 release from nanoparticles was evaluated by Micro BCA assay. The percentage of CD4+CD25+Treg cells in peritoneal fluid was demonstrated by flow cytometer. In vitro experiment we co-culture ectopic endometrial cells (EEC) with isolated CD4+CD25+Treg cells in peritoneal fluid (PF), proliferation and invasion of ectopic endometrial cells (EEC) was measured by BrdU ELISA assay and Matrigel invasion assay. In comparison with anti-CTLA-4 without nanoparticles, the bioconjugates PLGA/anti-CTLA-4 were tolerated in peritoneal fluid with a controlled release of anti-CTLA-4 in 3, 7, 14days. Moreover, PLGA/anti-CTLA-4 had superior protective regulation ability to reduce level of CD4+CD25+Treg cells in peritoneal fluid. Most strikingly, in vitro experiment, PLGA/anti-CTLA-4 exhibited better ability in inhibiting proliferation and invasion of ectopic endometrial cells in co-culture system compared with anti-CTLA-4. Progressively, PLGA/anti-CTLA-4 had better suppressive activity to inhibited IL-10 and TGF-beta secreted by CD4+CD25+Treg cells which indicating that PLGA/anti-CTLA-4 suppressed cells proliferation and invasion through reduced IL-10 and TGF-beta production. Thus, PLGA/anti-CTLA-4 may
van Esch, Sadie; van Diepen, Anouk T N; Struijk, Dirk G; Krediet, Raymond T
♦ Preservation of the peritoneum is required for long-term peritoneal dialysis (PD). We investigated the effect of multiple peritonitis episodes on peritoneal transport. ♦ Prospectively collected data from 479 incident PD patients treated between 1990 and 2010 were analyzed, using strict inclusion criteria: follow-up of at least 3 years with the availability of a Standard Peritoneal Permeability Analysis (SPA) in the first year after start of PD and within the third year of PD, without peritonitis preceding the first SPA. For the purpose of the study, we only included patients who remained peritonitis-free (n = 28) or who experienced 3 or more peritonitis episodes (n = 16). ♦ At baseline the groups were similar with regard to small solute and fluid transport. However, the frequent peritonitis group had lower peritoneal protein clearances compared to the no peritonitis group, resulting in lower dialysate concentrations of proteins: albumin 196.5 mg/L vs 372.5 mg/L, IgG 36.4 mg/L vs 65.0 mg/L, and α-2-macroglobulin (A2M) 1.9 mg/L vs 3.6 mg/L, p peritonitis group. Frequent peritonitis did not affect free water transport. ♦ Slow initial peritoneal transport rates of serum proteins result in lower dialysate concentrations, and likely a lower opsonic activity, which is a risk factor for peritonitis. Patients with frequent peritonitis show an increase in small solute transport and a concomitant decrease of ultrafiltration. In long-term peritonitis-free PD patients, small solute transport decreased, while ultrafiltration increased. This suggests that frequent peritonitis leads to an increase of the vascular peritoneal surface area without all the structural membrane alterations that may develop after long-term PD. Copyright © 2016 International Society for Peritoneal Dialysis.
Yılmaz, Zülfükar; Yıldırım, Yaşar; Aydın, Fatma Yılmaz; Aydın, Emre; Kadiroğlu, Ali Kemal; Yılmaz, Mehmet Emin; Acet, Halit
Fluid overload is a common and serious problem that leads to severe complications in dialysis patients. We aimed to compare hydration status as measured with bioimpedance analysis (BIA) method in hemodialysis (HD) and peritoneal dialysis (PD) patients, as well as investigating the association between blood pressure, left ventricular mass index (LVMI) and hydration status. We examined 43 HD and 33 PD patients. Blood pressure was recorded. In each group, echocardiographic examinations were performed on all patients. Hydration status was assessed using multifrequency bioelectrical impedance analysis. Overhydration was defined as an overhydration (OH)/extracellular water (ECW) ratio of >0.15. The OH/ECW ratio was significantly higher in PD patients compared to post-HD patients. Overhydration was statistically more frequent in PD than in post-HD patients (30.3% vs. 11.6%, P=0.043). Systolic blood pressure (SBP) in both post-HD and PD groups, and LVMI in the PD group were found to be significantly higher in overhydrated patients than non-overhydrated patients. In multiple linear regression analyses, increased OH/ECW ratio was independently associated with higher SBP and LVMI. Fluid overload may be an even more prevalent and serious problem in PD patients. Overhydration is closely associated with increased blood pressure and LVMI. OH/ECW ratio, a derived parameter of fluid load measured by BIA, was a significant and independent determinant of SBP and LVMI. Copyright © 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
Exame do fluido peritoneal e hemograma de eqüinos submetidos à laparotomia e infusão intraperitoneal de carboximetilcelulose Peritoneal fluid exam and hemogram of horses submited to laparotomy and carboxymethylcellulose intraperitoneal infusion
Marco Aurélio Ferreira Lopes
Full Text Available A aplicação intraperitoneal de carboximetilcelulose (CMC tem sido utilizada na prevenção de aderências peritoneais em animais e em humanos. Os objetivos deste trabalho foram avaliar a resposta do peritônio ao trauma cirúrgico e à aplicação de CMC e estudar como se processa a metabolização da CMC. Dezenove eqüinos mestiços foram submetidos à laparotomia, quando se produziram lesões no jejuno distal por abrasão da serosa e isquemia. Nos 9 eqüinos do grupo tratamento, antes da síntese da parede abdominal, foi instilada, na cavidade peritoneal, uma solução estéril de CMC, a 1% na dose de 7ml/kg. Nos eqüinos do grupo controle, nenhum medicamento foi aplicado na cavidade peritoneal. Após a cirurgia, colheram-se sangue e fluido peritoneal em 9 momentos: 4 horas após o fim da cirurgia, nos 3 primeiros dias pós-operatórios, pela manhã e a cada 48 horas nos dias subseqüentes (no 5º, 7º, 9º, 11º e 13º dias pós-operatórios. Os exames laboratoriais demonstraram que todos os animais desenvolveram inflamação peritoneal. Entretanto, nos animais do grupo tratamento, esta inflamação foi mais intensa e com um curso mais longo. Observou-se também que a excreção da CMC ocorreu por fagocitose.Intraperitoneal application of carboxymethylcellulose (CMC has been used for peritoneal adhesions prevention in animals and humans. The objectives of this research was to study the peritoneal response to surgical trauma and application of CMC and also to study how CMC excretion occurs. Nineteen healthy mixed breed horses were submited to laparotomy to produce lesions in distal jejunum by serosal abrasion and ischemia. In the nine horses of the treatment group, 7ml/kg of a 1% CMC sterile solution were instilated in peritoneal cavity before abdominal wall syntesis. No medication was instiled in peritoneal cavitiy of the control group horses. After surgery, blood and peritoneal fluid were colected in 9 postoperative moments: 4 hours after
Glińska-Suchocka, K; Sławuta, P; Jankowski, M; Kubiak, K; Spużak, J; Borusewicz, P
The aim of the study was to assess pH, pO2 and pCO2 in peritoneal fluid. The study was conducted on a group of 22 dogs with symptoms of ascites. Group 1 consisted of 4 dogs with adenocarcinoma, group 2--of 6 dogs with glomerulonephritis, group 3 of 8 dogs with hepatic cirrhosis and group 4 of 4 dogs with bacterial peritonitis. An abdominal cavity puncture was performed in all dogs and the fluid was drawn into a heparinized syringe in order to assess pH, pO2 and pCO2 . The analysis of pH in the peritoneal fluid revealed statistically significant differences between group 4 and groups 1 (p=0.01), 2 (p=0.01), and 3 (p=0.01). The lowest pH value compared to the other studied groups was recorded in group 4. In group 4, the pO2 was the lowest compared to the other groups (group 1 p=0.01, group 2 p=0.01, group 3 p=0.01). The value of pCO2 was the highest in group 4 compared to groups 1, 2, and 3. The study found statistically significant differences in pH, pCO2 and pCO2 between group 4 (the group of dogs with bacterial peritonitis) and the other groups of dogs. This was probably linked to the pathogenesis of peritonitis. As a result of an inflammatory reaction within the peritoneal cavity, there is an increase in fibrin accumulations leading to a decreased oxygen supply causing the oxidative glucose metabolism to change into a non-oxidative glucose metabolism. This, in turn, causes a decrease in pH, acidosis, and a low oxidoreduction potential. It also impairs phagocytosis and activates proteolytic enzymes which create ideal conditions for the growth of anaerobic bacteria. The obtained results indicate that the pH, pO2 and pCO2 may be used to differentiate bacterial peritonitis from ascites of other etiologies.
van Diepen, Anouk T.N.; van Esch, Sadie; Struijk, Dirk G.; Krediet, Raymond T.
♦ Objective: Little or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of peritoneal transport before and after infection. ♦ Participants: We analyzed prospectively collected data from 541 incident peritoneal dialysis (PD) patients, aged > 18 years, between 1990 and 2010. Standard Peritoneal Permeability Analyses (SPA) within the year before and within the year after (but not within 30 days) the first peritonitis were compared. In a control group without peritonitis, SPAs within the first and second year of PD were compared. ♦ Main outcome measurements: SPA data included the mass transfer area coefficient of creatinine, glucose absorption and peritoneal clearances of β-2-microglobulin (b2m), albumin, IgG and α-2-macroglobulin (a2m). From these clearances, the restriction coefficient to macromolecules (RC) was calculated. Also, parameters of fluid transport were determined: transcapillary ultrafiltration rate (TCUFR), lymphatic absorption (ELAR), and free water transport. Crude and adjusted linear mixed models were used to compare the slopes of peritoneal transport parameters in the peritonitis group to the control group. Adjustments were made for age, sex and diabetes. ♦ Results: Of 541 patients, 367 experienced a first peritonitis episode within a median time of 12 months after the start of PD. Of these, 92 peritonitis episodes were preceded and followed by a SPA within one year. Forty-five patients without peritonitis were included in the control group. Logistic reasons (peritonitis group: 48% vs control group: 83%) and switch to hemodialysis (peritonitis group: 22% vs control group: 3%) were the main causes of missing SPA data post-peritonitis and post-control. When comparing the slopes of peritoneal transport parameters in
Yeo, Seung Geun; Won, Yong Sung; Kim, Sang Hoon; Park, Dong Choon
Endometriosis, although not malignant, has clinically demonstrated properties of invasiveness and metastasis. The pathogenesis of endometriosis, however, has not yet been elucidated. The immunological differences between endometriosis and malignant gynecologic tumors were analyzed by assessing C-type lectin receptors, which are associated with innate immunity, and immunoglobulin secretion, which is associated with B cell adaptive immunity, in the peritoneal fluid of these patients. Peritoneal fluid samples were obtained from 42 patients with benign masses (control group), 38 with endometriosis, and 43 with gynecologic (ovarian, uterine, and cervical) cancers. The levels of expression in these samples of mRNAs encoding the C-type lectin receptors Dectin-1, MR1, MR2, DC-SIGN, Syk, Card 9, Bcl 10, Malt 1, src, Dec 205, Galectin, Tim 3, Trem 1, and DAP 12, were measured by real-time reverse transcription polymerase chain reaction, and the concentrations of IgG, IgA and IgM were measured by enzyme-linked immunosorbent assays (ELISA). Findings in the three groups were compared. The level of galectin mRNA was significantly lower, and the levels of MR2 and DAP 12 mRNAs significantly higher, in the endometriosis than in the control group (pgynecologic cancer group, the level of Bcl 10 mRNA was significantly lower, and the levels of MR1, MR2, Syk, Card 9, Malt 1, Dec 205, Tim 3, and DAP 12 mRNAs significantly higher, in the endometriosis group (pcontrol group (pgynecologic cancer groups. IgA and IgG concentrations in peritoneal fluid were significantly lower in the gynecologic cancer than in the control group (p0.05). C-type lectin receptors and immunoglobulins act cooperatively and are closely associated in the pathogenesis of endometriosis. The decreased expression of galectin mRNA in the peritoneal fluid of the endometriosis group suggests that endometriosis and gynecologic cancers have similar immunologic characteristics.
... include: Infections. An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An ... day. You might have a lower risk of peritonitis because you connect and disconnect to the dialysis ...
... Dialysis Population Following the Use of Contaminated Peritoneal Dialysis Fluids. ... that this supply of PD fluid was stored in a warm and humid environment. ... lost the negative vacuum between the inner bag and the outer plastic envelope, ...
Marí-Alexandre, Josep; Barceló-Molina, Moisés; Belmonte-López, Elisa; García-Oms, Javier; Estellés, Amparo; Braza-Boïls, Aitana; Gilabert-Estellés, Juan
To define the microRNA (miRNA) profile and its relationship with cytokines content in peritoneal fluid (PF) from endometriosis patients. Case-control study. University hospital, research institute. One hundred twenty-six women with endometriosis (EPF) and 45 control women (CPF). MiRNA arrays were prepared from six EPF and six CPF. Quantitative reverse transcription-polymerase chain reaction validation of nine selected miRNAs (miR-29c-3p, -106b-3p, -130a-3p, -150-5p, -185-5p, -195-5p, -451a, -486-5p, and -1343-5p) was performed. Vascular endothelial growth factor-A (VEGF-A), thrombospondin-1 (TSP-1), urokinase plasminogen activator (uPA), plasminogen activator inhibitor-1 (PAI-1), matrix metalloproteinase-3 (MMP3), tissue inhibitor of metalloproteinases type 1 (TIMP-1), interleukin (IL)-6, IL-8, IL-17A, macrophage inflammatory protein 1β (MIP1beta), platelet-derived growth factor α-polypeptide A, and regulated on activation, normal T cell expressed and secreted (RANTES) were quantified by ELISA and MILLIPLEX. MiRNA arrays showed 126 miRNAs differentially expressed (fold change ±1.2) (78 down-regulated, 48 up-regulated) in EPF. Validation showed higher levels of miR-106b-3p, -451a, -486-5p, IL-6, IL-8, uPA, and TIMP-1 in EPF. In menstrual phase, EPF presented up-regulation of miR-106b-3p, -130a-3p, -150-5p, -185-5p, -451a, -486-5p, VEGF-A, IL-8, MIF 1β, uPA, and PAI-1 compared with other phases; however, CPF did not. MiRNA-486-5p was up-regulated in sterile EPF compared with sterile controls, and VEGF-A, IL-8, and TIMP-1 were increased in sterile and fertile EPF compared with fertile CPF. MiRNAs seem to be involved in the peritoneal alterations in endometriosis, suggesting new mechanisms by which ectopic lesions could implant in endometriosis patients; and to serve as biomarkers for fertility outcome prediction. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Krediet, R. T.; Ho-Dac-Pannekeet, M. M.; Imholz, A. L.; Struijk, D. G.
OBJECTIVE: To give a survey of the principles of peritoneal fluid transport in general, followed by an analysis of the effects of icodextrin on the transport of fluid and solutes. DESIGN: A review of the literature and of data on the effects of icodextrin in continuous ambulatory peritoneal dialysis
Spontaneous bacterial peritonitis (SBP); Ascites - peritonitis; Cirrhosis - peritonitis ... who are on peritoneal dialysis for kidney failure. Peritonitis may have other causes . These include infection from ...
Kussmann, Manuel; Hauer, Stefan; Pichler, Petra; Reznicek, Gottfried; Burgmann, Heinz; Poeppl, Wolfgang; Zeitlinger, Markus; Wiesholzer, Martin
Peritonitis is still the main infectious complication among patients on peritoneal dialysis. For treatment of peritoneal dialysis-related peritonitis, the intraperitoneal administration of antibiotics admixed to peritoneal dialysis fluids (PDFs) should be preferred. However, the influence of diverse PDFs on the activity of frequently used antibiotics has been investigated insufficiently. Thus, the present study set out to investigate the in vitro activity of fosfomycin against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Staphylococcus aureus in commercially available PDFs. Time-kill curves in four different PDFs (Dianeal®, Extraneal®, Nutrineal®, and Physioneal®) were performed over 24 h with two different concentrations of fosfomycin (150 and 400 mg/L) and without antibiotics as control. Cation-adjusted Mueller Hinton broth (CA-MHB) was used as a comparator solution. In blank PDFs, bacterial growth of each organism evaluated was reduced when compared to CA-MHB. For S. aureus in blank Physioneal®, a reduction under the limit of detection was observed within 24 h. The activity of fosfomycin was reduced in all PDFs when compared to CA-MHB except for P. aeruginosa in Nutrineal® where the activity of fosfomycin was increased when investigated at 400 mg/L. Against E.coli, bactericidal activity was demonstrated in Extraneal®, Nutrineal®, and Physioneal®. Fosfomycin resistance (MIC > 1024 mg/L) was observed for P. aeruginosa in CA-MHB at both concentrations and in Nutrineal® at 150 mg/L. Fosfomycin is active in PDFs particularly against the frequently isolated enterobacterium E. coli. The choice of the respective PDF considerably influences the microbiological outcome in vitro. Further studies are warranted to investigate the clinical relevance of these findings.
Keywords: intradialytic parenteral nutrition, nutritional management, encapsulating peritoneal sclerosis ... reflection of fluid retention and the underlying inflammatory process, ... The patient appeared weak and frail, with severe generalised muscle ... was recommended on diagnosis of EPS to prevent further peritoneal.
Doenges, Stephanie J; Weber, Karin; Dorsch, Roswitha; Fux, Robert; Fischer, Andrea; Matiasek, Lara A; Matiasek, Kaspar; Hartmann, Katrin
The objective of this study was to evaluate the sensitivity and specificity of a real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR) detecting feline coronavirus (FCoV) RNA in cerebrospinal fluid (CSF) of cats with and without neurological and/or ocular signs for the diagnosis of feline infectious peritonitis (FIP). This prospective case-control study included 34 cats. Nineteen cats had a definitive histopathological diagnosis of FIP (seven of these with neurological and/or ocular signs), and 15 cats had other diseases but similar clinical signs (three of these with neurological and/or ocular signs). Real-time RT-PCR was performed on the CSF of all cats, and sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were calculated. Real-time RT-PCR of CSF showed a specificity of 100% in diagnosing FIP, a sensitivity of 42.1%, a PPV of 100% and an NPV of 57.7%. The sensitivity of the real-time RT-PCR of CSF in cats with neurological and/or ocular signs was 85.7%. Although it is known that RT-PCR can give false positive results, especially if performed using serum or plasma, this real-time RT-PCR detecting FCoV RNA in CSF can be considered a reliable specific tool for the diagnosis of FIP. If only cats with neurological involvement are evaluated, the sensitivity of this real-time RT-PCR in CSF is also high. © ISFM and AAFP 2015.
Gruendl, Stefanie; Matiasek, Kaspar; Matiasek, Lara; Fischer, Andrea; Felten, Sandra; Jurina, Konrad; Hartmann, Katrin
Objectives The aim of the study was to evaluate whether an ante-mortem diagnosis of central nervous system (CNS) feline infectious peritonitis (FIP) is possible via immunocytochemical staining (ICC) of feline coronavirus antigen (FCoV) within macrophages of cerebrospinal fluid (CSF). Methods Prospectively, CSF samples of 41 cats were investigated, including cats with histopathologically confirmed FIP and neurological signs (n = 10), cats with confirmed FIP without CNS involvement (n = 11), cats with neurological signs but another confirmed CNS disease (n = 17), and cats without neurological signs and a disease other than FIP (n = 3). ICC staining of CSF macrophages was performed in all cats. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of CSF ICC were calculated. Results Of 10 samples from cats with CNS FIP, eight had detectable CSF macrophages, seven of which were positive for FCoV. Ten of 11 samples from cats with confirmed FIP without neurological signs had macrophages in the CSF, with all 10 being ICC-positive. In cats with other CNS disorders, 11/17 had macrophages, two of which stained positively. In cats with diseases other than FIP and without neurological disorders, 2/3 revealed macrophages, with one cat showing positive ICC staining. Diagnosis of FIP via CSF ICC had a sensitivity of 85.0% and a specificity of 83.3%. PPV and NPV were 85.0% and 83.3%. Conclusions and relevance CSF ICC is a highly sensitive test for ante-mortem diagnosis of FIP manifesting in the CNS. However, CNS ICC specificity is too low to confirm FIP and the method should only be applied in conjunction with other features such as CSF cytology. CNS ICC could be helpful to discover pre-neurological stages of CNS FIP.
Na, Yong-Jin; Lee, Dong-Hyung; Kim, Seung-Chul; Joo, Jong-Kil; Wang, Ji-Won; Jin, Jun-O; Kwak, Jong-Young; Lee, Kyu-Sup
Chemokines have been implicated in the pathological process of endometriosis. We compared the effects of peritoneal fluid obtained from patients with endometriosis (ePF) and controls without endometriosis (cPF) on the release of monocyte-specific CC chemokines such as monocyte chemotactic protein-1 (MCP-1), regulated upon activation normal T cell expressed and secreted (RANTES), and macrophage inflammatory protein-1α (MIP-1α) by neutrophils, monocytes, and T cells. Moreover, we evaluated the correlation between the levels of chemokines in ePF and their release by these cells. Cells were obtained from healthy young volunteers and cultured with ePF (n = 12) or cPF (n = 8). The chemokine levels in the ePF and the supernatants of cultured cells with ePF were then measured by ELISA. There was a positive correlation between the levels of MCP-1 and MIP-1α in ePF. The addition of ePF to the cell cultures failed to increase the release of MCP-1, RANTES, and MIP-1α when compared to cPF, but the levels of RANTES in ePF were positively correlated with the release of RANTES by ePF-treated monocytes and T cells. Moreover, there was a positive correlation between the levels of RANTES and MIP-1α released by neutrophils and between the levels of MCP-1 and MIP-1α released by T cells. Finally, the levels of RANTES released by monocyte-derived macrophages and monocytes cultured with ePF were positively correlated. These findings suggest that monocytes, neutrophils, and T cells release differential levels of MCP-1, RANTES, and MIP-1α in response to stimulation with ePF.
Raquel Yvonne Arantes Baccarin
Full Text Available The purpose of this paper is to view the interrelation between the peritoneal fluid analysis from horses with abdominal discomfort, regarding the pathology site, the occurrence or not of strangulating obstruction, the treatment performed and the presence of peritoneal fluid, classified either as modified transudate or exsudate. In order to achieve that, 373 clinical records of colicky horses referred to the Veterinary Hospital between 1985 and 1991 were studied, and 98 of these, were selected, in which peritoneal fluid sampling and analysis had been carried out in a routine manner. Greater amount of exsudate than that of modified transudate was observed. Horses with wide spread intestinal disease showed the best recovery rates. Regardless of the site of the lesion, those exhibiting strangulating obstruction had the lowest rates of survival, and this kind of obstruction was more frequently observed in the small intestine. Among the parameters considered in the peritoneal fluid analysis, fluid color was the most reliable indicator od strangulating obstruction and/or intestinal ischemia. Finally, peritoneal fluid analysis and citology alone were not sufficient to diagnose the cause of the colic, due to the great variation observed in each pathology group: associated to the clinical evaluation of the patient, however, they can bring up the need for surgical intervention.
Tural Kara, Tugce; Yilmaz, Songul; Ozdemir, Halil; Birsin Ozcakar, Zeynep; Derya Aysev, Ahmet; Ciftci, Ergin; Ince, Erdal
Peritonitis is a serious problem in children receiving peritoneal dialysis. Campylobacter jejuni is an unusual cause of peritonitis. A 10-year-old boy who had end stage renal failure due to atypical hemolytic uremic syndrome was admitted to our hospital with abdominal pain and fever. Peritoneal dialysis fluid was cloudy and microscopic examination showed abundant leukocytes. Intraperitoneal cefepime treatment was started. Campylobacter jejuni was isolated from peritoneal dialysis fluid culture and oral clarithromycin was added to the treatment. At the end of therapy, peritoneal fluid culture was negative. To our knowledge, C. jejuni peritonitis was not reported in children previously. Although C. jejuni peritonitis is rarely encountered in children, it should be considered as an etiologic factor for peritonitis. Sociedad Argentina de Pediatría.
Anderson, J. H.; Stewart, C. J.; Hansell, D. T.; Anderson, J. R.
We report two patients who presented with small bowel obstruction secondary to peritoneal mesothelioma. The difficulties in establishing this diagnosis at an early stage are illustrated. Recent advances in the management of peritoneal mesothelioma are reviewed.
Marciniak, M.; Przedlacki, J.; Baczynski, D.; Wankowicz, Z.
Human serum albumin (HSA) labeled with 131 I or 99m Tc was adopted in isotopic diagnostics for evaluation of volume and dynamics of vascular system. Because of high doses absorbed by patient's body due to long half-life period and high energy of 131 I application of 99m Tc (low energy, short half-life) to HSA labelling would be useful. Condition for applying of 99m Tc-HSA in monitoring of peritoneal dialysis kinetics is complex stability during four-hour period in peritoneal dialysis conditions. Evaluation of stability of 99m Tc-HSA complex in period from 30 minutes to 4 hours after complex preparation was done by means of paper radiochromatography and column chromatography. Additionally, separation of the complex after one- and four-hour incubations with solutions for peritoneal dialysis was done. The studies carried out proved stability of the complex during 4-hour period after preparation and incubation with solutions for peritoneal dialysis. 99m Tc-HSA complex content was above 98% at all time intervals. The result obtained point out possibility of replacing of albumin labeled with 131 I by albumin labeled with 99m Tc
Parikova, Alena; Smit, Watske; Struijk, Dirk G.; Zweers, Machteld M.; Krediet, Raymond T.
BACKGROUND: Water transport in peritoneal dialysis (PD) patients is across the small pores and water channels, the latter allowing free water transport. The objective of the study was to investigate the contribution of each transport route on transcapillary ultrafiltration (TCUF). METHODS: Standard
Coester, Annemieke M.; Smit, Watske; Struijk, Dirk G.; Krediet, Raymond T.
Ultrafiltration in peritoneal dialysis occurs through endothelial water channels (free water transport) and together with solutes across small pores: solute coupled water transport. A review is given of cross-sectional studies and on the results of longitudinal follow-up
Fernández–Perpén, Antonio; Pérez–Lozano, María Luisa; Bajo, María–Auxiliadora; Albar–Vizcaino, Patricia; Correa, Pilar Sandoval; del Peso, Gloria; Castro, María–José; Aguilera, Abelardo; Ossorio, Marta; Peter, Mirjam E.; Passlick–Deetjen, Jutta; Aroeira, Luiz S.; Selgas, Rafael; López–Cabrera, Manuel; Sánchez–Tomero, J. Antonio
♦ Background: Peritoneal membrane damage induced by peritoneal dialysis (PD) is largely associated with epithelial-to-mesenchymal transition (EMT) of mesothelial cells (MCs), which is believed to be a result mainly of the glucose degradation products (GDPs) present in PD solutions. ♦ Objectives: This study investigated the impact of bicarbonate-buffered, low-GDP PD solution (BicaVera: Fresenius Medical Care, Bad Homburg, Germany) on EMT of MCs in vitro and ex vivo. ♦ Methods: In vitro studies: Omentum-derived MCs were incubated with lactate-buffered standard PD fluid or BicaVera fluid diluted 1:1 with culture medium. Ex vivo studies: From 31 patients randomly distributed to either standard or BicaVera solution and followed for 24 months, effluents were collected every 6 months for determination of EMT markers in effluent MCs. ♦ Results: Culturing of MCs with standard fluid in vitro resulted in morphology change to a non-epithelioid shape, with downregulation of E-cadherin (indicative of EMT) and strong induction of vascular endothelial growth factor (VEGF) expression. By contrast, in vitro exposure of MCs to bicarbonate/low-GDP solution had less impact on both EMT parameters. Ex vivo studies partially confirmed the foregoing results. The BicaVera group, with a higher prevalence of the non-epithelioid MC phenotype at baseline (for unknown reasons), showed a clear and significant trend to gain and maintain an epithelioid phenotype at medium- and longer-term and to show fewer fibrogenic characteristics. By contrast, the standard solution group demonstrated a progressive and significantly higher presence of the non-epithelioid phenotype. Compared with effluent MCs having an epithelioid phenotype, MCs with non-epithelioid morphology showed significantly lower levels of E-cadherin and greater levels of fibronectin and VEGF. In comparing the BicaVera and standard solution groups, MCs from the standard solution group showed significantly higher secretion of
Yun, Ji Young; Byun, Jae Young; Lee, Sang Hoon; Kwon, Tae Ahn; Kim, Yeon Kil; Kim, Young Ok; Song, Kyung Sup [The Catholic Univ. of Korea College of Medicine, Seoul (Korea, Republic of)
To evaluate the CT findings of peritonitis associated with continuous ambulatory peritoneal dialysis(CAPD). We retrospectively analyzed CT scans of 14 symptomatic patients with peritonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomiting in one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, we evaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern of enhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omental change. On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainly in the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity(n=13), including the lesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anterior peritoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five. Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five of these, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticular opacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, and cocoon formation appear to be CT features of CAPD peritonitis.
Yun, Ji Young; Byun, Jae Young; Lee, Sang Hoon; Kwon, Tae Ahn; Kim, Yeon Kil; Kim, Young Ok; Song, Kyung Sup
To evaluate the CT findings of peritonitis associated with continuous ambulatory peritoneal dialysis(CAPD). We retrospectively analyzed CT scans of 14 symptomatic patients with peritonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomiting in one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, we evaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern of enhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omental change. On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainly in the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity(n=13), including the lesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anterior peritoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five. Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five of these, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticular opacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, and cocoon formation appear to be CT features of CAPD peritonitis
Hare, Jennifer; Clark-Carter, David; Forshaw, Mark
Peritoneal dialysis (PD) requires patients to take an active role in their adherence to fluid restrictions. Although fluid non-adherence had been identified among this patient group, no specific interventions have been researched or published with in the PD population. The current study sought to investigate whether an applied cognitive behavioural therapy (CBT-based intervention) used among haemodialysis patients would improve fluid adherence among PD patients; utilizing clinical indicators used in practice. Fifteen PD patients identified as fluid non-adherent were randomly assigned to an intervention group (IG) or a deferred-entry control group (CG). The study ran for a total of 21 weeks, with five data collection points; at baseline, post-intervention and at three follow-up points; providing a RCT phase and a combined longitudinal analysis phase. The content of the group intervention encompassed educational, cognitive and behavioural components, aimed to assist patients' self-management of fluid. No significant differences in weight (kg) reduction were found in either phase and undesirable changes in blood pressure (BP) were observed. However, in the longitudinal phase, a statistically significant difference in oedematous status was observed at 6-week follow-up; which may be indicative of fluid adherence. Positive and significant differences were observed in the desired direction for measures of psychological well-being, quality of life and health beliefs; areas correlated with enhanced fluid adherence in other research. This study reveals encouraging and significant changes in predictors of fluid adherence. Although there were no significant changes in weight as a crude clinical measure of fluid intake, significant reductions in oedematous status were observed as a consequence of this CBT-based group intervention.
Equine piroplasmosis is an infectious, tick-borne disease caused by the hemoprotozoan parasites Theileria (previously Babesia) equi and Babesia caballi. Piroplasmosis affects all wild and domestic equid species and causes signs related to intravascular hemolysis and associated systemic illness. Infe...
Bajo, María Auxiliadora; Pérez-Lozano, María Luisa; Albar-Vizcaino, Patricia; del Peso, Gloria; Castro, María-José; Gonzalez-Mateo, Guadalupe; Fernández-Perpén, Antonio; Aguilera, Abelardo; Sánchez-Villanueva, Rafael; Sánchez-Tomero, J Antonio; López-Cabrera, Manuel; Peter, Mirjam E; Passlick-Deetjen, Jutta; Selgas, Rafael
Peritoneal membrane deterioration during peritoneal dialysis (PD) is associated with epithelial-to-mesenchymal transition (EMT) of mesothelial cells (MC), which is believed to be mainly due to glucose degradation products (GDPs) present in PD solutions. Here we investigate the impact of GDPs in PD solutions on the EMT of MC in vitro and ex vivo. For in vitro studies, omentum-derived MC were incubated with standard PD fluid or low-GDP solution diluted 1:1 with culture medium. For ex vivo studies, 33 patients, who were distributed at random to either the 'standard' or the 'low GDP' groups, were followed over 24 months. Effluents were collected every 6 months to determine EMT markers in effluent MC. Exposure of MC to standard fluid in vitro resulted in morphological change into a non-epitheloid shape, down-regulation of E-cadherin, indicative of EMT, and in a strong induction of vascular endothelial growth factor (VEGF) expression. In contrast, in vitro exposure of MC to low-GDP solution did not lead to these phenotype changes. This could be confirmed ex vivo, as the prevalence of non-epitheloid phenotype of MC in the standard group was significantly higher with increasing PD duration and MC isolated from this group showed significantly higher levels of EMT-associated molecules including fibronectin, collagen I, VEGF, IL-8 and TGF-β levels when compared with the low-GDP group. Over time, the expression of E-cadherin also decreased in the standard but increased in the low-GDP group. In addition, the levels of EMT-associated molecules (fibronectin, VEGF and IL-8) increased in the standard but decreased in the low-GDP group. A similar trend was also observed for collagen I and for TGF-β (for the first year), but did not reach global statistical significance. Accordingly, effluent MC with non-epitheloid morphology showed significantly lower levels of E-cadherin and greater levels of fibronectin, collagen I, VEGF and IL 8 when compared with MC with epitheloid phenotype
Sia, Christopher S B; Paul, Eldho; Tregaskis, Peter; Walker, Rowan G; Wilson, Scott G
The longitudinal effects of peritoneal dialysis (PD) peritonitis on small solute clearance and ultrafiltration are controversial. We identified 27 patients with PD peritonitis over a 4-year period at a tertiary hospital. Adequacy tests at an "early" (1 - 3 months), "intermediate" (6 ± 2 months), and a "late" (12 ± 2 months) time period after the episode were compared with a pre-peritonitis baseline. The effect of time on serum albumin, weekly creatinine clearance, Kt/V, and net fluid volume removal was assessed. At 12 months, 16/27 (59.3%) patients were no longer on PD. Ten were transferred to hemodialysis, predominantly due to peritonitis (60%). Five patients died, and 1 received a renal allograft. Total daily fluid volume removal significantly decreased over time with an aggregated mean reduction of 523 mL/day between the baseline and 12-month test (1,624 ± 139 mL vs. 1,101 ± 160 mL; p = 0.02). This was due to an equivalent loss of both ultrafiltration and residual urine output, although the separate decline in these individual parameters was not statistically significant. There was no significant change in Kt/V, creatinine clearance, or serum albumin indicating preserved solute transport in those patients with sustained technique survival post peritonitis. Peritonitis is a common cause for transfer to hemodialysis. Fluid volume removal is the most significantly affected parameter at 12 months post peritonitis, driven by the combination of both ultrafiltration reduction and loss of residual diuresis. Clinicians should be aware that peritonitis identifies patients at high risk for technique failure. These findings should prompt clinicians to closely surveil volume status and consider backup dialytic strategies as early as 12 months post peritonitis. .
Lemoine, Lieselotte; Thijssen, Elsy; Noben, Jean-Paul; Adriaensens, Peter; Carleer, Robert; Speeten, Kurt Van der
Oxaliplatin is a platinum (Pt) 1 containing antineoplastic agent that is applied in current clinical practice for the treatment of colon and appendiceal neoplasms. A fully validated, highly sensitive, high throughput inductively coupled plasma mass spectrometry (ICP-MS) method is provided to quantify the total Pt content in plasma, plasma ultrafiltrate, urine and peritoneal fluid. In this ICP-MS approach, the only step of sample preparation is a 1000-fold dilution in 0.5% nitric acid, allowing the analysis of 17 samples per hour. Detection of Pt was achieved over a linear range of 0.01-100 ng/mL. The limit of quantification was 18.0 ng/mL Pt in plasma, 8.0 ng/mL in ultrafiltrate and 6.1 ng/mL in urine and peritoneal fluid. The ICP-MS method was further validated for inter-and intraday precision and accuracy (≤15%), recovery, robustness and stability. Short-term storage of the biofluids, for 14 days, can be performed at -4 °C, -24 °C and -80 °C. As to long-term stability, up to 5 months, storage at -80 °C is encouraged. Furthermore, a timeline assessing the total and unbound Pt fraction in plasma and ultrafiltrate over a period of 45 h is provided. Following an incubation period of 5 h at 37 °C, 19-21% of Pt was recovered in the ultrafiltrate, emphasizing the extensive and rapid binding of oxaliplatin-derived Pt to plasma proteins. The described method can easily be implemented in a routine setting for pharmacokinetic studies in patients treated with oxaliplatin-based hyperthermic intraperitoneal perioperative chemotherapy. Copyright © 2018 Elsevier B.V. All rights reserved.
I. V. Stepanov
Full Text Available The literature review examines the main pathological and morphogenetic aspects of the development of peritoneal carcinomatosis and its molecular and biological features. In addition, the basic principles of peritoneal carcinomatosis classification have been presented and groups of tumors, which may be complicated by dissemination to the peritoneum, have been designated. Particular attention is paid to the problems of diagnosis and treatment.
Velkey, Bálint; Vitális, Eszter; Vitális, Zsuzsanna
Spontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III. generation cephalosporin. Nosocomial spontaneous bacterial peritonitis often caused by Gram-positive bacteria and multi-resistant pathogens can also be expected thus carbapenem should be the choice of the empiric treatment. Antibiotic prophylaxis should be considered. Norfloxacin is used most commonly, but changes are expected due to increase in quinolone resistance. As a primary prophylaxis, a short-term antibiotic treatment is recommended after gastrointestinal bleeding for 5 days, while long-term prophylaxis is for patients with low ascites protein, and advanced disease (400 mg/day). Secondary prophylaxis is recommended for all patients recovered from spontaneous bacterial peritonitis. Due to increasing antibiotic use of antibiotics prophylaxis is debated to some degree. Orv. Hetil., 2017, 158(2), 50-57.
Concentrações de FSH, LH, estradiol, progesterona e histamina no soro, no fluido peritoneal e no fluido folicular de mulheres com e sem endometriose FSH, LH, estradiol, progesterone, and histamine concentrations in serum, peritoneal fluid and follicular fluid of women with and without endometriosis
Andréa Pereira de Lima
Full Text Available OBJETIVOS: relatos da literatura mostram que não há dados conclusivos sobre a associação entre a endometriose e as concentrações de hormônios envolvidos no controle da reprodução. Este estudo foi realizado para determinar as concentrações de FSH, LH, estradiol (E, progesterona (P e histamina (Hi no soro, no fluido peritoneal e no fluido folicular de mulheres com e sem endometriose. MÉTODOS: a extensão da doença foi estadiada de acordo com a American Fertility Society classification (1997. Para a coleta de soro e de fluido peritoneal foram selecionadas 28 mulheres com endometriose submetidas à laparoscopia diagnóstica (18 mulheres inférteis com endometriose I-II e dez mulheres inférteis com endometriose III-IV. Para o grupo controle, foram selecionadas 21 mulheres férteis submetidas à laparoscopia para esterilização tubárea. O fluido folicular foi obtido de 39 mulheres inférteis submetidas a fertilização in vitro (21 mulheres com endometriose e 18 mulheres sem endometriose. RESULTADOS: as concentrações de FSH e LH no soro, no fluido peritoneal e no fluido folicular não diferiram significativamente entre os grupos. As concentrações de E e P no fluido peritoneal foram significativamente mais baixas em mulheres inférteis com endometriose (E: 154,2±15,3 para estágios I-II e 89,3±9,8 ng/mL para estágios III-IV; P: 11,2±1,5 para estágios I-II e 7,6±0,8 ng/mL para estágios III-IV em comparação com mulheres controle (E: 289,1±30,1; P: 32,8±4,1 ng/mL (Testes de Kruskal-Wallis/Dunn; pPURPOSE: literature reports show that there are no conclusive data about the association between endometriosis and the concentrations of hormones involved in the control of reproduction. Thus, the present study was undertaken to determine FSH, LH, estradiol (E, progesterone (P, and histamine (Hi concentrations in serum, peritoneal fluid and follicular fluid of women with and without endometriosis. METHODS: the extent of the disease
Conclusions: Fluid overload may be an even more prevalent and serious problem in PD patients. Overhydration is closely associated with increased blood pressure and LVMI. OH/ECW ratio, a derived parameter of fluid load measured by BIA, was a significant and independent determinant of SBP and LVMI.
Full Text Available The nonlinear mathematical model for solute and fluid transport induced by the osmotic pressure of glucose and albumin with the dependence of several parameters on the hydrostatic pressure is described. In particular, the fractional space available for macromolecules (albumin was used as a typical example and fractional fluid void volume were assumed to be different functions of hydrostatic pressure. In order to find non-uniform steady-state solutions analytically, some mathematical restrictions on the model parameters were applied. Exact formulae (involving hypergeometric functions for the density of fluid flux from blood to tissue and the fluid flux across tissues were constructed. In order to justify the applicability of the analytical results obtained, a wide range of numerical simulations were performed. It was found that the analytical formulae can describe with good approximation the fluid and solute transport (especially the rate of ultrafiltration for a wide range of values of the model parameters.
Herzog, Rebecca; Bender, Thorsten O; Vychytil, Andreas; Bialas, Katarzyna; Aufricht, Christoph; Kratochwill, Klaus
The ability of cells to respond and survive stressful conditions is determined, in part, by the attachment of O-linked N-acetylglucosamine (O-GlcNAc) to proteins (O-GlcNAcylation), a post-translational modification dependent on glucose and glutamine. This study investigates the role of dynamic O-GlcNAcylation of mesothelial cell proteins in cell survival during exposure to glucose-based peritoneal dialysis fluid (PDF). Immortalized human mesothelial cells and primary mesothelial cells, cultured from human omentum or clinical effluent of PD patients, were assessed for O-GlcNAcylation under normal conditions or after exposure to PDF. The dynamic status of O-GlcNAcylation and effects on cellular survival were investigated by chemical modulation with 6-diazo-5-oxo-L-norleucine (DON) to decrease or O-(2-acetamido-2-deoxy-D-glucopyranosylidene)amino N-phenyl carbamate (PUGNAc) to increase O-GlcNAc levels. Viability was decreased by reducing O-GlcNAc levels by DON, which also led to suppressed expression of the cytoprotective heat shock protein 72. In contrast, increasing O-GlcNAc levels by PUGNAc or alanyl-glutamine led to significantly improved cell survival paralleled by higher heat shock protein 72 levels during PDF treatment. Addition of alanyl-glutamine increased O-GlcNAcylation and partly counteracted its inhibition by DON, also leading to improved cell survival. Immunofluorescent analysis of clinical samples showed that the O-GlcNAc signal primarily originates from mesothelial cells. In conclusion, this study identified O-GlcNAcylation in mesothelial cells as a potentially important molecular mechanism after exposure to PDF. Modulating O-GlcNAc levels by clinically feasible interventions might evolve as a novel therapeutic target for the preservation of peritoneal membrane integrity in PD. Copyright © 2014 by the American Society of Nephrology.
Ishii, Chikako; Kaneko, Kenji; Kato, Hitonari; Tada, Shinpei
Fifty patients with peritonitis carcinomatosa were evaluated with computed tomography (CT). CT findings included evidence of mesenteric thickening (60 %), solid mass (20 %), loculated ascites (16 %), ascites (14 %), partly dilated intestine (10 %). Mesenteric thickening showed both intraperitoneal and subperitoneal metastasis. Arrested flow of ascitic fluid (loculated ascites) was one of the most predicting findings of peritonitis carcinomatosa. The seven false negative cases related to small metastatic foci, long distance between autopsy and the last CT examination, or paucity of intraabdominal fat. (author)
Ros, P.R.; Yuschok, T.J.; Buck, J.L.; Shekitka, K.M.; Kaude, J.V.; Armed Forces Inst. of Pathology, Washington, DC
Previous imaging reports of peritoneal mesothelioma have described a variety of radiologic appearances, but have not included its pathologic classification. We retrospectively reviewed 10 cases of peritoneal mesothelioma representing the following histologic categories: 7 epithelial, 2 sarcomatoid, and one biphasic. By imaging, epithelial mesotheliomas demonstrated diffuse thickening of the peritoneum and mesentery and/or multiple small nodules. The sarcomatoid-type appeared as a mass and the biphasic-type had radiologic and gross pathologic features of both sarcomatoid and epithelial types. We conclude that peritoneal mesothelioma presents with a wide spectrum of radiographic appearances and should therefore be included in the differential diagnoses of diffuse as well as localized peritoneal processes. (orig.)
van Esch, Sadie; Struijk, Dirk G; Krediet, Raymond T
patients who experienced peritonitis (p peritonitis. The two groups showed a similar decrease in the mesothelial cell mass marker cancer antigen 125 during follow-up. ♦ On top of the natural course of peritoneal function, peritonitis episodes to some extent influence the time-course of small-solute and fluid transport-especially the transport of solute-free water. Those modifications increase the risk for overhydration. Copyright © 2016 International Society for Peritoneal Dialysis.
Michau, Tammy Miller
Glaucoma is a multifactorial neurodegenerative ocular disease leading to progressive loss of retinal ganglion cells and their axons that form the optic nerve, causing blindness. Knowledge of the pathogenesis and development of equine glaucoma is in its infancy compared with human glaucoma. Glaucoma occurs most commonly secondary to uveitis and may be underdiagnosed or misdiagnosed in horses suffering from uveitis. Recognition and clinical diagnosis of glaucoma in the horse is improved with clinician awareness and the availability of handheld tonometers. Therapy for glaucoma is aimed at decreasing aqueous humor production through medical and surgical means. Even with therapy, long-term prognosis for vision is poor. Copyright © 2017 Elsevier Inc. All rights reserved.
Williams, Katherine E; Miroshnychenko, Olga; Johansen, Eric B; Niles, Richard K; Sundaram, Rajeshwari; Kannan, Kurunthachalam; Albertolle, Matthew; Zhou, Yan; Prasad, Namrata; Drake, Penelope M; Giudice, Linda C; Hall, Steven C; Witkowska, H Ewa; Buck Louis, Germaine M; Fisher, Susan J
Endometriosis, ectopic growth of the uterine lining (endometrium), which affects 6-11% of reproductive age women, is associated with pelvic pain and infertility. We investigated the peritoneal fluid (PF), urine and omental fat (OF) proteomes of women with endometriosis vs. individuals with no surgically visualized endometriosis. All participants were enrolled in the NICHD-funded ENDO Study. A two-step proteomic study was performed. The first, a broad survey, employed a semi-quantitative gel LC-mass spectrometry (MS) workflow: SDS PAGE fractionation, trypsin digestion and LC-MS/MS. The results showed sample integrity but failed to detect any differences between women with and without endometriosis. The second step was a quantitative analysis of OF samples. We employed another sample set (n=30) from women ± disease and isobaric mass-tag (iTRAQ) chemistry to label peptides and 2D LC-MS/MS for protein identification and quantification. Three proteins-matrix metalloproteinase-9, neutrophil elastase, and FAM49B-were significantly lower in abundance in samples from women with endometriosis. Interestingly, neutrophil elastase and FAM49B levels were associated with higher levels of a subset of endocrine disrupting chemicals (EDCs) that were previously measured in the same samples. The results of these experiments showed the feasibility of associating endometriosis with changes in the OF protein repertoire and EDC levels. Endometriosis, pathological growth of the uterine lining, is associated with significant morbidities, including pain and infertility. However, the causes of this common condition are poorly understood. This study determined whether endometriosis was associated with changes in the protein composition of peritoneal fluid, urine and/or omental fat. A protein of unknown function (FAM49B) and two proteinases (metalloproteinase-9, neutrophil elastase) were down regulated in OF samples from women with versus without endometriosis. These findings suggested
Lee, Dong-Hyung; Kim, Seung-Chul; Joo, Jong-Kil; Kim, Hwi-Gon; Na, Young-Jin; Kwak, Jong-Young; Lee, Kyu-Sup
Hormones and inflammation have been implicated in the pathological process of endometriosis; therefore, we investigated the combined effects of 17β-estradiol (E2) and peritoneal fluid obtained from patients with endometriosis (ePF) or a control peritoneal fluid (cPF) obtained from patients without endometriosis on the release of monocyte chemotactic protein-1 (MCP-1) by monocytes and the role of signaling pathways. Monocytes were cultured with ePF and cPF in the presence of E2; the MCP-1 levels in the supernatants were then measured by ELISA. In addition, mitogen activated protein kinase (MAPK) activation was measured by Western blotting of phosphorylated proteins. E2 down-regulated MCP-1 release by lipopolysaccharide- or cPF-treated monocytes, but failed to suppress its release by ePF-treated monocytes. The release of MCP-1 by ePF- and cPF-treated monocytes was efficiently abrogated by p38 mitogen activated protein kinase (MAPK) inhibitors; however, the MCP-1 release by cPF-treated monocytes, but not by ePF-treated monocytes, was blocked by a MAPK kinase inhibitor. In addition, ePF and cPF induced the phosphorylation of extracellular stress regulated kinase (ERK)1/2, p38 MAPK and c-Jun N-terminal kinase (JNK). E2 decreased the phosphorylation of p38 MAPK, but not ERK1/2 in ePF-treated monocytes; however, E2 decreased the phosphorylation of p38 MAPK, ERK1/2 and JNK in cPF-treated monocytes. The ability of E2 to modulate MCP-1 production is impaired in ePF-treated monocytes, which may be related to regulation of MAPK activity. These findings suggest that the failure of E2 to suppress ePF-treated production of MCP-1 may be involved in the pathogenesis of endometriosis. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.
Presence of Leishmania amastigotes in peritoneal fluid of a dog with leishmaniasis from Alagoas, Northeast Brazil Presença de formas amastigotas de Leishmania em fluido peritoneal de cão com leishmaniose proveniente de Alagoas, nordeste do Brasil
Full Text Available The goal of this short communication is to report the uncommon presence of intracellular amastigotes of Leishmania in peritoneal fluid of a dog with leishmaniasis from Alagoas State, Brazil. Physical examination of an adult male rottweiler suspected to be suffering of leishmaniasis revealed severe loss of weight, ascitis, splenomegaly, moderately enlarged lymph nodes, onychogryphosis, generalized alopecia, skin ulcers on the posterior limbs, and conjunctivitis. Samples of bone marrow, popliteal lymph node, skin ulcer, and peritoneal fluid were collected and smears of each sample were prepared and stained with hematoxylin and eosin. Numerous amastigotes were detected in bone marrow, popliteal lymph node, and skin ulcer smears. Smears of peritoneal fluid revealed the unusual presence of several free and intracellular amastigotes of Leishmania. Future studies are needed to determine whether the cytology of ascitic fluid represents a useful tool for diagnosis Leishmania infection in ascitic dogs, particularly in those living in areas where canine leishmaniasis is enzootic.O objetivo desta comunicação é descrever a presença incomum de formas amastigotas de Leishmania em fluido peritoneal de um cão com leishmaniose proveniente do Estado de Alagoas, nordeste do Brasil. O exame físico de um cão macho adulto da raça rottweiler, apresentando suspeita de leishmaniose, revelou perda de peso severa, esplenomegalia, linfonodos moderadamente aumentados, ascite, onicogrifose, alopecia generalizada, conjuntivite e presença de lesões cutâneas ulceradas localizadas nos membros posteriores. Foram coletadas amostras de medula óssea, linfonodo poplíteo, fluido peritoneal e úlcera cutânea. A partir das amostras, foram elaborados esfregaços, os quais foram corados pela hematoxilina e eosina. Inúmeras formas amastigotas foram detectadas na medula óssea, linfonodo poplíteo e úlcera cutânea. Esfregaços de fluido peritoneal revelaram a presença, n
The definitive diagnosis of peritoneal mesothelioma and its differentiation from metastatic peritoneal carcinomatosis may be difficult because of the clinical, macroscopic, and microscopic variability of the tumor. To this purpose, a combination of criteria, including the clinical picture, the gross pathologic findings, the exclusion of other primary neoplasms, and the microscopic findings, must be taken into consideration. Conventionally, these criteria may be established only after surgical exploration and extensive sampling. Experience with patients with peritoneal mesothelioma and metastatic peritoneal carcinomatosis, as well as a review of the recent imaging literature, shows excellent correlation between computed tomography or ultrasound and the operative or autopsy findings. These imaging modalities showed soft-tissue masses or nodules; thickened omentum (omental cake), peritoneum, mesentery, and bowel wall; pleural plaques; and usually disproportionally small, if any, ascites. The latter two observations may be useful in differentiating mesothelioma from carcinomatosis macroscopically. Furthermore, fine-needle aspiration biopsy, after performing wide sampling of the tumors in different locations under ultrasonic or computed tomographic guidance, produced diagnostic cytologic specimens. Thus, the need for exploratory surgery may be alleviated, and the diagnosis of peritoneal mesothelioma may be made prospectively and relatively noninvasively with the use of computed tomography or ultrasound and fine-needle aspiration biopsy. Since epidemiologic studies predict increasing incidence of this neoplasm, especially among asbestos workers, it is suggested that these techniques be seriously considered as screening methods for high-risk populations.67 references
Walkey, M M; Friedman, A C; Sohotra, P; Radecki, P D
Seventy-three abdominopelvic contrast-enhanced CT scans obtained in 60 patients with peritoneal tumor spread were reviewed retrospectively to determine the CT signs of peritoneal malignancy. Ascites was present in 54 studies (74%) and was the most common CT finding. Loculation of the fluid occurred in 25 (46%) of these. In nine (17%) of the 54, a new finding, absence of cul-de-sac fluid in the presence of generalized ascites, was noted. Parietal peritoneal thickening with contrast enhancement of the peritoneum, making the peritoneum visible as a thin line along the abdominal wall, was present in 45 (62%) of studies. This is believed to represent confluent peritoneal metastases. Small-bowel involvement was present in half of the cases (wall thickening and irregularity with or without obstruction). Tumor involvement of the omentum was visible as soft-tissue permeation of fat, enhancing nodules, and/or an omental cake. Of the 26 patients without a previously known malignancy, identification of the primary tumor in addition to peritoneal carcinomatosis was possible in 13 (50%). Appreciation of the spectrum of CT findings in peritoneal carcinomatosis is essential for accurate evaluation of scans in patients with abdominopelvic malignancies.
Bro, S; Brandi, L; Olgaard, K
levels after 2-6 weeks of treatment. No statistically significant difference was observed between the two groups. In both groups median PTH levels were kept below 2.5 times the upper normal limit for non-uraemic patients; median P concentrations below 1.80 mmol/l and median iCa levels within 1.25-1......OBJECTIVE: A comparison of (i) levels of plasma ionized calcium (Ca), phosphate (P) and iPTH, (ii) risk of hypercalcaemia and (iii) need for Al-containing P binders, in patients on CAPD treated with calcium carbonate as the main P binder and twice weekly oral doses of alfacalcidol for control...... of secondary hyperparathyroidism during a 1 year follow-up after switching from a dialysis fluid with a Ca concentration of 1.75 mmol/l to 1.25 mmol/l (n = 39) or 1.35 mmol/l (n = 37). RESULTS: In both groups, a significant initial increase of iPTH was seen. However, iPTH was again suppressed to baseline...
Kuroda, Tatsuo; Honna, Toshiro; Morikawa, Nobuyuki
Recent advances in imaging the fetus in uterine have brought about the knowledge of prenatal process of the meconium peritonitis (mp), a chemical peritonitis by intestinal perforation, which was unknown hitherto. This paper describes the retrospective examination of perinatal diagnosis, treatment and management of mp essentially based on authors' experiences. Subjects are 18 fetuses (6.9%) with mp or suspicious mp/260 with possible diseases necessary for surgery during the period Mar. 2002-Dec. 2007. All subjects received ultrasonography (US) and MR imaging and were diagnosed as mp in 12 cases (66.7%). Seven cases were found to be in the fibroadhesive type (FA), 4 in cystic type (C) and 1 in generalized type (G), and neonates with the second and third types tended to be resulted in premature birth. The causes were found by laparotomy to be due to intestinal atresia (10 cases, 83.3%), atresia complicated with aproctia (1) and midgut axial volvulus (1). FA underwent intestinal anastomosis, and C and G, peritoneal drainage followed by anastomosis. For more appropriate perinatal management and possible prenatal surgery, needed is further elucidation of clinical features and pathophysiology of the disease. (R.T.)
Effect of a syringe aspiration technique versus a mechanical suction technique and use of N-butylscopolammonium bromide on the quantity and quality of bronchoalveolar lavage fluid samples obtained from horses with the summer pasture endophenotype of equine asthma.
Bowser, Jacquelyn E; Costa, Lais R R; Rodil, Alba U; Lopp, Christine T; Johnson, Melanie E; Wills, Robert W; Swiderski, Cyprianna E
OBJECTIVE To evaluate the effect of 2 bronchoalveolar lavage (BAL) sampling techniques and the use of N-butylscopolammonium bromide (NBB) on the quantity and quality of BAL fluid (BALF) samples obtained from horses with the summer pasture endophenotype of equine asthma. ANIMALS 8 horses with the summer pasture endophenotype of equine asthma. PROCEDURES BAL was performed bilaterally (right and left lung sites) with a flexible videoendoscope passed through the left or right nasal passage. During lavage of the first lung site, a BALF sample was collected by means of either gentle syringe aspiration or mechanical suction with a pressure-regulated wall-mounted suction pump. The endoscope was then maneuvered into the contralateral lung site, and lavage was performed with the alternate fluid retrieval technique. For each horse, BAL was performed bilaterally once with and once without premedication with NBB (21-day interval). The BALF samples retrieved were evaluated for volume, total cell count, differential cell count, RBC count, and total protein concentration. RESULTS Use of syringe aspiration significantly increased total BALF volume (mean volume increase, 40 mL [approx 7.5% yield]) and decreased total RBC count (mean decrease, 142 cells/μL), compared with use of mechanical suction. The BALF nucleated cell count and differential cell count did not differ between BAL procedures. Use of NBB had no effect on BALF retrieval. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that retrieval of BALF by syringe aspiration may increase yield and reduce barotrauma in horses at increased risk of bronchoconstriction and bronchiolar collapse. Further studies to determine the usefulness of NBB and other bronchodilators during BAL procedures in horses are warranted.
R. H. Bhatt
Full Text Available Peritoneal dialysis is a technique whereby infusion of dialysis solution into the peritoneal cavity is followed by a variable dwell time and subsequent drainage. During peritoneal dialysis, solutes and fluids are exchanged between the capillary blood and the intraperitoneal fluid through a biologic membrane, the peritoneum. Inadequate renal function leads to disturbance in the removal of the extra fluid and waste products. It removes the waste product and extra fluid from the body in renal failure in small animal practice. Peritoneal dialysis is more accessible, more affordable and easier to administer to the small animal patient. The most common indication for peritoneal dialysis in dogs is acute renal failure (ARF. Peritoneal dialysis is an important therapeutic tool for mitigating clinical signs of uremia and giving the kidneys time to recover in cats with acute kidney injury when conventional therapy is no longer effective. [Vet. World 2011; 4(11.000: 517-521
Full text: Intraperitoneal seeding, the so-called peritoneal carcinomatosis (PC) is a common mechanism of spread in advanced intra-abdominal malignancies including ovarian (71%), gastric (17%) and colorectal (10%) cancers. When cancer cells from a growing primary neoplasm reach the peritoneal surface, they are carried out by the peritoneal fluid and disseminated throughout the peritoneal cavity.the location of implants development is governed mostly by peritoneal fluid circulation and by anatomic pathways formed by peritoneal reflections, namely ligaments, mesenteries and omenta. The most common sites where the peritoneal fluid may temporarily arrested facilitating implantation of cancer cells include cul-de-sac, distal small bowel mesentery, right paracolic gutter, posterior sub-hepatic space, greater omentum and subphrenic spaces. MDCT with thin collimation and i.v contrast material supplemented by multiplanar reconstructions is the primary imaging modality for the investigation of peritoneal carcinomatosis. Ascitis, contrast enhanced smooth, nodular, or plaque-like peritoneal thickening, peritoneal nodules, plaques or masses, rounded, ill-defined soft-tissue or cystic mesenteric masses, mesenteric fixation with increased attenuation values and thickening, irregular soft-tissue permeation of omental fat or confluent solid omental masses are the most frequent CT findings of peritoneal carcinomatosis. CT has a sensitivity and specificity between 85-95%, depending on the size, location and applied examination protocol. MR imaging using a post-gadolinium enhanced 3dFlASH sequence with fat saturation may alternatively
Sørensen, Mette Aamand; Jacobsen, Stine; Petersen, Lars Jelstrup
and cerebrospinal ﬂuid and blood. Only a few papers have been published within each area, indicating that few equine researchers are aware of the unique opportunities provided by the technique. This review discusses the theory and applications of microdialysis with a special emphasis on clinical and experimental...... equine studies, which may be useful to veterinary experimental and clinical researchers....
Fulton, I.C.; Anderson, B.
The most common use for nuclear medicine in equine practice is bone imaging using technetium 99m as the radionuclide. This article will describe establishment of a facility to perform equine scintigraphy, the peculiarities associated with nuclear medicine and horses and describe a variety of the pathology we identify using scintigraphy. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc
Patricia Filippsen Favaro
Full Text Available Equine influenza virus (EIV (H3N8 and H7N7 is the causative agent of equine influenza, or equine flu. The H7N7 subtype has been considered to be extinct worldwide since 1980. Affected animals have respiratory symptoms that can be worsened by secondary bacterial respiratory infection, thereby leading to great economic losses in the horse-breeding industry. In Brazil, equine influenza outbreaks were first reported in 1963 and studies on hemagglutination antibodies against viral subtypes in Brazilian horses have been conducted since then. The objective of the present review was to present the history of the emergence of EIV around the world and in Brazil and the studies that have thus far been developed on EIV in Brazilian equines.
Full Text Available Hypothyroidism is an uncommon cause of ascites. Here we describe a case of a 75 year-old female patient with spontaneous bacterial peritonitis and subclinical hypothyroidism that resolved with thyroid replacement and antibiotic therapy respectively. Ascitic fluid analysis revealed a gram-positive bacterium on gram staining. A review of the literature revealed just one other reported case of myxoedema ascites with concomitant spontaneous bacterial peritonitis and no case has till been reported of spontaneous bacterial peritonitis in subclinical hypothyroidism.
Greene, S K
The reintroduction and development of safe motorized instruments, the increased availability of continuing education, and the understanding and implementation of appropriate procedures allow practitioners to provide better dental care. Veterinarians realize that sedation, analgesia, a full-mouth speculum, and proper instrumentation are necessary to provide these services. Continued instrument design, future research, and new treatment and prophylactic protocols should have a positive impact on the future of equine dental health. New and rediscovered procedures for equilibrating equine occlusion are allowing horses to masticate more efficiently, carry a bit more comfortably, and experience improved performance. The horse, the horse owner, and the veterinary profession all benefit from providing complete equine dental care.
Full Text Available Peritonitis is a common and life-threatening complication of acute peritoneal dialysis (PD. Diagnosis requires the presence of clinical signs of peritonitis which are nonspecific and laboratory investigations [total leukocyte count (TLC, Gram-stain, and culture of PD effluent fluid] which are time-consuming and not available at the bedside. In this study, we evaluated the use of leukocyte esterase reagent strip (LERS as a bedside test to diagnose peritonitis in patients undergoing acute PD. Patients who underwent acute PD were monitored for signs and symptoms of peritonitis. PD effluent fluid analysis included TLC, absolute neutrophil count, Gram-stain, and culture for the diagnosis of peritonitis. LERS (Multistix 10SG was simultaneously dipped in PD effluent fluid and read at two minutes. Reading of + was considered as indicative of peritonitis. Twenty-one out of 166 (12.6% patients undergoing acute PD developed peritonitis. LERS detected peritonitis in 20 patients. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV of LERS were 95.2%, 95.2%, 74.1%, and 99.3%, respectively. LERS has very high sensitivity and NPV and can be used as a rapid bedside tool to exclude peritonitis in patients undergoing acute PD.
Das, B.K.; Senthilnathan, M.S.; Pradhan, P.K.; Nagabhushan, S.; Jeloka, T.K.; Sharma, R.K.
Assessment of peritoneal permeability is necessary for successful management of end-stage renal disease (ESRD) patients by continuous ambulatory peritoneal dialysis (CAPD). The objective of this study was to develop an alternative method of assessing the peritoneal permeability and to compare this method with the conventional method, the peritoneal equilibrium test, first described by Twardowski in 1987. Twenty patients undergoing regular CAPD were included in this study. Before starting the peritoneal dialysis, 370 MBq (10 mCi) technetium-99m diethylene triamine penta-acetic acid ( 99m Tc-DTPA) was injected intravenously. A standard dose of the same quantity was kept and used later for calculations. At the end of 4 h, a dialysate fluid sample (1 ml) was collected and the total dialysis effluent fluid volume was measured. Excretion of 99m Tc-DTPA into the dialysate fluid as a percentage of the injected dose was calculated. Simultaneously, standard peritoneal equilibrium test values were recorded for comparison. Peritoneal excretion of 99m Tc-DTPA ranged from 8% to 25% of the injected dose, depending on the peritoneal membrane permeability. When the results were compared with the conventional method, a good correlation (r=0.79) was found. This innovative radionuclide technique is a simple and convenient method to assess the peritoneal membrane permeability and can be used as an alternative to the peritoneal equilibrium test, which is very cumbersome and associated with many limitations. (orig.)
Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar
Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.
Magnus, Robert P
The take-home message in marketing your equine practice is simple: understand your position in the target market and the buying behavior of your current and prospective customers. Time well spent on analysis and evaluation of options can maximize customer value in the services and products you offer. This allows you to capture profit and to attain your personal and professional goals as an equine practitioner.
Kim, Tae Hoon [Dankook Univ. Hospital, Seoul (Korea, Republic of)
Sclerosing encapsulating peritonitis is a well recognized, but uncommon, complication of chronic ambulatory peritoneal dialysis. I report a case of sclerosing encapsulating peritonitis in which percutaneous catheter drainage was performed preoperatively. Ultrasonography(US) and computed tomography(CT) showed a large multi-septated cystic mass which occupied nearly all the peritoneal cavity. Percutaneous drainage with two 8.5 French catheters was preoperatively performed under fluoroscopy and about 2100 ml of bloody fluid was drained for 20 days. On follow-up CT, the size of the cyst had significantly decreased and anoperation was performed. It is considered that percutaneous catheter drainage is useful in the preoperative decompression of sclerosing encapsulating peritonitis.
Kim, Tae Hoon
Sclerosing encapsulating peritonitis is a well recognized, but uncommon, complication of chronic ambulatory peritoneal dialysis. I report a case of sclerosing encapsulating peritonitis in which percutaneous catheter drainage was performed preoperatively. Ultrasonography(US) and computed tomography(CT) showed a large multi-septated cystic mass which occupied nearly all the peritoneal cavity. Percutaneous drainage with two 8.5 French catheters was preoperatively performed under fluoroscopy and about 2100 ml of bloody fluid was drained for 20 days. On follow-up CT, the size of the cyst had significantly decreased and anoperation was performed. It is considered that percutaneous catheter drainage is useful in the preoperative decompression of sclerosing encapsulating peritonitis
Kanjanabuch, Talerngsak; Lumlertgul, Nuttha; Pearson, Lachlan J; Chatsuwan, Tanittha; Pongpirul, Krit; Leelahavanichkul, Asada; Thongbor, Nisa; Nuntawong, Gunticha; Praderm, Laksamon; Wechagama, Pantiwa; Narenpitak, Surapong; Wechpradit, Apinya; Punya, Worauma; Halue, Guttiga; Naka, Phetpailin; Jeenapongsa, Somboon; Eiam-Ong, Somchai
♦ BACKGROUND: Melioidosis, an infectious disease caused by Burkholderia pseudomallei , is endemic in Southeast Asia and Northern Australia. Although a wide range of clinical manifestations from this organism are known, peritonitis associated with peritoneal dialysis (PD) has rarely been reported. ♦ PATIENTS AND METHODS: Peritoneal dialysis patients from all regions in Thailand were eligible for the study if they had peritonitis and either peritoneal fluid or effluent culture positive for B. pseudomallei . Patient data obtained included baseline characteristics, laboratory investigations, treatments, and clinical outcomes. When possible, PD fluid and removed Tenckhoff (TK) catheters were submitted for analyses of minimal inhibitory concentration (MIC) and microbial biofilm, respectively. ♦ RESULTS: Twenty-six patients were identified who were positive for peritoneal B. pseudomallei infection. The recorded mean age was 50 ± 15 (24 - 75) years, and the majority (58%) were female. Most of the cases were farmers living in Northeastern and Northern Thailand. Almost half of the cases had diabetes. Infections were reported commonly during the monsoon season and winter. The clinical presentations of peritonitis were similar to the manifestations from other microorganisms. Nine patients (41%) died (7 from sepsis), 6 fully recovered, and 7 switched to permanent hemodialysis. The mortality was potentially associated with sepsis ( p = 0.007), infection during the monsoon season ( p = 0.017), high initial dialysate neutrophils ( p = 0.045), and high hematocrit ( p = 0.045). Although no antibiotic resistance to ceftazidime and carbapenems was detected, approximately 50% of patients died with this treatment. Microbial biofilms were identified on the luminal surface of 4 out of 5 TK catheters, but the removal of the catheter did not alter the outcomes. ♦ CONCLUSION: Peritoneal dialysis-related peritonitis due to melioidosis is uncommon but highly fatal. Increased awareness
Raaijmakers, R.; Schroder, C.; Monnens, L.A.H.; Cornelissen, E.A.M.; Warris, A.
Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573
Lee, Martin B; Bargman, Joanne M
To clarify misconceptions about the feasibility and risks of peritoneal dialysis that unnecessarily limit peritoneal dialysis uptake or continuation in patients for whom peritoneal dialysis is the preferred dialysis modality. The inappropriate choice of haemodialysis as a result of these misconceptions contributes to low peritoneal dialysis penetrance, increases transfer from peritoneal dialysis to haemodialysis, increases expenditure on haemodialysis and compromises quality of life for these patients. Peritoneal dialysis is an excellent renal replacement modality that is simple, cost-effective and provides comparable clinical outcomes to conventional in-centre haemodialysis. Unfortunately, many patients are deemed unsuitable to start or continue peritoneal dialysis because of false or inaccurate beliefs about peritoneal dialysis. Here, we examine some of these 'myths' and critically review the evidence for and against each of them. We review the feasibility and risk of peritoneal dialysis in patients with prior surgery, ostomies, obesity and mesh hernia repairs. We examine the fear of mediastinitis with peritoneal dialysis after coronary artery bypass graft surgery and the belief that the use of hypertonic glucose dialysate causes peritoneal membrane failure. By clarifying common myths about peritoneal dialysis, we hope to reduce overly cautious practices surrounding this therapy.
Hanson, R.D.; Hunter, T.B.
Rare, sporadic cases of tuberculous peritonitis do occur in the United States and other advanced countries. Because there are few descriptions of the CT appearance of the peritoneal forms of tuberculous (TB), this report illustrates a case of tuberculous peritonitis with prominent CT findings and discusses the differentiation of this entity from other, more common diseases
Val-Bernal, José-Fernando; Mayorga, Marta; García-Arranz, Pilar; Salcedo, Waleska; León, Alicia; Fernández, Fidel A
Vernix caseosa peritonitis is a rare complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Most cases occur after cesarean section. We discuss herein two patients, aged 33 and 29 years, who presented with vernix caseosa peritonitis seven to nine days after a cesarean delivery. Laparotomy was performed and it revealed neither uterine rupture nor other surgical emergencies, but cheesy exudates on the serosal surface of all viscera. Appendicectomy was performed. Histopathologic study revealed acute fibrinous serositis and a mixed cellular infiltrate, rich in neutrophils, around fetal desquamated anucleate squamous cells. Patients´ recovery was complete. Clinical diagnosis of vernix caseosa peritonitis should be suspected in patients presenting post-cesarean section with an acute abdomen. Distinctive histopathologic findings allow making the correct diagnosis. Vigilant monitoring after diagnosis is essential as delayed morbidities may appear.
van Westrhenen, Roos; Westra, Wytske M.; van den Born, Jacob; Krediet, Raymond T.; Keuning, Eelco D.; Hiralall, Johan; Dragt, Cindy; Hekking, Liesbeth H. P.
BACKGROUND: In experimental peritoneal dialysis (PD) studies, the occurrence of peritonitis is a confounder in the interpretation of effects of chronic peritoneal exposure to dialysis solutions. Since fluid cannot be drained in most experimental PD models in the rat, it is impossible to diagnose
Maxwell, Lara K
Since vaccination may not prevent disease, antiherpetic drugs have been investigated for the therapy of several equine herpesviruses. Drug efficacy has been assessed in horses with disease, but most evidence is in vitro, in other species, or empirical. Oral valacyclovir is most often administered in the therapy of equine herpesvirus type-1 (EHV-1) to protect adult horses from equine herpesvirus myeloencephalopathy, while oral acyclovir is frequently administered for EHV-5 infection in the therapy of equine multinodular pulmonary fibrosis. Other antiherpetic drugs are promising but require further investigation. Several topical drugs are also empirically used in the therapy of equine viral keratitis. Copyright © 2016 Elsevier Inc. All rights reserved.
Henriksen, M. D. L.; Andersen, P. H.; Plummer, C. E.
The last 30 years have seen many changes in the understanding of the pathogenesis and treatment of equine corneal stromal abscesses (SAs). Stromal abscesses were previously considered an eye problem related to corneal bacterial infection, equine recurrent uveitis, corneal microtrauma and corneal....... Medical and surgical treatments are now directed towards elimination of fungal and bacterial infections, reduction and replacement of diseased corneal stroma, and suppression of iridocyclitis. If the abscess and anterior uveitis do not respond satisfactorily to medical therapy, full thickness or split...
Kaiser, A; Meier, H P; Straub, R; Gerber, V
Equine Infectious Anemia (EIA) is a reportable, eradicable epizootic disease caused by the equine lentivirus of the retrovirus family which affects equids only and occurs worldwide. The virus is transmitted by blood, mainly by sanguivorous insects. The main symptoms of the disease are pyrexia, apathy, loss of body condition and weight, anemia, edema and petechia. However, infected horses can also be inapparent carriers without any overt signs. The disease is diagnosed by serological tests like the Coggins test and ELISA tests. Presently, Switzerland is offi cially free from EIA. However, Switzerland is permanently at risk of introducing the virus as cases of EIA have recently been reported in different European countries.
Tokita, N.; Raju, M.R.
Methods have been developed to distinguish subpopulations of murine peritoneal cells, and these were applied to the measurement of early changes in peritoneal cells after irradiation. The ratio of the two major subpopulations in the peritoneal fluid, lymphocytes and macrophages, was measured rapidly by means of cell volume distribution analysis as well as by hypotonic propidium iodide (PI) staining. After irradiation, dose and time dependent changes were noted in the cell volume distributions: a rapid loss of peritoneal lymphocytes, and an increase in the mean cell volume of macrophages. The hypotonic PI staining characteristics of the peritoneal cells showed two or three distinctive G 1 peaks. The ratio of the areas of these peaks was also found to be dependent of the radiation dose and the time after irradiation. These results demonstrate that these two parameters may be used to monitor changes induced by irradiation (biological dosimetry), and to sort different peritoneal subpopulations
Graney, K.; Chu, J.; Lin, P.C.
Full text: A 78-year old male in end stage renal failure (ESRF) with a background of NIDDM retinopathy, nephropathy, and undergoing continuous ambulatory peritoneal dialysis (CAPD) presented with anorexia, clinically unwell, decreased mobility and right scrotal swelling. There was no difficulty during CAPD exchange except there was a positive fluid balance Peritoneal dialysates remained clear A CAPD peritoneal study was requested. 100Mbq 99mTc Sulphur Colloid was injected into a standard dialysate bag containing dialysate. Anterior dynamic images were acquired over the abdomen pelvis while the dialysate was infused Static images with anatomical markers were performed 20 mins post infusion, before and after patient ambulation and then after drainage. The study demonstrated communication between the peritoneal cavity and the right scrotal sac. Patient underwent right inguinal herniaplasty with a marlex mesh. A repeat CAPD flow study was performed as follow up and no abnormal connection between the peritoneal cavity and the right scrotal sac was demonstrated post operatively. This case study shows that CAPD flow studies can be undertaken as a simple, minimally invasive method to evaluate abnormal peritoneal fluid flow dynamics in patients undergoing CAPD, and have an impact on dialysis management. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc
van Esch, Sadie; Krediet, Raymond T.; Struijk, Dirk G.
Despite advances in treatment and prevention, peritonitis remains a major problem in peritoneal dialysis (PD) patients with often technique failure as a consequence. The last decades the focus of PD peritonitis has changed from lowering peritonitis incidence to improvement of peritonitis outcome.
Salzer, William L
Peritoneal dialysis is an effective treatment modality for patients with end-stage renal disease. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. Data from a 2004 survey reports the percentage of patients with end-stage renal disease treated with peritoneal dialysis to be 5%–10% in economically developed regions like the US and Western Europe to as much as 75% in Mexico. This disparity is probably related to the availability and access to hemodialysis, or in some cases patient preference for peritoneal over hemodialysis. Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis. Fifty years ago, with the advent of the Tenckhoff catheter, patients averaged six episodes of peritonitis per year on peritoneal dialysis. In 2016, the International Society for Peritoneal Dialysis proposed a benchmark of 0.5 episodes of peritonitis per year or one episode every 2 years. Despite the marked reduction in peritonitis over time, peritonitis for the individual patient is problematic. The mortality for an episode of peritonitis is 5% and is a cofactor for mortality in another 16% of affected patients. Prevention of peritonitis and prompt and appropriate management of peritonitis is essential for the long-term success of peritoneal dialysis in all patients. In this review, challenges and solutions are addressed regarding the pathogenesis, clinical features, diagnosis, treatment, and prevention of peritoneal dialysis-related peritonitis from the viewpoint of an infectious disease physician.
S. P. Waghmare
Full Text Available Equine influenza virus is a leading cause of respiratory disease in the horses. The disease is the OIE listed disease of equines, ponies, mules and donkeys and spreads very fast. The sporadic outbreaks of the disease have occurred all over the country. Many cases have been reported in Delhi, Meerut, Saharanpur, Jaipur, Hisar, Calcutta, Ahmedabad. Nearly all the horses at Matheran (Hill station were infected with influenza. The disease has spread like wildfire at the stables of Royal Western India Turf Club (RWITC at Pune and suspended the Mumbai racing season for prolonged period of time resulting in marked economic losses. After affecting racing in Mumbai, Calcutta and New Delhi, the dreaded equine influenza has spread to Karnataka and Mysore. An outbreak of disease has marred the racing season across the country. The disease was first detected in Jammu & Kashmir before entering the central region Horses at the army polo clubs and Delhi equestrian center were also affected. As per the recent survey conducted by the army across India, it has been found that 5400 horses are infected so far, especially thoroughbred most severely. Nearly, 95 % of horses on a major farm in India are suspected of suffering from equine influenza. The government also banned inter-state movement of horses for three months to contain the disease. [Vet World 2010; 3(4.000: 194-197
Santhakumaran, Territa; Samad, Nasreen; Fan, Stanley L
Peritoneal dialysis peritonitis and fluid overhydration (OH) are frequent problems in peritoneal dialysis. The latter can cause gut wall oedema or be associated with malnutrition. Both may lead to increased peritonitis risk. We wished to determine if OH is an independent risk factor for peritonitis (caused by enteric organisms). Retrospectively study of patients with >2 bioimpedance assessments (Body Composition Monitor). We compared peritonitis rates of patients with above or below the median time-averaged hydration parameter (OH/extracellular water, OH/ECW). Multivariate analysis was performed to determine independent risk factors for peritonitis by enteric organism. We studied 580 patients. Peritonitis was experienced by 28% patients (followed up for an average of 17 months). The overall peritonitis rate was 1:34 patient months. Patients with low OH/ECW values had significantly lower rates of peritonitis from enteric organisms than overhydrated patients (incident rate ratio 1.53, 95% confidence interval 1.38-1.70, P peritonitis from enteric organisms when multivariate model included demographic parameters (odds ratio for a 1% increment of OH/ECW was 1.05; 95% confidence interval 1.01-1.10, P peritonitis. While this may partly be due to the high co-morbidity of patients (advanced age and diabetes), on multivariate analysis, only inclusion of nutritional parameters reduced this association. It remains to be determined if overhydration will prove to be a modifiable risk factor for peritonitis or whether malnutrition will prove to be more important. © 2015 Asian Pacific Society of Nephrology.
Camsari, T.; Celik, A.; Ozaksoy, D.; Salman, S.; Cavdar, C.; Sifil, A.
The purpose of the study was to evaluate the non-infectious complications of continuous ambulatory peritoneal dialysis (CAPD) using peritoneal computed tomography (PCT). Twenty symptomatic patients were included in the study. Initially 2000 ml of dialysate fluid was infused into the peritoneal cavity and standard peritoneal computed cavity and standard peritoneal computed tomography (SPCT) serial scans with 10 mm thickness were performed from the mid-thoracic region to the genital organs. Afterwards, 100 ml of non-ionic contrast material containing 300 mg/ml iodine was injected through the catheter and was distributed homogeneously in the intra-abdominal dialysate fluid by changing the positions of the patients; after waiting for 2-4 h, the CT scan was repeated as peritoneal contrast computed tomography (PCCT). In patients (n = 20) both SPCT and PCCT revealed 90 % (n = 18) pathological findings. But PCCT showed 60 % (n = 12) additional pathological findings. We believe that PCT is beneficial for evaluation of non-infectious complications of CAPD. But PCCT is superior to SPCT in evaluating non-infectious complications encountered in patients on CAPD treatment. (author)
Lock, J F; Eckmann, C; Germer, C-T
Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.
Patel, R.R.; Planche, K.
The peritoneal cavity is a complex anatomical structure with multiple attachments and connections. These are better understood with reference to the embryological development of this region. Armed with this knowledge, the diagnosis and assessment of a wide range of common intra-abdominal diseases becomes straightforward. This article will review and simplify the terminology, complex embryological development, and anatomy of the peritoneum, peritoneal attachments, and the reflections forming the peritoneal boundaries. Normal anatomy will be described using schematic diagrams with corresponding computed tomography (CT) and magnetic resonance imaging (MRI) images, including CT peritoneograms. The relevance of intra- and extra-peritoneal anatomy to common pathological processes will be demonstrated
Walkey, M.M.; Friedman, A.C.; Radecki, P.D.; Sohotra, P.
Seventy-three abdominopelvic CT studies in 60 patients with peritoneal tumor spread were reviewed. Ascites was the most common CT finding (74%), with loculation occurring in half. A new finding, loculation of fluid out of the cul-de-sac, is described. Parietal peritoneal thickening and enhancement was visible as a thin enhancing line along the peritoneal surface in 62% of studies. This represents the CT correlate of miliary seeding that has progressed to the point of confluence. Tumor involvement of the omentum was manifest as marbled fat, enhancing nodules, or an omental cake. Mucin-producing implants and their progression to pseydomyxoma peritonei were observed. In 26 patients without a known malignancy, a specific diagnosis was possible in 13 (50%) with identification of a primary tumor. Of 13 patients with no visible primary, six (46%) had ovarian peritoneal carcinomatosis with normal-sized ovaries or minimal adnexal pathology
Prasad, Kashi Nath; Singh, Kamini; Rizwan, Arshi; Mishra, Priyanka; Tiwari, Dinesh; Prasad, Narayan; Gupta, Amit
♦ Background: Peritoneal dialysis (PD) is an established treatment modality for end-stage renal disease (ESRD). Peritonitis remains a serious complication in PD patients and an important cause of drop-out from the program. Types of pathogens and their drug resistance patterns may determine the outcome of peritonitis. The present study was undertaken to determine the microbiology of peritonitis in PD patients, antibiotic resistance in commonly isolated bacterial pathogens and clinical outcomes. ♦ Method: We enrolled 211 patients with ESRD undergoing PD who developed peritonitis during 2002 to 2011. PD fluids were cultured and antibiotic susceptibility test of the bacterial isolates was performed. ♦ Result: A total of 303 peritonitis episodes with an overall incidence of 0.41 episodes per patient-year were recorded. Gram-positive, gram-negative, fungi, Mycobacterium tuberculosis and ≥ 2 organisms were isolated from 102 (33.7%), 89 (29.4%), 41 (13.5%), 11 (3.6%) and five (1.6%) episodes respectively; 55 (18.2%) episodes were culture negative. Coagulase-negative Staphylococcus spp. (CONS) was the most common isolate. Catheter loss and hospital admission in gram-negative peritonitis were significantly higher than in gram-positive peritonitis (36/89 (40.4%) vs 20/102 (19.6%), p peritonitis due to vancomycin-resistant enterococci, ESBL- and MBL-producing bacteria. ♦ Conclusion: Emerging antimicrobial resistance calls for prompt diagnosis and aggressive empiric therapy based on the local sensitivity data. PMID:24584592
Sadath, Shameema A; Abo Diba, Fathiya I; Nayak, Surendra; Shamali, Iman Al; Diejomaoh, Michael F
Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section. We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.
Turco, G.; Chiesa, G.M.; De Manzoni, G.
The peritoneum of the great abdominal cavity and its recesses are a blind radiographical area which can however be easily outlined by US when it contains fluid. The anatomical study of these usually virtual cavities represent the purpose of this paper. The natural contrast of the peritoneal fluid as amplified by the mechanical effect produced by an adequate amount of fluid, allows a clear visualization of the anatomy of various peritoneal structures in either upper (subphrenic, subhepatic, lesser sac, etc.) or lower (pelvic) areas. The sovramesocolic and the infracolic compartments are in comunication through the two external paracolic gutters which are the main passageways for the fluids between upper and lower compartments. In fact, peritoneal fluids are in constant movement due to different factors, such as gravity, statics, which causes the peritoneal fluids to flow into the lowest part of the peritoneal cavity, and hydrostatic pressure. Pressure differences are thought to convey fluids from various sites of the abdomen into different areas. In the lower abdomen, pressure is 3 times as much as in the upper abdomen, which causes the fluids to move into the subhepatic and subphrenic regions. The redistribution of fluids can be influenced by particular anatomical causes. The phrenicocolic ligament, e.g., is a barrier to the advancing of fluds along the left paracolic gutter, which makes the right paracolic gutter the main passageway for the fluids. This pattern explains why abscesses are more frequent in the right than in the upper left abdominal regions. Another example in the tiny Winslow opening, which does not allow inflammatory material to pass into the lesser sac in case of inflammatory processes of the great peritoneal cavity and viceversa. Moreover, pointing out fluid collections and abscesses is important, since an early diagnosis and a topografic map are essential order to plan treatment
Full Text Available Equine viral arteritis (EVA is a contagious disease of equids caused by equine artheritis virus (EAV, widespread in most countries in the world, where patients are diagnosed. The infection usually starts asymptomatic. Clinical signs indicate respiratory infection of different intensity and also abortions are present at different stages of gestation. Large prevalence of this disease in the world has become a growing economic problem. The disease is specific to a particular kind of animals, and it affects only equids (horses, donkeys, mules, mule and zebras. In countries where the infection has been confirmed, the percentage of positive animals differ. Likewise, there is difference in percentage among certain animal kinds. The highest percentage of positive animals has been found in totters and the lowest in cold-blooded.
Greaves, I; Kane, K; Richards, N T; Elliott, T S; Adu, D; Michael, J
We report an outbreak of fungal peritonitis due to Candida parapsilosis in 12 patients undergoing chronic ambulatory peritoneal dialysis (CAPD). All 12 patients were treated by removal of the CAPD catheter together with systemic antifungal therapy. There were no peritonitis-related deaths. Four patients were successfully returned to CAPD at a later date. Microbiological investigation during the outbreak demonstrated colonization of various areas of the CAPD Unit and medical ward with the organism. C. parapsilosis was also isolated from pigeon guano obtained from window-sills. The number of cases of peritonitis due to this organism decreased markedly after bird-proof netting was installed. We believe that this is the first report of an outbreak of CAPD peritonitis due to faecal carriage of C. parapsilosis by pigeons.
Mihalache, O; Bugă, C; Doran, H; Catrina, E; Bobircă, F; Andreescu, A; Mustățea, P; Pătrașcu, T
Peritonitis is the main complication of peritoneal dialysis (PD) and also an important factor for raising the cost of the method to the level of hemodialysis. Associated with PD, peritonitis is responsible for the increase of morbidity and mortality of the procedure and, at the same time, the main cause of the technique failure. Severe and prolonged peritonitis or repeated episodes of peritonitis lead to ultrafiltration failure. Peritonitis treatment should aim for a rapid remission of inflammation in order to preserve the peritoneal membrane functional integrity. The treatment of PD peritonitis consists mainly of antibiotic therapy, surgical intervention not being usually required. However, it is of outmost importance to differentiate the so-called "catheter related" peritonitis from secondary peritonitis due to visceral lesions, in which the surgical treatment comes first. The confusion between secondary and "catheter related" peritonitis may lead to serious errors in choosing the correct treatment, endangering the patient's life. The differential diagnosis between a refractory or secondary peritonitis in a peritoneal dialyzed patient may be very difficult. In front of a refractory PD peritonitis, surgical exploration must not be delayed. Also we have to keep in mind that the aim of peritonitis treatment is the saving of the peritoneal membrane and not the catheter.
Das, B.K.; Senthilnathan, M.S.; Pradhan, P.K.; Jeloka, T.K.; Nagabhushan, S.; Sharma, R.K.
Aim: Assessment of peritoneal permeability is necessary for successful management of End Stage Renal Disease (ESRD) patients by Continuous Ambulatory Peritoneal Dialysis (CAPD). Twardowski in 1987 described for the first time a method know as Peritoneal Equilibration Test (PET ) to determine peritoneal membrane characteristics. However, this test is not only cumbersome but is associated with several limitations. The objective of this study was to develop an alternative method of assessing the peritoneal permeability and compare this method with the conventional PET. Method: Twenty patients under going regular CAPD were included in this study. Before starting the peritoneal dialysis 370 MBq (10 mCi) 99mTc-DTPA was injected intravenously in the same standard precondition as for PET evaluation. A standard dose of same quantity was kept and used later for calculations. At the end of four hours a dialysate fluid sample (1 ml) was collected and the total dialysis effluent fluid volume was measured. Excretion of 99mTc-DTPA into the dialysate fluid as percentage of injected dose was calculated. Simultaneously standard PET values were recorded for comparison. Results: Peritoneal excretion of 99mTc-DTPA ranged from 8 % to 16 % of the injected dose depending upon the peritoneal membrane permeability. Depending upon the DTPA excretion the patients were divided into 4 groups: High Transporter (15% and above; High Average (12 to 15 %); Low Average (10 to 12%); Low Average (10% and less). When the results were compared with the conventional PET values, a good correlation (r=0.79) could be found. Conclusion: Determining the excretion of 99mTc-DTPA in the dialysate fluid after 4 hrs as percentage of the injected dose is a simple and convenient method to assess the peritoneal membrane permeability and can be used as an alternative technique to conventional PET which is very cumbersome and associated with many limitations
Chao, Chia-Ter; Lee, Szu-Ying; Yang, Wei-Shun; Chen, Huei-Wen; Fang, Cheng-Chung; Yen, Chung-Jen; Chiang, Chih-Kang; Hung, Kuan-Yu; Huang, Jenq-Wen
Background Bacterial infections account for most peritoneal dialysis (PD)-associated peritonitis episodes. However, anaerobic PD peritonitis is extremely rare and intuitively associated with intra-abdominal lesions. In this study, we examined the clinical characteristics of PD patients who developed anaerobic peritonitis. Methods We retrospectively identified all anaerobic PD peritonitis episodes from a prospectively collected PD registry at a single center between 1990 and 2010. Only patient...
Berg, Lise Charlotte; Mata, Xavier; Thomsen, Preben Dybdahl
Cartilage-derived retinoic acid sensitive protein (CD-RAP) also known as melanoma inhibitory activity (MIA) has already been established as a marker for chondrocyte differentiation and a number of cancerous condition sin humans. Studies have also shown that CD-RAP/MIA is a potential marker of joint......RNA in articular cartilage and chondrocytes from horses with no signs of joint disease. The expression decreased as the cells dedifferentiated in monolayer culture. We also identified an equine CD-RAP/MIA splioce variant similar to that reported in humans. The CD_RAP/MIA protein was detected in equine synovial...... fluid, serum and culture medium from chondrocyte cultures. In conclusion, CD-RAP/MIA is expressed in equine cartilage and chondrocytes, and the protein can be detected in equine serum, synovial fluid and in culture medium from chondrocyte cultures. The equine gene and resulting protein share great...
Full Text Available The objective of the study was to identify the microbiological spectrum and drug-sensitivity pattern of peritonitis in patients on continuous ambulatory peritoneal dialysis. This was a prospective study done over a period of a year-and-a-half at a tertiary-care hospital in a hilly state of India. The effluent dialysate bags from 36 consecutive patients with peritonitis were studied. One hunderd ml dialysate fluid was processed under aseptic conditions by lysis centrifugation method. Microscopy and culture was done from the deposits for bacteriological, fungal, and mycobacterial isolates. They were identified by colony morphology and their biochemical reactions. Drug susceptibility testing was done by Kirby-Bauer disc diffusion method. In 36 dialysates, 33 (91.6% dialysates were culture-positive and in 3 (8.4%, the culture was negative. A total of 36 microorganisms were isolated in 33 cultures. Among the 36 microorganisms, 19 (52.8% isolates were gram-positive, 10 (27.8% were gram-negative, 5 (13.9% were fungi, and 2 (5.6% were mycobacterial isolates. All gram-positive organisms were sensitive to ampicillin, amoxi-clavulanic acid, cefazolin, clindamycin, and vancomycin. Neither a methicillin-resistant Staphylococci aureus nor a vancomycin-resistant Enterococcus was isolated in gram-positive isolates. Gram-negative organisms were sensitive to ciprofloxacin, ceftriaxone, ceftazidime, cefepime, gentamicin, piperacillin-tazobactam and imipenem. One of the gram-negative isolate was an extended spectrum beta-lactamase producer. Gram-positive peritonitis was more frequent than gram-negative peritonitis in our continuous ambulatory peritoneal dialysis patients. Mycobacterial causes were responsible for peritonitis in patients with culture-negative peritonitis which was not responding to the conventional antimicrobial therapy.
Full Text Available Sclerosing peritonitis is a rare condition characterised by ascites, peritoneal and bowel wall thickening. Causes reported in the literature include luteal ovarian the comas, peritoneal dialysis, peritoneal chemotherapy and liver cirrhosis. We report an interesting case of a woman presenting with diarrhoea, abdominal distension, ascites and pleural effusion. She was subsequently diagnosed with Sclerosing Peritonitis caused by a degenerating fibroid which was successfully treated by Total Abdominal Hysterectomy and Bilateral Salpingoophrectomy.
Coche, Emmanuel; Lonneux, Max; Goffin, Eric
The authors describe a rare case of peritoneal transdiaphragmatic hernia discovered immediately after a car accident in a young male patient on peritoneal dialysis. The potential role of CT peritoneography and peritoneal scintigraphy to demonstrate and understand thoracic complications of ambulatory peritoneal dialysis is discussed. (orig.)
Full Text Available Eosinophilic peritonitis is an uncommon clinical entity with diagnostic considerations separate from those of tuberculous peritonitis. We report a patient on continuous ambulatory peritoneal dialysis (CAPD with eosinophilic peritonitis resulting from tuberculous peritonitis. Acid-fast stain and mycobacterial culture of peritoneal dialysis effluent were both negative result. In the peritoneal dialysis effluent and blood samples, Mycobacterium tuberculosis was detected by polymerase chain reaction analyses. The initiation of antituberculous therapy resulted in resolution of the eosionphilia in the dialysis effluent. After 14 days of antituberculous therapy, the polymerase chain reaction analyses of tuberculosis were negative for both the blood and peritoneal dialysis effluents. Evaluation of tuberculosis infection is necessary if the CAPD-related peritonitis presents with an unusual and unexplained clinical course. Polymerase chain reaction can play an important role in the diagnosis of tuberculous peritonitis in patients undergoing CAPD.
Liu, Jian; Huang, Xun; Liu, Yao; Xu, Hui; Gong, Rui'e; Li, Chunhui
To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy. Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed. Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found. Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis
Horzinek, M.C.; Haagmans, B.L.; Egberink, H.F.
Cats that have succumbed to feline infectious peritonitis, an immune- mediated disease caused by variants of feline coronaviruses, show apoptosis and T-cell depletion in their lymphoid organs. The ascitic fluid that develops in the course of the condition causes apoptosis in vitro but only in activated T cells. Since feline infectious peritonitis virus does not infect T cells, and viral proteins did not inhibit T-cell proliferation, we postulate that soluble mediators released during the infe...
Full Text Available Equine Recurrent Airway Obstruction (RAO, also known as heaves or broken wind, is one of the most common disease in middle-aged horses. Inflammation of the airway is inducted by organic dust exposure. This disease is characterized by neutrophilic inflammation, bronchospasm, excessive mucus production and pathologic changes in the bronchiolar walls. Clinical signs are resolved in 3-4 weeks after environmental changes. Horses suffering from RAO are susceptible to allergens throughout their lives, therefore they should be properly managed. In therapy the most importanthing is to eliminate dustexposure, administration of corticosteroids and use bronchodilators to improve pulmonary function.
Jun 2, 1971 ... efficiency due to vasodilatation of the peritoneal vessels.' DIALYSIS ... osmotic load in the face of a decreasing blood urea and may thus help ... infection, heart failure, sodium and volume de- depletion; ..... around the catheter.
Manoel João Batista Castello Girão
Full Text Available Carcinomas of peritoneal origin represent a seldom diagnosed entity of unknown etiology, with important implications in terms of prophylactic oophorectomy. Initially described in patients belonging to families at high risk for ovarian cancer, it possibly has a pathogeny similar to that of endosalpingiosis and of some cases of endometriosis. We report a case of peritoneal borderline mucinous carcinoma with an anatomopathological diagnosis of normal ovaries.
Vogel, H.; Garcia Rodriguez, H.C.; Universidad de Monterrey
Examination of a peritonitis tuberculosa in three children, each of one year of age, resulted in an X-ray film morphology of the type known in peritonitis tuberculosa in adults. The identification of extended loops of constant localisation is a pointer in this direction. Diagnosis becomes even more probable if the clinical pattern is also considered or if there are changes in the lung. (orig.) [de
Although diagnostic images can be obtained with traditional rare-earth film-screen combinations, digital radiography (DR) has enhanced the ability of the general practitioner to obtain diagnostic radiographs of the equine head. With the widespread availability of DR in equine practices, the practitioner can more readily learn the correct positioning for the various projections of the equine head that are used to evaluate the dentition and sinuses. Digital systems provide rapid processing of the image, enabling the practitioner to correct positioning errors and retake the image without significant delay. Copyright © 2013 Elsevier Inc. All rights reserved.
Jenner, F; van Osch, G J V M; Weninger, W; Geyer, S; Stout, T; van Weeren, René; Brama, P; van Weeren, René
REASONS FOR PERFORMING STUDY: Articular cartilage regeneration is the focus and goal of considerable research effort. Since articular chondrocytes descend from a distinct cohort of progenitor cells located in embryonic nascent joints (interzones), establishing the timing of equine interzone
A mixture of St. John's wort and sea buckthorn oils regresses endometriotic implants and affects the levels of inflammatory mediators in peritoneal fluid of the rat: A surgically induced endometriosis model.
İlhan, Mert; Süntar, İpek; Demirel, Mürşide Ayşe; Yeşilada, Erdem; Keleş, Hikmet; Küpeli Akkol, Esra
Sea buckthorn (Hippophae rhamnoides L.) and St. John's wort (Hypericum perforatum L.) are used as an emmenagog and for the treatment of other gynecological disorders including uterus inflammation and endometriosis. The aim of the present study is to investigate the potential of a mixture of sea buckthorn and St. John's wort oils (HrHp oil) in the treatment of endometriosis. The activity was assessed in surgically induced endometriosis in rats. A 15-mm piece of endometrium was sutured into the abdominal wall. Twenty-eight days later, a second laparotomy was performed to calculate the endometrial foci areas and to score intra-abdominal adhesions. The rats were treated with either vehicle, HrHp oil formulation, or the reference (buserelin acetate). At the end of the experiment all rats were sacrificed and endometriotic foci areas and intra-abdominal adhesions were re-evaluated. The tissue sections were analyzed histopathologically. Peritoneal fluids of the experimental animals were collected in order to detect the levels of tumor necrosis factor-α, vascular endothelial growth factor, and interleukin-6, which might be involved in the etiology of endometriosis. In the HrHp oil-treated group, the volumes of endometriotic implants were found to be significantly decreased (from 50.8 mm 3 to 18.6 mm 3 , pnecrosis factor-α decreased from 7.02±1.33 pg/mL to 4.78±1.02 pg/mL (pvascular endothelial growth factor from 17.39±8.52 pg/mL to 9.67±5.04 pg/mL (ptreatment. HrHp oil may be a promising alternative for the treatment of endometriosis. Copyright © 2016. Published by Elsevier B.V.
Kim, Ji-Yeon; Lee, Dong-Hyung; Joo, Jong-Kil; Jin, Jun-O; Wang, Ji-Won; Hong, Young-Seoub; Kwak, Jong-Young; Lee, Kyu-Sup
Intraperitoneal immuno-inflammatory changes may be associated with the pathogenesis of endometriosis. We evaluated the effects of peritoneal fluid obtained from patients with endometriosis (ePF) on the release of interferon-gamma-induced protein-10 (IP-10/CXCL10) and interleukin-8 (IL-8/CXCL8) by neutrophils, CD4(+) T cells, and monocytes. Neutrophils, CD4(+) T cells, and monocytes were cultured with ePF and the chemokine levels in the supernatants were then measured using enzyme-linked immunosorbent assay. The addition of ePF to cultures of CD4(+) T cells led to a significant increase in the release of IP-10 when compared with control PF without endometriosis (cPF). There was a positive correlation between the levels of IL-8 and IP-10 in ePF (R = 0.89, P = 0.041), but not between the levels of IP-10 and IL-8 released by neutrophils, CD4(+) T cells, and monocytes. The levels of IP-10 in ePF were positively correlated with the release of IP-10 by ePF-treated neutrophils (R = 0.89, P ePF significantly enhanced the interferon-gamma-induced release of IP-10 by nuetrophils and CD4(+) T cells. These findings suggest that neutrophils and T cells release differential levels of IP-10 and IL-8 in response to stimulation with ePF, and that these cells are a major source of IP-10 in the PF of endometriosis patients.
Full Text Available Abstract Background Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. Methods From January 1992 and January 2002 a total of 935 patients (mean age 42.3 ± 17.2 years underwent emergent and/or urgent surgery. Among them, 602 (64.3% were operated on laparoscopically (of whom 112 -18.7% – with peritonitis, according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. Results The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat. of cases, and 90.6% (87 of these patients were treated successfully by Laparoscopy. Conclusion Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal
Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG
Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.
Bakir, N.; Surachno, S.; Sluiter, W. J.; Struijk, D. G.
The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed. We
Arnold, Julia; Barcena de Arellano, Maria L; Rüster, Carola; Vercellino, Giuseppe F; Chiantera, Vito; Schneider, Achim; Mechsner, Sylvia
To investigate possible mechanisms of pain pathophysiology in patients with peritoneal endometriosis, a clinical study on sensory and sympathetic nerve fibre sprouting in endometriosis was performed. Peritoneal lesions (n=40) and healthy peritoneum (n=12) were immunostained and analysed with anti-protein gene product 9.5 (PGP 9.5), anti-substance P (SP) and anti-tyrosine hydroxylase (TH), specific markers for intact nerve fibres, sensory nerve fibres and sympathetic nerve fibres, respectively, to identify the ratio of sympathetic and sensory nerve fibres. In addition, immune cell infiltrates in peritoneal endometriotic lesions were analysed and the nerve growth factor (NGF) and interleukin (IL)-1β expression was correlate with the nerve fibre density. Peritoneal fluids from patients with endometriosis (n=40) and without endometriosis (n=20) were used for the in vitro neuronal growth assay. Cultured chicken dorsal root ganglia (DRG) and sympathetic ganglia were stained with anti-growth associated protein 43 (anti-GAP 43), anti-SP and anti-TH. We could detect an increased sensory and decreased sympathetic nerve fibres density in peritoneal lesions compared to healthy peritoneum. Peritoneal fluids of patients with endometriosis compared to patients without endometriosis induced an increased sprouting of sensory neurites from DRG and decreased neurite outgrowth from sympathetic ganglia. In conclusion, this study demonstrates an imbalance between sympathetic and sensory nerve fibres in peritoneal endometriosis, as well as an altered modulation of peritoneal fluids from patients with endometriosis on sympathetic and sensory innervation which might directly be involved in the maintenance of inflammation and pain. Copyright © 2011 Elsevier Inc. All rights reserved.
Bundgaard, Louise; Jacobsen, Stine; Sørensen, Mette Aamand
Progress in MS-based methods for veterinary research and diagnostics is lagging behind compared to the human research, and proteome data of domestic animals is still not well represented in open source data repositories. This is particularly true for the equine species. Here we present a ﬁrst...... Equine PeptideAtlas encompassing high-resolution tandem MS analyses of 51 samples representing a selection of equine tissues and body ﬂuids from healthy and diseased animals. The raw data were processed through the Trans-Proteomic Pipeline to yield high quality identiﬁcation of proteins and peptides....... The current release comprises 24 131 distinct peptides representing 2636 canonical proteins observed at false discovery rates of 0.2% at the peptide level and 1.4% at the protein level. Data from the Equine PeptideAtlas are available for experimental planning, validation of new datasets, and as a proteomic...
Kihm, Lars P.; Müller-Krebs, Sandra; Klein, Julia; Ehrlich, Gregory; Mertes, Laura; Gross, Marie-Luise; Adaikalakoteswari, Antonysunil; Thornalley, Paul J.; Hammes, Hans-Peter; Nawroth, Peter P.; Zeier, Martin; Schwenger, Vedat
Residual renal function and the integrity of the peritoneal membrane contribute to morbidity and mortality among patients treated with peritoneal dialysis. Glucose and its degradation products likely contribute to the deterioration of the remnant kidney and damage to the peritoneum. Benfotiamine decreases glucose-induced tissue damage, suggesting the potential for benefit in peritoneal dialysis. Here, in a model of peritoneal dialysis in uremic rats, treatment with benfotiamine decreased peri...
Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO₂ pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO₂, N₂O and O₂ seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no
van Esch, Sadie; van Diepen, Anouk T. N.; Struijk, Dirk G.; Krediet, Raymond T.
♦ Preservation of the peritoneum is required for long-term peritoneal dialysis (PD). We investigated the effect of multiple peritonitis episodes on peritoneal transport. ♦ Prospectively collected data from 479 incident PD patients treated between 1990 and 2010 were analyzed, using strict inclusion
Cho, Yeoungjee; Struijk, Dirk Gijsbert
Peritoneal dialysis (PD)-related peritonitis remains to be one of the most frequent and serious complications of PD. In this study, existing literature has been reviewed on PD peritonitis caused by atypical organisms and antibiotic resistant organisms and their impact on patient outcomes. Although
Fadok, Valerie A
Horses develop many skin and respiratory disorders that have been attributed to allergy. These disorders include pruritic skin diseases, recurrent urticaria, allergic rhinoconjunctivitis, and reactive airway disease. Allergen-specific IgE has been detected in these horses, and allergen-specific immunotherapy is used to ameliorate clinical signs. The best understood atopic disease in horses is insect hypersensitivity, but the goal of effective treatment with allergen-specific immunotherapy remains elusive. In this review, updates in pathogenesis of allergic states and a brief mention of the new data on what is known in humans and dogs and how that relates to equine allergic disorders are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.
Borucki, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)
Eastern equine encephalitis virus (EEEV) is a mosquito-borne virus capable of causing large outbreaks of encephalitis in humans and horses. In North America, EEEV infection has a very high mortality rate in humans, and survivors often suffer severe neurological sequelae. Interestingly, EEEV infections from South American isolates are generally subclinical. Although EEEV is divided into two antigenic varieties and four lineages, only eleven isolates have been sequenced and eight of these are from the North American variety (Lineage I). Most sequenced strains were collected from mosquitoes and only one human isolate has been sequenced. EEEV isolates exist from a variety of hosts, vectors, years, and geographical locations and efforts should focus on sequencing strains that represent this diversity.
Johnson, David W.; Brown, Fiona G.; Clarke, Margaret; Boudville, Neil; Elias, Tony J.; Foo, Marjorie W.Y.; Jones, Bernard; Kulkarni, Hemant; Langham, Robyn; Ranganathan, Dwarakanathan; Schollum, John; Suranyi, Michael G.; Tan, Seng H.; Voss, David
♦ Background: A multicenter, multi-country randomized controlled trial (the balANZ study) recently reported that peritonitis rates significantly improved with the use of neutral-pH peritoneal dialysis (PD) solutions low in glucose degradation products (“biocompatible”) compared with standard solutions. The present paper reports a secondary outcome analysis of the balANZ trial with respect to peritonitis microbiology, treatment, and outcomes. ♦ Methods: Adult incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. ♦ Results: The safety population analysis for peritonitis included 91 patients in each group. The unadjusted geometric mean peritonitis rates in those groups were 0.30 [95% confidence interval (CI): 0.22 to 0.41] episodes per patient-year for the biocompatible group and 0.49 (95% CI: 0.39 to 0.62) episodes per patient-year for the control group [incidence rate ratio (IRR): 0.61; 95% CI: 0.41 to 0.90; p = 0.01]. When specific causative organisms were examined, the rates of culture-negative, gram-positive, gram-negative, and polymicrobial peritonitis episodes were not significantly different between the biocompatible and control groups, although the biocompatible group did experience a significantly lower rate of non-pseudomonal gram-negative peritonitis (IRR: 0.41; 95% CI: 0.18 to 0.92; p = 0.03). Initial empiric antibiotic regimens were comparable between the groups. Biocompatible fluid use did not significantly reduce the risk of peritonitis-associated hospitalization (adjusted odds ratio: 0.80; 95% CI: 0.48 to 1.34), but did result in a shorter median duration of peritonitis-associated hospitalization (6 days vs 11 days, p = 0.05). Peritonitis severity was more likely to be rated as mild in the biocompatible group (37% vs 10%, p = 0.001). Overall peritonitis-associated technique failures and peritonitis-related deaths were comparable in the two groups
Nessim, Sharon J.; Nisenbaum, Rosane; Bargman, Joanne M.; Jassal, Sarbjit V.
♦ Background: Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. ♦ Methods: Using data collected in the Canadian multicenter Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. ♦ Results: During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) had at least 2 episodes with the same organism. The organism most commonly causing repeat infection was coagulase-negative Staphylococcus (CNS), accounting for 65.7% of cases. Compared with peritonitis caused by other organisms, a first CNS peritonitis episode was associated with an increased risk of subsequent CNS peritonitis within 1 year (odds ratio: 2.1; 95% confidence interval: 1.5 to 2.8; p peritonitis, 48% of repeat episodes occurred within 6 months of the earlier episode. ♦ Conclusions: In contrast to previous data, we did not find a high proportion of patients with multiple peritonitis episodes caused by the same organism. Coagulase-negative Staphylococcus was the organism most likely to cause peritonitis more than once in a given patient, and a prior CNS peritonitis was associated with an increased risk of CNS peritonitis within the subsequent year. PMID:22215659
Notgrass, Clayton G.; Pettinelli, J. Douglas
This article describes the Equine Assisted Growth and Learning Association's (EAGALA) experiential model called "Equine Assisted Psychotherapy" (EAP). EAGALA's model is based on the Association for Experiential Education's (AEE) tenets and is focused on the learner's experience with horses. Drawing on the historical use of equines in the…
van Diepen, Anouk T. N.; van Esch, Sadie; Struijk, Dirk G.; Krediet, Raymond T.
Little or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of
Shaun K Morris
Full Text Available Rothia dentocariosa is a commensal organism of the human oropharynx. Clinical infection due to this organism is rare. A case of recurrent peritoneal dialysis-related peritonitis caused by R dentocariosa and a review of the literature is reported. Isolation of R dentocariosa from dialysate fluid should not be dismissed as a contaminant. Although there are no interpretive criteria for antimicrobial susceptibility testing, R dentocariosa appears to be susceptible to a variety of antibiotics including beta-lactams, vancomycin and aminoglycosides. Optimal therapy of peritoneal dialysis peritonitis caused by this organism may also require removal of the catheter.
Krediet, R. T.
New peritoneal dialysis (PD) patients have a better survival than new haemodialysis (HD) patients in the first years on dialysis. During long-term treatment, this changes into a survival advantage for HD. The superior initial survival on PD is related to a better preservation of residual renal
Mar 27, 2015 ... not be familiar with the entity, can potentially be confused with malignant or parasitic lesions. Familiarity with their characteristic computed tomographic ... preventing unnecessary surgical intervention in an asymptomatic patient.3,4 It is important to differentiate giant peritoneal loose bodies from lesions such ...
Woo, Young Hoon; Oh, Yeon Hee; Kim, Hong; Kim, Jung Sik; Woo, Seong Ku; Kim, Ok Bae; Joo, Yang Goo
The peritoneal mesothelioma is a rare neoplasm which arises from the peritoneal lining of the abdomen, tending to spread along the peritoneal cavity and to invade abdominal organs. Authors report the CT findings of 4 patients with histologically proven peritoneal mesothelioma seen at Dongsan Medical Center, School of Medicine, Keimyung University. None of them had a history of exposure to asbestos and no clear etiologic factor could be determined in any patient. CT showed peritoneal and mesenteric thickenings in all cases, omental thickenings in 3 cases, peritoneal nodules, mesenteric masses or omental masses in 2 cases each other, bowel wall involvement in 1 case, and disproportionally small ascites in 2 cases. Distant hematogenous metastases to the liver and retroperitoneal lymph nodes were seen in 1 case. Our experience with 4 peritoneal mesotheliomas as well as a review of the recent imaging literature shows excellent correlation between computed tomography and the operitoneoscopic findings
Full Text Available Peritonitis is one of the most important causes of treatment failure in peritoneal dialysis (PD patients. This study describes changes in characteristics of causative organisms in PD-related peritonitis and antimicrobial susceptibility.In this single center study we analyzed retrospective 487 susceptibility profiles of the peritoneal fluid cultures of 351 adult patients with peritonitis from 1979 to 2014 (divided into three time periods, P1-P3.Staphylococcus aureus decreased from P1 compared to P2 and P3 (P<0.05 and P<0.01, respectively. Methicillin-resistant S. aureus (MRSA occurred only in P3. Methicillin-resistant Staphylococcus epidermidis (MRSE increased in P3 over P1 and P2 (P <0.0001, respectively. In P2 and P3, vancomycin resistant enterococci were detected. The percentage of gram-negative organisms remained unchanged. Third generation cephalosporin resistant gram-negative rods (3GCR-GN were found exclusively in P3. Cefazolin-susceptible gram-positive organisms decreased over the three decades (93% in P1, 75% in P2 and 58% in P3, P<0.01, P<0.05 and P<0.0001, respectively. Vancomycin susceptibility decreased and gentamicin susceptibility in gram-negatives was 94% in P1, 82% in P2 and 90% in P3. Ceftazidim susceptibility was 84% in P2 and 93% in P3.Peritonitis caused by MSSA decreased, but peritonitis caused by MRSE increased. MRSA peritonitis is still rare. Peritonitis caused by 3GCR-GN is increasing. An initial antibiotic treatment protocol should be adopted for PD patients to provide continuous surveillance.
Gowda, Keshava Murty Narayana; Zidan, Marwan; Walters, Henry L; Delius, Ralph E; Mastropietro, Christopher W
We aimed to determine whether infants undergoing cardiac surgery would more efficiently attain negative fluid balance postoperatively with passive peritoneal drainage as compared to traditional pleural drainage. A prospective, randomized study including children undergoing repair of tetralogy of Fallot (TOF) or atrioventricular septal defect (AVSD) was completed between September 2011 and June 2013. Patients were randomized to intraoperative placement of peritoneal catheter or right pleural tube in addition to the requisite mediastinal tube. The primary outcome measure was fluid balance at 48 hours postoperatively. Variables were compared using t tests or Fisher exact tests as appropriate. A total of 24 patients were enrolled (14 TOF and 10 AVSD), with 12 patients in each study group. Mean fluid balance at 48 hours was not significantly different between study groups, -41 ± 53 mL/kg in patients with periteonal drainage and -9 ± 40 mL/kg in patients with pleural drainage (P = .10). At 72 hours however, postoperative fluid balance was significantly more negative with peritoneal drainage, -52.4 ± 71.6 versus +2.0 ± 50.6 (P = .04). On subset analysis, fluid balance at 48 hours in patients with AVSD was more negative with peritoneal drainage as compared to pleural, -82 ± 51 versus -1 ± 38 mL/kg, respectively (P = .02). Fluid balance at 48 hours in patients with TOF was not significantly different between study groups. Passive peritoneal drainage may more effectively facilitate negative fluid balance when compared to pleural drainage after pediatric cardiac surgery, although this benefit is not likely universal but rather dependent on the patient's underlying physiology. © The Author(s) 2014.
Johnson, David W.; McDonald, Stephen P.; Boudville, Neil; Borlace, Monique; Badve, Sunil V.; Sud, Kamal; Clayton, Philip A.
Background and objectives There is conflicting evidence comparing peritonitis rates among patients treated with continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). This study aims to clarify the relationship between peritoneal dialysis (PD) modality (APD versus CAPD) and the risk of developing PD-associated peritonitis. Design, setting, participants, & measurements This study examined the association between PD modality (APD versus CAPD) and the risks, microbiology, and clinical outcomes of PD-associated peritonitis in 6959 incident Australian PD patients between October 1, 2003, and December 31, 2011, using data from the Australia and New Zealand Dialysis and Transplant Registry. Median follow-up time was 1.9 years. Results Patients receiving APD were younger (60 versus 64 years) and had fewer comorbidities. There was no association between PD modality and time to first peritonitis episode (adjusted hazard ratio [HR] for APD versus CAPD, 0.98; 95% confidence interval [95% CI], 0.91 to 1.07; P=0.71). However, there was a lower hazard of developing Gram-positive peritonitis with APD than CAPD, which reached borderline significance (HR, 0.90; 95% CI, 0.80 to 1.00; P=0.05). No statistically significant difference was found in the risk of hospitalizations (odds ratio, 1.12; 95% CI, 0.93 to 1.35; P=0.22), but there was a nonsignificant higher likelihood of 30-day mortality (odds ratio, 1.33; 95% CI, 0.93 to 1.88; P=0.11) at the time of the first episode of peritonitis for patients receiving APD. For all peritonitis episodes (including subsequent episodes of peritonitis), APD was associated with lower rates of culture-negative peritonitis (incidence rate ratio [IRR], 0.81; 95% CI, 0.69 to 0.94; P=0.002) and higher rates of gram-negative peritonitis (IRR, 1.28; 95% CI, 1.13 to 1.46; P=0.01). Conclusions PD modality was not associated with a higher likelihood of developing peritonitis. However, APD was associated with a borderline
Alvarez, Eduardo; Castillo, Alvaro; Iturrieta, Isabel
Fungal peritonitis is a relatively uncommon infection in peritoneal dialysis patients. However, it can be associated with significant morbimortality. In recent reports, Candida species and other filamentous fungi have been reported as being aetiological agents. Thermoascus species are ubiquitous, thermophilic fungi, with an anamorph in the Paecilomyces genus. Here we present the first report of fungal peritonitis by Thermoascus crustaceus from Chile. We present the case of an 83-year-old female patient, with a history of cholecystectomy, hernia repair, severe arterial hypertension, hip and knee osteoarthritis and several episodes of peritoneal dialysis with a cloudy exudate. Bacterial cultures were negative. In addition, a history of two months with intermittent fever peaks mainly in the evening was reported. Blood culture bottles inoculated with peritoneal fluid revealed the presence of fungal growth. Morphological and molecular studies allowed us to identify the aetiological agent as Thermoascus crustaceus. An antifungal susceptibility test was performed using the M38-A2 method, developed by the Clinical and Laboratory Standards Institute (CLSI). The MIC values to amphotericin B, itraconazole, voriconazole and echinochandins were 0.5, 0.25, 0.25 and 0.125μg/ml, respectively. Antifungal treatment with amphotericin B was prescribed, with good patient progress. Fungal peritonitis is a very rare entity. Moreover, the spectrum of fungal pathogens continues to expand, a reason for which morphological and molecular studies are necessary for a rapid diagnosis. Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.
Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia
Sequential peritoneal equilibration test (sPET) is based on the consecutive performance of the peritoneal equilibration test (PET, 4-hour, glucose 2.27%) and the mini-PET (1-hour, glucose 3.86%), and the estimation of peritoneal transport parameters with the 2-pore model. It enables the assessment of the functional transport barrier for fluid and small solutes. The objective of this study was to check whether the estimated model parameters can serve as better and earlier indicators of the changes in the peritoneal transport characteristics than directly measured transport indices that depend on several transport processes. 17 patients were examined using sPET twice with the interval of about 8 months (230 ± 60 days). There was no difference between the observational parameters measured in the 2 examinations. The indices for solute transport, but not net UF, were well correlated between the examinations. Among the estimated parameters, a significant decrease between the 2 examinations was found only for hydraulic permeability LpS, and osmotic conductance for glucose, whereas the other parameters remained unchanged. These fluid transport parameters did not correlate with D/P for creatinine, although the decrease in LpS values between the examinations was observed mostly for patients with low D/P for creatinine. We conclude that changes in fluid transport parameters, hydraulic permeability and osmotic conductance for glucose, as assessed by the pore model, may precede the changes in small solute transport. The systematic assessment of fluid transport status needs specific clinical and mathematical tools beside the standard PET tests.
Fielding, C Langdon
With advances in technology and owner education, field management in equine veterinary medicine continues to evolve. Equine gastrointestinal disease is one of the most common types of emergencies evaluated by equine practitioners, and many of these patients can be effectively managed in the field. Although the equine veterinarian must make numerous decisions, fluid therapy, pain management, and antimicrobial use are 3 of the major choices that must be addressed when initiating field treatment of equine gastrointestinal disease. This article addresses the practical use of these 3 treatment categories that are essential to field practice. Copyright © 2018 Elsevier Inc. All rights reserved.
Matsuoka, Y.; Itai, Y.; Ohtomo, K.; Nishikawa, J.; Sasaki, Y.
Peritoneal calcification is noted in peritoneal dissemination from serious cystoadenocarcinoma of the ovary, pseudomyxoma peritonei and meconium peritonitis. This article discusses a case of peritoneal disseminated calcification from gastric carcinoma. To the author's knowledge, this is the first report in English literature of gastric cancer showing peritoneal calcification. (author). 10 refs.; 1 fig
Horzinek, M.C.; Haagmans, B.L.; Egberink, H.F.
Cats that have succumbed to feline infectious peritonitis, an immune- mediated disease caused by variants of feline coronaviruses, show apoptosis and T-cell depletion in their lymphoid organs. The ascitic fluid that develops in the course of the condition causes apoptosis in vitro but only in
Sattar, Z.; Iqbal, M.
Introduction: Diagnostic laparoscopy allows the visual examination and documentation of intra-abdominal organs in order to detect any pathology. It is an important tool for final minimally invasive exploration of patients with abdominal tuberculosis, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. Objective: To determine the frequency of peritoneal tuberculosis using diagnostic laparoscopy in clinically suspected cases of peritoneal tuberculosis. Study Design: Cross sectional survey. Setting: The study was conducted in all the four Surgical Wards on surgical floor of Mayo Hospital Lahore. Duration of Study with Dates: Six months (1st July 2009 to 31st December 2009). Material and Methods: 35 Patients aged between 13-60 years with clinical suspicion of peritoneal tuberculosis were selected. The patients underwent the procedure accordingly. Per operative diagnosis of peritoneal tuberculosis made on the basis of presence of any or all of the operative (laparoscopic) findings such as multiple peritoneal adhesions, fibrous bands, whitish peritoneal tubercles, omental thickening and ascites. Diagnosis was confirmed with histopathology of peritoneal tissue biopsy. Also the biochemical analysis and culture sensitivity of ascetic fluid was routinely performed if any ascites is present. Results: Out of 35 patients, 40% were males and 60% females with mean age of 24.91+-6.69 years. The Laparoscopic findings of peritoneal tuberculosis were whitish peritoneal tubercles (57.2%) peritoneal adhesions (28.6%), ascites (17.2%), omental thickening (14.3%), fibrous bands (11.4%) and swollen edematous appendix (5.7%). Eighty percent were labeled with diagnosis of peritoneal tuberculosis on basis of diagnostic laparoscopy. These patients were confirmed to have peritoneal tuberculosis on histopathology of tissue biopsy. Conclusion: Diagnostic laparoscopy is useful in patients with suspected peritoneal
Kihm, Lars P; Müller-Krebs, Sandra; Klein, Julia; Ehrlich, Gregory; Mertes, Laura; Gross, Marie-Luise; Adaikalakoteswari, Antonysunil; Thornalley, Paul J; Hammes, Hans-Peter; Nawroth, Peter P; Zeier, Martin; Schwenger, Vedat
Residual renal function and the integrity of the peritoneal membrane contribute to morbidity and mortality among patients treated with peritoneal dialysis. Glucose and its degradation products likely contribute to the deterioration of the remnant kidney and damage to the peritoneum. Benfotiamine decreases glucose-induced tissue damage, suggesting the potential for benefit in peritoneal dialysis. Here, in a model of peritoneal dialysis in uremic rats, treatment with benfotiamine decreased peritoneal fibrosis, markers of inflammation, and neovascularization, resulting in improved characteristics of peritoneal transport. Furthermore, rats treated with benfotiamine exhibited lower expression of advanced glycation endproducts and their receptor in the peritoneum and the kidney, reduced glomerular and tubulointerstitial damage, and less albuminuria. Increased activity of transketolase in tissue and blood contributed to the protective effects of benfotiamine. In primary human peritoneal mesothelial cells, the addition of benfotiamine led to enhanced transketolase activity and decreased expression of advanced glycation endproducts and their receptor. Taken together, these data suggest that benfotiamine protects the peritoneal membrane and remnant kidney in a rat model of peritoneal dialysis and uremia. Copyright © 2011 by the American Society of Nephrology
Chakma, Sujit M.; Singh, Rahul L.; Parmekar, Mahadev V.; Singh, K.H. Gojen; Kapa, Buru; Sharatchandra, K.H.; Longkumer, Amenla T.; Rudrappa, Santhosh
Introduction: Perforation peritonitis mostly results from the perforation of a diseased viscus. Other causes of perforation include abdominal trauma, ingestion of sharp foreign body and iatrogenic perforation. The diagnosis is mainly based on clinical grounds. Plain abdominal X-rays (erect) may reveal dilated and oedematous intestines with pneumoperitoneum. Ultrasound and CT scan may diagnose up to 72% and 82% of perforation respectively. The present study was carried out to study various etiological factors, modes of clinical presentation, morbidity and mortality patterns of perforation peritonitis presented in the RIMS hospital, Imphal, India. Material and Methods: The study was conducted from September 2010 to August 2012 on 490 cases of perforation peritonitis admitted and treated in the Department of Surgery. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Results: A total of 490 patients of perforation peritonitis were included in the study, with mean age of 48.28 years. 54.29% patients were below 50 years and 45.71% patients were above 50 years. There were 54.29% male patients and 45.71% female patients. Only 30% patients presented within 24 hours of onset of symptoms, 31.43% patients presented between 24 to 72 hours and 38.57% patients presented 72 hours after the onset of symptoms. Mean duration of presentation was 54.7 hours. Overall 469 patients were treated surgically and 21 patients were managed conservatively. Overall morbidity and mortality recorded in this study were 52.24% and 10% respectively. PMID:24392388
Tani, Hirohiko; Sato, Yukiyasu; Ueda, Masashi; Miyazaki, Yumiko; Suginami, Koh; Horie, Akihito; Konishi, Ikuo; Shinomura, Tamayuki
Sampson's theory cannot explain why only some cycling women develop peritoneal endometriosis. Few studies have focused on the pelvic peritoneum, which receives regurgitated endometrial tissues. We hypothesized that molecular alterations in the peritoneum are involved in the development of peritoneal endometriosis and conducted a microarray analysis to compare macroscopically normal peritoneum sampled from women with peritoneal endometriosis (endometriotic peritoneum) and those without (non-endometriotic peritoneum). Versican, a major proteoglycan component of the extracellular matrix, is one of the molecules up-regulated in endometriotic peritoneum. To investigate the role of versican in peritoneal endometriosis. Design, Patients, and Main Outcome Measure: Endometriotic peritoneum and non-endometriotic peritoneum were subjected to RT-PCR, immunostaining, and Western blotting. The versican V1 isoform was stably transfected into Chinese hamster ovary cells (CHO-V1), and the effects of CHO-V1-derived conditioned medium (V1-CM) on primary human endometrial stromal cells were investigated with attachment, invasion, and proliferation assays. The effects of peritoneal fluid collected from endometriotic women (endometriotic PF) or cytokines/growth factors, which were shown to be elevated in endometriotic PF, on versican expression in a human peritoneal cell line (HMrSV5) were also examined. Versican V1 expression levels were significantly higher in endometriotic peritoneum. In vitro, V1-CM promoted attachment to the HMrSV5 cell monolayer as well as the Matrigel invasion of endometrial stromal cells. Although versican V1 expression was up-regulated by TGF-β1 in HMrSV5 cells, it remained unchanged in endometriotic PF. Our results suggest the involvement of peritoneal versican in the development of peritoneal endometriosis.
Chacon, Alexander C; Phillips, Brett E; Chacon, Miranda A; Brunke-Reese, Deborah; Kelleher, Shannon L; Soybel, David I
Recent studies suggest that purified omega-3 fatty acids may attenuate acute inflammation and hasten the transition to healing. In this study, we tested the hypothesis that pretreatment with omega-3-rich fish oil (FO) would promote resolution of peritoneal inflammation through production of specific lipid mediators. C57/BL6 mice were given a daily 200-μL oral gavage of saline (CTL) or FO (1.0-1.5 g/kg/d docosahexaenoic acid and 1.3-2.0 g/kg/d eicosapentaenoic acid) for 7 d before chemical peritonitis was induced with thioglycollate. Peritoneal lavage fluid was collected before induction and at days 2 and 4 after peritonitis onset. Prostaglandin E2 (PGE2), Leukotriene B4 (LTB4), Resolvin D1 (RvD1), and the composition of immune cell populations were examined in peritoneal lavage exudates. Cells harvested from the peritoneum were assessed for macrophage differentiation markers, phagocytosis, and lipopolysaccharide-induced cytokine secretion profiles (interleukin [IL]-6, IL-10, IL-1β, TNFα). The ratio of RvD1 to pro-inflammatory PGE2 and LTB4 was increased in the peritoneal cavity of FO-supplemented animals. FO induced a decrease in the number of monocytes in the lavage fluid, with no change in the number of macrophages, neutrophils, or lymphocytes. Macrophage phagocytosis and M1/M2 messenger RNA markers were unchanged by FO with the exception of decreased PPARγ expression. FO increased ex vivo TNFα secretion after stimulation with lipopolysaccharide. Our findings provide evidence that nutraceutically relevant doses of FO supplements given before and during chemical peritonitis shift the balance of lipid mediators towards a proresolution, anti-inflammatory state without drastically altering the number or phenotype of local innate immune cell populations. Copyright © 2016 Elsevier Inc. All rights reserved.
Norman O. Machado
Full Text Available Sclerosing encapsulating peritonitis (SEP is a rare chronic inflammatory condition of the peritoneum with an unknown aetiology. Also known as abdominal cocoon, the condition occurs when loops of the bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Due to its rarity and nonspecific clinical features, it is often misdiagnosed. The condition presents with recurrent episodes of small bowel obstruction and can be idiopathic or secondary; the latter is associated with predisposing factors such as peritoneal dialysis or abdominal tuberculosis. In the early stages, patients can be managed conservatively; however, surgical intervention is necessary for those with advanced stage intestinal obstruction. A literature review revealed 118 cases of SEP; the mean age of these patients was 39 years and 68.0% were male. The predominant presentation was abdominal pain (72.0%, distension (44.9% or a mass (30.5%. Almost all of the patients underwent surgical excision (99.2% without postoperative complications (88.1%.
Full Text Available The dysfunction of the catheter in peritoneal dialysis (PD is a frequent compli-cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re-quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.
Equine piroplasmosis (EP) is a disease of equidae including horses, donkeys, mules and zebras caused by either of two protozoan parasites, Theileria equi or Babesia caballi. These parasites are biologically transmitted between hosts via tick-vectors and although they have inherent differences, they ...
Vekens, Nicky Van Der; Hunter, Ingrid; Gøtze, Jens Peter
Cardiac biomarkers such as troponins and natriuretic peptides are routinely used in human medicine for the evaluation of myocardial damage and heart failure. Recently, these markers have also been introduced in veterinary medicine. Comparison between human and equine cardiac biomarker studies sho...
Background Bacterial infections account for most peritoneal dialysis (PD)-associated peritonitis episodes. However, anaerobic PD peritonitis is extremely rare and intuitively associated with intra-abdominal lesions. In this study, we examined the clinical characteristics of PD patients who developed anaerobic peritonitis. Methods We retrospectively identified all anaerobic PD peritonitis episodes from a prospectively collected PD registry at a single center between 1990 and 2010. Only patients receiving more than 3 months of PD were enrolled. We analyzed clinical features as well as outcomes of anaerobic PD peritonitis patients. Results Among 6 patients, 10 episodes of PD-associated peritonitis were caused by anaerobic pathogens (1.59% of all peritonitis episodes during study the period), in which the cultures from 5 episodes had mixed growth. Bacteroides fragilis was the most common species identified (4 isolates). Only 3 episodes were associated with gastrointestinal lesions, and 4 episodes were related to a break in sterility during exchange procedures. All anaerobic pathogens were susceptible to clindamycin and metronidazole, but penicillin resistance was noted in 4 isolates. Ampicillin/sulbactam resistance was found in 2 isolates. In 5 episodes, a primary response was achieved using the first-generation cephalosporin and ceftazidime or aminoglycoside. In 3 episodes, the first-generation cephalosporin was replaced with aminoglycosides. Tenckhoff catheter removal was necessary in 2 episodes. Only one episode ended with mortality (due to a perforated bowel). Conclusion Anaerobic PD-associated peritonitis might be predominantly caused by contamination, rather than intra-abdominal events. Half of anaerobic PD-associated peritonitis episodes had polymicrobial growth. The overall outcome of anaerobic peritonitis is fair, with a high catheter survival rate. PMID:23705895
Pers, Charlotte; Tvedegaard, Erling; Christensen, Jens Jørgen
The first reported case of peritonitis caused by Capnocytophaga cynodegmi is presented. The patient was treated with peritoneal dialysis and had contact with a cat. C. cynodegmi is part of the normal oral flora of dogs and cats but is very rarely isolated in clinical specimens from humans....
Kao, Chih-Chin; Chiang, Chih-Kang; Huang, Jenq-Wen
Peritonitis is a major complication of peritoneal dialysis (PD) and remains the most common cause of PD failure. Micrococci are catalase-positive, coagulase-negative, and gram-positive cocci that are spherical, often found in tetrad, and belong to the family Micrococcaceae. Micrococcus species are commonly found in the environment, and it is now recognized that Micrococcus species can be opportunistic pathogens in immunocompromised patients. The only consistent predisposing factor for Micrococcus infection is an immunocompromised state. We report three cases of Micrococcus PD peritonitis. Improper practice of PD may have been the causative factor. Although Micrococcus species are low-virulence pathogens, infection could result in refractory peritonitis and subsequent PD failure. Intraperitoneal administration of vancomycin for at least 2 weeks is recommended for Micrococcus peritonitis.
Joffe, P; Henriksen, Jens Henrik Sahl
The present study was undertaken in order to assess bidirectional peritoneal kinetics of albumin after simultaneous i.v. and i.p. injection of radioiodinated albumin tracers (125I-RISA and 131I-RISA) in eight clinically stable uraemic patients undergoing continuous ambulatory peritoneal dialysis...... (CAPD). The plasma volume, intravascular albumin mass (IVM), and overall extravasation rate of albumin were not significantly different from that found in healthy controls. Albumin flux from the plasma into the peritoneal cavity was 3.71 +/- 0.82 (SD) mumol/h, which was only 3% of the overall...... extravasation rate (137 +/- 52 mumol/h). Albumin flux from the peritoneal cavity into the plasma was substantially lower (0.22 +/- 0.07 mumol/h, P peritoneal accumulation of the albumin from plasma over 4 h was 14 +/- 3.2 mumol, which was significantly lower than the intraperitoneal albumin...
Kolmos, Hans Jørn; Hemmeløff Andersen, Karl Erik; Hansen, Lise
118 episodes of infectious peritonitis registered among 156 patients treated with intermittent peritoneal dialysis over a 5-yr period were analysed with special reference to potential routes of infection associated with the dialysis catheter. Peritonitis was randomly distributed among the patients......, and the change of keeping free of peritonitis declined exponentially with time. The main factor determining the individual number of episodes was the total space of time, in which a patient had been wearing a dialysis catheter, whereas the number of catheter disconnections played no significant role. A relative...... preponderance of cases due to Enterobacteriaceae was noted within the first week after catheter implantation. In contrast with this, peritonitis with skin microorganisms was not associated with the implantation of catheters....
Houen, Gunnar; Pihl, Tina Holberg; Andersen, Pia Haubro
Objectives With the aim of producing antibodies for an equine Group specific component (Gc)-globulin assay, the protein was purified from normal equine plasma. Methods Equine Gc-globulin was purified from healthy horse plasma using ion exchange chromatography (Q-Sepharose, CM......-Sepharose) and preparative PAGE. Results Equine Gc-globulin has successfully been purified from healthy horse plasma and rabbits and mice are being immunized to produce specific antibodies. Conclusions Purification of equine Gc-globulin and the production of specific antibodies will make it possible to develop an assay...... to be a sensitive marker of acute tissue injury and fatal outcome in humans. Patients with a low plasma concentration of Gc-globulin due to severe tissue injury might potentially benefit from infusions with purified Gc-globulin . With an equine Gc-globulin assay, future studies will investigate the concentration...
Chao, Chia-Ter; Lee, Szu-Ying; Yang, Wei-Shun; Chen, Huei-Wen; Fang, Cheng-Chung; Yen, Chung-Jen; Chiang, Chih-Kang; Hung, Kuan-Yu; Huang, Jenq-Wen
Introduction: Non-Pseudomonas gram-negative bacteria are responsible for an increasing proportion of cases of peritoneal dialysis (PD)-related peritonitis. The role of Citrobacter species in the etiology of PD-related peritonitis is often underestimated. In the present study, we aimed to describe the clinical features, laboratory findings, and short- and long-term outcomes in PD-related peritonitis caused by Citrobacter. Methods: A retrospective review of all episodes of PD-related peritonitis caused by Citrobacter from a single center between 1990 and 2010 was performed. Clinical features, microbiological data, and outcomes of these episodes were analyzed. Results: Citrobacter species was responsible for 11 PD-related episodes (1.8% of all peritonitis episodes) in 8 patients. Citrobacter freundii was the most common etiologic species (73%), and mixed growth was found in the other 3 episodes (27%). Approximately half (46%) of the episodes were associated with constipation and/or diarrhea. Of the Citrobacter isolates from all episodes, 54% were resistant to cefazolin, and only 18% were susceptible to cefmetazole. All isolates were susceptible to ceftazidime, cefepime, carbapenem, and aminoglycosides. More than half of the patients (54%) were hospitalized for index peritonitis, and 27% of the episodes involved a change in antibiotic medication. One patient had relapsing peritonitis caused by C. koseri (9%). The mortality rate of PD-related peritonitis caused by Citrobacter was 18%, and 89% of surviving patients developed technique failure requiring a modality switch after an average of 12 months of follow-up (range 1.2-31.2 months). Conclusion: PD-related peritonitis caused by Citrobacter is associated with poor outcomes, including high rates of antibiotic resistance, a high mortality rate, and a high rate of technique failure among survivors during the follow-up period. PMID:23869184
Ham, Taylor Marie
Equine assisted psychotherapy (EAP) is an emerging experiential methodologythat has recently gained recognition as a method for addressing a range of presentingproblems for a wide variety of client populations. Couples therapy is one area that thepractice of equine assisted psychotherapy has recently gained traction. This studydescribes the practice of equine assisted couples therapy in terms of practitionercharacteristics, approach to treatment, therapeutic goals and outcomes. Mental healthp...
Osterwalder, P; Widmer, M; Widmer, U; Schulthess, G
Because of deteriorating general health, weight loss of 5 kg and leftsided epigastric pain a 44 year old innkeeper was evaluated unsuccessfully for 1 month. Thereafter a protein- and lymphocyte-rich ascites developed. CT-scans revealed a thickened visceral peritoneum and multiple, marginally increased retroperitoneal lymph nodes. The history of the patient originating from former Jugoslavia was suspicious for inadequately treated tuberculous pericarditis. Hence this diagnosis tuberculous peritonitis became probable but for practical reasons could not be proven neither by biopsy nor by culture. Under probatory antituberculous treatment the patient's general condition improved rapidly, the ascites disappeared and initially elevated parameters for infection normalized.
Goodson, Teresa; Randell, Susan; Moore, Lisa
Feline infectious peritonitis (FIP) frequently results in death in cats. It is caused by a mutated, highly contagious coronavirus, and it is more common in indoor cats in multicat households. A complex interaction between the coronavirus and the feline immune system causes disseminated vasculitis, which is the hallmark of FIP. New tests are being developed, but the antemortem diagnosis of FIP continues to be difficult and frustrating. Current treatments are crude and involve supportive care and immunosuppression. Minimizing exposure is the best method of preventing infection.
Christensen, Michelle Brønniche; Sørensen, Jens Christian; Jacobsen, Stine
BACKGROUND: Serum amyloid A (SAA) is useful as a diagnostic marker of systemic inflammation in horses, but only heterologous assays based on non-equine calibration and standardization are available for measurements of equine SAA. More accurate measurements could be obtained using purified species......-specific SAA in native conformation for assay calibration and standardization. Further knowledge about the biochemical properties of SAA would facilitate a future production of native species-specific calibration material Therefore, the aim of the study was an investigation of the solubility and potentials...... for purification of equine SAA based on biochemical properties.Freeze dried equine acute phase serum was dissolved in 70% 2-propanol, 8 M urea, and milli-Q water, respectively. Supercritical fluid extraction (SFE), size-exclusive chromatography (FPLC-SEC), and preparative isoelectric focusing (IEF) were performed...
Michael Vincent F. Tablang
Full Text Available Spontaneous bacterial peritonitis is a severe and life-threatening complication in patients with ascites caused by advanced liver disease. The organisms most commonly involved are coliform bacteria and third-generation cephalosporins are the empiric antibiotics of choice. This is an uncommon case of spontaneous bacterial peritonitis caused by Listeria monocytogenes in a female patient with liver cirrhosis from autoimmune hepatitis. She did not improve with ceftriaxone and her course was complicated by hepatic encephalopathy, seizures and multi-organ failure. This case emphasizes that a high index of suspicion should be maintained for timely diagnosis and treatment. Listerial peritonitis should be suspected in patients with end-stage liver disease and inadequate response to conventional antibiotics within 48–72 h. Ampicillin/sulbactam should be initiated while awaiting results of ascitic fluid or blood culture.
Kim, Eun Sook; Park, Mi Sook; Cho, On Koo; Koh, Byung Hee; Kim, Soon Yong
CT findings in 137 patients with peritoneal cacinomatosis were reviewed to determine the CT signs of peritoneal malignancy. CT of the 20 liver cirrhosis and 17 tuberculous peritonitis were also reviewed to define the differential point between benign and malignant peritoneal change. The results were as follows. 1. The most common primary malignancy encountered in peritoneal carcinomatosis was stomach Ca.(50.4%), followed by pancreas Ca, hepatoma, colon Ca. and ovarian Ca. 2. Ascites was the most common CT feature of peritoneal malignancy, present in 99 cases (72.3%). The amount of ascites was voluminous, grade III in 70% of cases and showed high density ascites with average 23 Hounsfield units. 3. Greater omentum involvement was noted in 88 patients, peritoneum in 71 patients and mesentery in 65% patients. There was no correlation of the primary malignancy type with the incidence or pattern of the above mentioned site. 4. Bowel wall thickenings were observed in 51 patients, among which transverse colon was most frequently involved. 5. Mean attenuation value of ascites in liver cirrhosis was 10.7 HU, which was much lower than that of peritoneal carcinomatosis. 6. Even though intraperitoneal findings in Tbc. Peritonitis showed tendency of relatively small amount of ascites with more predominant mesenteric change, but, the findings of high density ascites, change of peritoneum and omentum etc. were very similar to those of peritoneal carcinomatosis. Therefore, based on only intraperitoneal change, differential diagnosis between them was difficult. 7. False negatives in CT diagnosis of peritoneal carcinomatosis occurred in 7 cases. There were tiny nodular changes in intraperitoneal cavity without ascites on operative findings
Cha, Soon Joo; Kang, Eun Young; Suh, Won Hyuck
Peritoneal metastasis is frequent mode of dissemination of intraabdominal malignancies. Radiologic diagnosis of peritoneal metastasis has relied on indirect evidence on a barium UGI series and small bowel examination. With the advent of CT scanning, CT is capable of direct imaging of peritoneum. The sensitivity of CT in detecting peritoneal metastasis and CT manifestation of peritoneal metastatic lesions had reported occasionally, but rarely in Korea. So, authors illustrated the CT manifestation of peritoneal metastatic lesions in 32 cases of macroscopically proven cases in laparoscopy or laparotomy in Korea University Hae Wha Hospital during recent 4 years. The results are as follows. 1. Of total 32 cases, 18 cases were male and 14 cases were female. Age incidence was the most common in 6th decade. 2. The most common type of malignancy that cause peritoneal metastasis was the stomach cancer and next common type of malignancies were pancreas cancer in men and ovarian cancer in women. 3. Of total 32 cases of peritoneal metastasis which was confirmed by laparoscopy or laparotomy macroscopically, 23 cases (72%) were detected peritoneal thickening and/or omental pathology by CT, and the remaining 9 cases (28%) were not detected by CT. 4. Ascites was present in 19 cases (59%). 5. Parietal peritoneal thickening was present in 16 cases (50%) by CT and sheetlike pattern was the most common findings. The patterns of peritoneal thickening was relatively nonspecific and was not correlated with primary tumor type. 6. Tumor involvement of greater omentum by CT was present in 19 cases (59%). There were 7 cases of smudged appearance pattern, 6 cases of nodular pattern, 6 cases of omental cake pattern and no cystic mass pattern. The patterns of omental pathology was relatively nonspecific and was nor correlated with primary tumor type
Gonzaga, Rosemary; Matzinger, Polly; Perez-Diez, Ainhoa
Here we describe a new population of NK cells that reside in the normal, un-inflamed peritoneal cavity. Phenotypically, they share some similarities with the small population of CD49b negative, CD27 positive immature splenic NK cells, and liver NK cells but differ in their expression of CD62L, TRAIL and EOMES. Functionally, the peritoneal NK cells resemble the immature splenic NK cells in their production of IFN-γ, GM-CSF and TNF-α and in the killing of YAC-1 target cells. We also found that the peritoneum induces different behavior in mature and immature splenic NK cells. When transferred intravenously into RAGγcKO mice, both populations undergo homeostatic proliferation in the spleen, but only the immature splenic NK cells, are able to reach the peritoneum. When transferred directly into the peritoneum, the mature NK cells survive but do not divide, while the immature NK cells proliferate profusely. These data suggest that the peritoneum is not only home to a new subset of tissue resident NK cells but that it differentially regulates the migration and homeostatic proliferation of immature versus mature NK cells. PMID:22079985
Nickerson, Joshua P; Kannabiran, Suma; Burbank, Heather N
Two patients with eastern equine encephalitis (EEE) presented to a tertiary referral center. Both subjects' brain magnetic resonance imaging showed T2/FLAIR (fluid-attenuated inversion recovery) hyperintensities including linear areas of hyperintensity in the external and internal capsules with sparing of the lentiform nuclei. Single case reports of imaging findings in EEE exist with nonspecific patterns of abnormality. We propose that this "( ) parentheses sign" on T2 or FLAIR imaging may distinguish EEE from other processes. Copyright © 2015 Elsevier Inc. All rights reserved.
Kim, Cheung Sook; Kim, Young Jae; Min, Seon Jeong; Cho, Seong Whi; Lee, Gyung Kyu; Lee, Eil Seong; Kang, Ik Won [Hallym University College of Medicine, Seoul (Korea, Republic of)
Sclerosing peritonitis is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD) and can lead to small bowel dysfunction involving abdominal pain, progressive loss of ultrafiltration, and small intestinal obstruction. Peritoneal thickening, in which calcification can develop, often starts as al small plaque which gradually becomes larger. We report a case of CAPD-related calcifying peritonitis.
Hemogasometria em eqüinos com compactação experimental do cólon maior tratados com sene, fluidoterapia enteral e parenteral Blood gas analysis in equine with experimental large colon impaction treated with sene, enteral and parenteral fluid therapy
José Dantas Ribeiro Filho
Full Text Available O equilíbrio ácido-base foi estudado em eqüinos com compactação experimental do cólon maior após o uso de solução isotônica poliônica enteral, sene mais hidratação intravenosa e hidratação intravenosa. As amostras sangüíneas foram colhidas de 20 animais, quatro grupos (E8, RL, SE e C de cinco animais cada. Os animais dos grupos tratados eram portadores de compactação no cólon maior induzida experimentalmente. Eqüinos no grupo E8 receberam solução isotônica poliônica enteral (8mL kg-1 h-1 48h-1; no grupo SE, sene foram administrados na dose de 20mg kg-1, duas doses de 24/24h, mais Ringer lactato intravenoso, 10mL kg-1h(-112h-1, durante dois dias; sendo que o grupo RL recebeu Ringer lactato intravenoso (16mL kg-1h(-112h-1 durante dois dias. O grupo C, controle, não foi tratado. Entre os tratamentos testados, a fluidoterapia intravenosa com solução de Ringer lactato (RL foi o tratamento mais eficiente para a correção das variáveis hemogasométricas em eqüinos com compactação do cólon maior. A solução isotônica poliônica enteral (E8 e sene associada com fluidoterapia intravenosa (SE foram eficientes, porém em menor grau.The blood acid-base status was studied in equines when induced large colon impaction was followed by applying an isotonic polionic enteral solution, or sene associated with intravenous fluid therapy, or fluid therapy alone. The blood samples were collected in twenty animals, four groups (E8, RL, SE, and C of five animals each. Animals of the treated groups had experimentally induced colon impactions. Equines in group E8 received isotonic polionic enteral solution (8 mL kg-1 h-1 48 h-1; in group SE, sene was applied at 20mg kg-1, two doses per animal, at 24-hour intervals, along with the Ringer lactate IV, 10mL kg-1 h-1, 12 h-1, both during two days; and in the RL animals received Ringer lactate IV only (16mL kg-1 h-1 12h-1, applied during two days. Group C was the non-treated control. Among the
McGuire, Amanda L; Carson, Christine F; Inglis, Timothy J J; Chakera, Aron
♦ Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. ♦ We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. ♦ The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. ♦ Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents. Copyright © 2015 International Society for Peritoneal Dialysis.
Isolamento, caracterização e diferenciação de células-tronco mesenquimais do líquido amniótico equino obtido em diferentes idades gestacionais Isolation, characterization and differentiation of mesenchymal stem cells derived from equine amniotic fluid obtained from different gestacional ages
Bruna De Vita
potencial de diferenciação em linhagens extra mesodermais já relatados na literatura.The interest in stem cells derived from fetal annexes of many species has exponentially increased during the last decades, because they are adult stem cell sources with potential of differentiation in several cell lineages; which present little or no immunogenicity and are an alternative with great importance for storage cell banks. Despite the rising interest, studies for the equine species are still rare. The aim of this study was to isolate, characterize and differentiate mesenchymal stem cells derived from equine amniotic fluid obtained from initial, middle and late third of gestation (AF-MSCs, and compare their results. Twenty three samples from equine amniotic fluid were evaluated by morphological, immunocytochemical and immunophenotypical (Flow cytometer assays and osteogenic, adipogenic and chondrogenic in vitro differentiation. All samples demonstrated plastic adhesion and fibroblastoid morphology. The immunocytochemical assay demonstrated cells from all the studied groups were positive for CD44, PCNA and vimentin and negative for cytokeratin and Oct-4. Flow cytometry demonstrated expression of CD44 and CD90 and no expression of CD34, where CD44 and CD90 markers presented decreasing pattern of expression in relation to the gestational development. All samples collected from all gestational phases were capable to differentiate in osteogenic, chondrogenic and adipogenic lineages. Thus, cells obtained from equine amniotic fluid presented morphological and immunophenotypical characteristics and potential of differentiation typical of MSCs showing that the collection can be performed at any stage of pregnancy. However, more studies should be performed about the expression of pluripotent markers as Oct-4 and the differentiation potential for extra mesodermal lineages prior demonstrated in the literature.
Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.
This package contains the instructor's manual, instructor's resource package, and student workbook for a 1-year introductory course in equine management and production. The course emphasizes the skills needed to manage small one- or two-horse facilities and to enter postsecondary equine education programs. The instructor's manual presents basic…
The equine veterinarian has regained its position in the veterinary profession. Equine veterinarians work in equine practices as well as in mixed practices. In general, it can be said that the backbone of equine work is formed by a relatively small amount of activities for which only a limited
.... APHIS-2006-0168] RIN 0579-AC49 Commercial Transportation of Equines to Slaughter AGENCY: Animal and... regarding the commercial transportation of equines to slaughter to add a definition of equine for slaughter... of equines in commercial transportation to slaughter are met. DATES: Effective Date: October 7, 2011...
Cheng, I K
The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last
Chao, Chia-Ter; Lee, Szu-Ying; Yang, Wei-Shun; Chen, Huei-Wen; Fang, Cheng-Chung; Yen, Chung-Jen; Chiang, Chih-Kang; Hung, Kuan-Yu; Huang, Jenq-Wen
Background Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD) peritonitis are rare. Methods All PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000). Results Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes) in 25 patients. A. baumannii was the most common pathogen (54%), followed by A. iwoffii (35%), with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01). The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05). All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%). Nearly half of the patients (46%) required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences. Conclusions The temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients. PMID:25314341
Full Text Available Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD peritonitis are rare.All PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000.Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes in 25 patients. A. baumannii was the most common pathogen (54%, followed by A. iwoffii (35%, with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01. The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05. All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%. Nearly half of the patients (46% required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences.The temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients.
Zaman, A.; Kareem, R.; Khan, E.M.
Background: Spontaneous bacterial peritonitis is one of the most frequent and serious complication in patients with liver cirrhosis and ascites associated with high mortality. Empiric antibiotic therapy should be initiated before the results of ascitic fluid cultures are available, guided by knowledge of the microbial spectrum of spontaneous bacterial peritonitis in a particular population. Methods: This is a descriptive study which was carried out in the Department of Gastroenterology and Hepatology, Postgraduate Medical Institute Hayatabad Medical Complex, Peshawar from January 2007 to December 2007. Fifty consecutive patients of established cirrhosis liver with ascites presenting with suspicion and or risk factors for spontaneous bacterial peritonitis were included in the study after informed consent. All selected patients were subjected to ascitic fluid tap. Twenty ml of ascitic fluid was aspirated in a heparinised disposable syringe; out of it 10 ml was immediately inoculated into blood culture bottle at bedside and sent for bacterial culture along with the remaining 10 ml for routine biochemical and cytological examination. Results: Out of 50 patients, 28 (56%) were diagnosed to have spontaneous bacterial peritonitis or its variants. Classic spontaneous bacterial peritonitis was present in 11 patients (39.28%), 16 (57.14%) patients were found to have culture negative neutrocytic ascites and one patient (3.57%) had bacterascites. Out of 28 cases of spontaneous bacterial peritonitis 12 samples of ascitic fluid showed positive culture reports. E. coli was the most frequently cultured organism isolated in 8 (66.66%) cases, Streptococcus pneumonae in 2 patients (16.66%), Staphylococcus aurus and Klebsiella each in 1 case (8.33%). Conclusion: Spontaneous bacterial peritonitis and its variants is a common complication of liver cirrhosis with ascites. E. coli is the most frequent offending organism in these cases. Knowledge of the microbial spectrum of spontaneous
Risk evaluation in secondary peritonitis can direct treatment planning, predict ... ulcer (22.9%) and ileum (18.6%). Patients who complicated .... Frequency Percentage. Appendicitis. 22. 31.4%. Duodenal perforation. 16. 22.9%. Ileal. 13. 18.6%.
Holmes, Mark A; Townsend, Hugh G G; Kohler, Andrea K; Hussey, Steve; Breathnach, Cormac; Barnett, Craig; Holland, Robert; Lunn, D P
Horses are commonly vaccinated to protect against pathogens which are responsible for diseases which are endemic within the general horse population, such as equine influenza virus (EIV) and equine herpesvirus-1 (EHV-1), and against a variety of diseases which are less common but which lead to greater morbidity and mortality, such as eastern equine encephalomyelitis virus (EEE) and tetanus. This study consisted of two trials which investigated the antigenicity of commercially available vaccines licensed in the USA to protect against EIV, EHV-1 respiratory disease, EHV-1 abortion, EEE and tetanus in horses. Trial I was conducted to compare serological responses to vaccines produced by three manufacturers against EIV, EHV-1 (respiratory disease), EEE, and tetanus given as multivalent preparations or as multiple vaccine courses. Trial II compared vaccines from two manufacturers licensed to protect against EHV-1 abortion, and measured EHV-1-specific interferon-gamma (IFN-gamma) mRNA production in addition to serological evidence of antigenicity. In Trial I significant differences were found between the antigenicity of different commercial vaccines that should be considered in product selection. It was difficult to identify vaccines that generate significant immune responses to respiratory viruses. The most dramatic differences in vaccine performance occurred in the case of the tetanus antigen. In Trial II both vaccines generated significant antibody responses and showed evidence of EHV-1-specific IFN-gamma mRNA responses. Overall there were wide variations in vaccine response, and the vaccines with the best responses were not produced by a single manufacturer. Differences in vaccine performance may have resulted from differences in antigen load and adjuvant formulation.
Kwong, Vickie Wai-Ki; Li, Philip Kam-Tao
There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A 'PD-first' or a 'PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of
Jesús Lucas Martín Espejo
Full Text Available Introducción: Valorar si el descanso peritoneal, de al menos un día semanal, ha supuesto mejoras en la rehabilitación de los pacientes y el impacto clínico que puede suponer. Nos planteamos además cuantificar el beneficio económico. Material y Método: Se realizó un estudio longitudinal, retrospectivo, descriptivo. De los pacientes atendidos en nuestra unidad desde el 1 de enero de 2014 al 31 de diciembre de 2014, se estudiaron los pacientes que cumplieran todo el año de seguimiento y que no procedieran de otras técnicas de depuración como la hemodiálisis o trasplante renal. La muestra de estudio estuvo compuesta por 40 pacientes, de los que 21 tuvieron prescrito al menos 1 día semanal de descanso peritoneal y 19 pacientes sin descanso. Se recogieron las siguientes variables al inicio del periodo de estudio y a los 12 meses: Variables demográficas, variables relacionadas con el estado de volumen, datos clínicos relacionados con la técnica, se pasó una encuesta de satisfacción a todos los pacientes estudiados, y se recogieron los importes del coste mensual de cada tipo de tratamiento. Resultados: Las diferencias iniciales entre los grupos, eran esperables ya que son los valores en los cuales se ha basado la prescripción del día de descanso. La exposición a la glucosa, al comienzo y al final fue menor en el grupo con descanso. Al año, no se encontró diferencias en los parámetros estudiados. Una encuesta de satisfacción nos reveló a que dedican los pacientes el día de descanso y los que no lo tienen a que lo dedicarían. Conclusiones: El descanso peritoneal no ha supuesto una peor evolución de los parámetros clínicos estudiados al año de seguimiento, cumpliendo las recomendaciones de adecuación de diálisis de las guías clínicas. La exposición a la glucosa, aun sin llegar a ser significativa por la duración del estudio, ha sido menor en el grupo con descanso. El día de descanso ha facilitado a los pacientes
Terebus Loock, M.; Lubrano, J.; Courivaud, C.; Bresson Vautrin, C.; Kastler, B.; Delabrousse, E.
Aim: To evaluate the computed tomography (CT) signs of encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD) as predictive factors for the evolution to abdominal cocoon (AC). Materials and methods: Clinical features and CT signs of 90 patients on PD were retrospectively reviewed. According to the clinical features, they were divided into three groups (asymptomatic, moderate, or severe). Clinical results were correlated with previously reported CT signs of EPS, i.e., peritoneal thickening, peritoneal calcifications, loculated fluids, small bowel faeces sign, small bowel obstruction, clustered bowel loops, pseudo sac, signs of bowel ischaemia or necrosis. AC was defined at CT by the association of clustered bowel loops and a pseudo sac. Statistical analysis was performed using the Fisher's exact test and the t-test. Results: Although demonstrated in symptomatic patients (p = 0.041), the occurrence of AC was not correlated with the severity of the symptoms (p = 0.16). Among the CT signs, the presence of loculated fluids (p = 0.011), a small bowel faeces sign (p = 0.002); and small bowel obstruction (p = 0.0001) were found to be statistically correlated with the appearance of an AC. Moreover, the association of loculated fluids, small bowel faeces sign, small bowel obstruction was extremely sensitive and specific in the development of AC (sensitivity = 67%, specifity = 100%, positive predictive value = 100%, negative predictive value = 96%). Conclusion: CT should be carried out in every symptomatic patient on PD. Indeed, the association of loculated fluid, small bowel faeces sign, and small bowel obstruction enables the prediction of the development of AC, which is likely to curtail PD and require surgery.
Barcena de Arellano, M L; Münch, S; Arnold, J; Helbig, S; Schneider, A; Mechsner, S
Recent studies demonstrated the potential involvement of nerve fibres in the chronic inflammatory process of endometriosis. We aimed to characterize nerve fibres in the proximal and distal areas of the peritoneal endometriotic lesions in order to understand the chronic inflammatory process in endometriosis. Peritoneal endometriotic lesions (proximal area) (n = 17), the matching unaffected peritoneum (distal area) and healthy peritoneum of patients without endometriosis (n = 15) were analysed with the neuronal markers PGP 9.5, calbindin, calretinin and parvalbumin. Peritoneal fluids of women with and without endometriosis were used for Western blot analysis and for the neuronal growth assay. The protein expression of neuronal PC-12 cells incubated with peritoneal fluids was analysed. The overall nerve fibre density was significantly reduced in the distal area of the lesion when compared with the proximal area or with healthy peritoneum. The density of calbindin-, calretinin- and parvalbumin-positive nerve fibres was significantly increased in the endometriosis group. Calretinin expression was elevated in the peritoneal fluid of women with symptomatic endometriosis when compared with women with asymptomatic endometriosis. Furthermore, PC-12 cells incubated with peritoneal fluid of women with endometriosis showed a higher proliferation rate and a stronger neurite outgrowth than the control group. PC-12 cells incubated in peritoneal fluids of women with endometriosis expressed less calretinin but more calbindin than the control group. Calcium-binding proteins seem to be increased in endometriosis-associated nerve fibres and might play an important role in the chronic inflammatory condition and the pain pathogenesis of endometriosis. © 2013 European Federation of International Association for the Study of Pain Chapters.
Das, B.K.; Senthilnathan, M.S.; Pradhan, P.K.; Jeloka, T.K.; Sharma, R.K.
Full text: Among various conservative treatment modalities for end stage renal disease (ESRD), continuous ambulatory peritoneal dialysis (CAPD) is increasingly being used in many centers. The success of CAPD depends largely on the permeable characteristics of the peritoneal membrane. Peritoneal Equilibration Test (PET), first described by Twardowski in 1987, is the most commonly used method for determination of peritoneal membrane characteristics. However, this test has several limitations. In order to find an alternative method for assessing peritoneal membrane characteristics we undertook this prospective study involving 20 patients. The main objective was to determine whether peritoneal excretion of intravenously applied Tc-99m-DTPA can be used for this purpose. 20 patients undergoing regular CAPD were included in this study. 370 MBq (10 mCi) of Tc-99m-DTPA was injected intravenously in the same standard preconditions as for the PET evaluation. A standard dose of 370 MBq (10 mCi) DTPA was kept and used later for calculations. At the end of 4 hours, a dialysate fluid sample was collected and the total dialysis effluent volume was measured. Excretion of Tc-99m-DTPA into the dialysate fluid as percentage of injected dose was calculated. Simultaneously standard PET values were determined. The peritoneal excretion of Tc-99m-DTPA ranged from 8 to 16 % of the injected dose depending upon the peritoneal membrane permeability. The patients were divided into following four groups depending upon DTPA excretion. High transporters (15 % and above); high average(12-15 %); low average (10-12 %); low transporters (10 % and less). When the results were compared with standard PET values, a good correlation could be established. We conclude that the radioisotope method using Tc-99m-DTPA can a good alternative technique to assess peritoneal membrane permeability. (author)
Brokelman, Walter; Holmdahl, Lena; Falk, Peter; Klinkenbijl, Jean; Reijnen, Michel
Laparoscopic surgery is considered to induce less peritoneal trauma than conventional surgery. The peritoneal plasmin system is important in the processes of peritoneal healing and adhesion formation. The present study assessed the peritoneal fibrinolytic response to laparoscopic and conventional
Ackerman, N.; Spencer, C.P.; Hager, D.A.; Poulos, P.W. Jr.
All personnel present in the X-ray examination room during equine radiography were monitored using low energy direct reading ionization chambers (pockets dosimeters) worn outside the lead apron at neck level. The individuals' task and dosimeter readings were recorded after each examination. Average doses ranged from 0 to 6 mrad per study. The greatest exposures were associated with radiography of the shoulder and averaged less than 4 mrad. The individual extending the horse's limb was at greatest risk although the individual holding the horse's halter and the one making the X-ray exposure received similar exposures. A survey of the overhead tube assembly used for some of the X-ray examinations also was performed. Meter readings obtained indicated an asymetric dose distribution around the tube assembly, with the highest dose occurring on the side to which the exposure cord was attached. Although the exposures observed were within acceptable limits for occupational workers, we have altered our protocol and no longer radiograph the equine shoulder unless the horse is anesthetized. Continued use of the pocket dosimeters and maintenance of a case record of radiation exposure appears to make the technologists more aware of radiation hazards
Tristan D. Yan
Full Text Available Malignant mesothelioma is a highly aggressive neoplasm. The incidence of malignant mesothelioma is increasing worldwide. Diffuse malignant peritoneal mesothelioma (DMPM represents one-fourth of all mesotheliomas. Association of asbestos exposure with DMPM has been observed, especially in males. A great majority of patients present with abdominal pain and distension, caused by accumulation of tumors and ascitic fluid. In the past, DMPM was considered a pre-terminal condition; therefore attracted little attention. Patients invariably died from their disease within a year. Recently, several prospective trials have demonstrated median survival of 40 to 90 months and 5-year survival of 30% to 60% after the combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy. This improvement in survival has prompted new searches into the medical science related to DMPM, a disease previously ignored as uninteresting. This review article focuses on the key advances in the epidemiology, diagnosis, staging, treatments and prognosis of DMPM that have occurred in the past decade.
Bunke, C M; Brier, M E; Golper, T A
The use of the "peritonitis rate" in the management of patients undergoing peritoneal dialysis is assuming importance in comparing the prowess of facilities, care givers and new innovations. For this to be a meaningful outcome measure, the type of infection (causative pathogen) must have less clinical significance than the number of infections during a time interval. The natural history of Staphylococcus aureus, pseudomonas, and fungal peritonitis would not support that the outcome of an episode of peritonitis is independent of the causative pathogen. Could this concern be extended to other more frequently occurring pathogens? To address this, the Network 9 Peritonitis Study identified 530 episodes of single organism peritonitis caused by a gram positive organism and 136 episodes caused by a single non-pseudomonal gram negative (NPGN) pathogen. Coincidental soft tissue infections (exit site or tunnel) occurred equally in both groups. Outcomes of peritonitis were analyzed by organism classification and by presence or absence of a soft tissue infection. NPGN peritonitis was associated with significantly more frequent catheter loss, hospitalization, and technique failure and was less likely to resolve regardless of the presence or absence of a soft tissue infection. Hospitalization and death tended to occur more frequently with enterococcal peritonitis than with other gram positive peritonitis. The outcomes in the NPGN peritonitis group were significantly worse (resolution, catheter loss, hospitalization, technique failure) compared to coagulase negative staphylococcal or S. aureus peritonitis, regardless of the presence or absence of a coincidental soft tissue infection. Furthermore, for the first time, the poor outcomes of gram negative peritonitis are shown to be independent of pseudomonas or polymicrobial involvement or soft tissue infections. The gram negative organism appears to be the important factor. In addition, the outcome of peritonitis caused by S. aureus
To investigate the role of intraocular leptospiral infections in horses with Equine Recurrent Uveitis (ERU) in the southern United States, blood and ocular fluid samples were collected from horses with a history and ocular findings consistent with ERU. Samples were also obtained from control horses ...
♦ Background: The clinical courses and long-term outcomes of viridans streptococcus (VS) peritoneal dialysis (PD) peritonitis remain unclear. ♦ Methods: We conducted a retrospective analysis of all PD patients in a single center with gram-positive cocci (GPC) peritonitis between 2005 and 2011, and divided them into 3 groups: VS, other streptococci and other GPC (apart from VS). Clinical characteristics and outcomes of the VS group were compared with the other streptococci and other GPC groups, with prognostic factors determined. ♦ Results: A total of 140 patients with 168 episodes of GPC peritonitis (44% of all peritonitis) were identified over 7 years. Among these, 18 patients (13%) developed VS peritonitis, while 14 patients (10%) developed other streptococcal peritonitis. Patients with VS peritonitis had a high cure rate by antibiotic alone (94%), despite a high polymicrobial yield frequency (28%). We found that VS peritonitis carried a lower risk of Tenckhoff catheter removal and relapsing episodes than other GPC peritonitis (6% vs 11%), and a lower mortality than other streptococci peritonitis (0% vs 7%). However, after the index peritonitis episodes, VS, other streptococci, and other GPC group had a significantly increased peritonitis incidence compared with the period before the index peritonitis (all p peritonitis had a significantly higher incidence of refractory peritonitis compared with other streptococci or other GPC peritonitis in the long term (both p peritonitis after the index episode as compared with other streptococcal or GPC peritonitis. It might be prudent to monitor the technique of these patients with VS peritonitis closely to avoid further peritonitis episodes. PMID:24497584
Al-Saadi, A.; Al-Wadan, Ali H.; Hamarnah, Samir A.; Amin, H.
Objective was to identify if there are any advantages of taking swab form the peritoneal fluid during appendectomy and if it has any clinical implication on the progress of diseases. Record of 160 patients who underwent appendectomy in Saqr Hospital, Rak, United Arab Emirates, from 2003-2005 and had culture and sensitivity from the peritoneal cavity were reviewed retrospectively. The macroscopic picture of the appendix, microorganism in peritoneal cultures, antibiotic and the extent using the result of the culture and sensitivity were evaluated. Patients with normal appendix who underwent laparoscopic appendectomy were excluded. Patients age ranged from 4-55 years with male to female ratio of 4:1, all had prophylactic antibiotics and standard surgical procedures; 60% had perforated appendix, 13% were gangrenous. The most common organisms cultured were, Escherichia coli and bacteroids, rate of wound infection was 5%. None of the patients had their course of antibiotics adjusted in response to the result of the swab. Swabs from the peritoneal cavity during appendectomy do not have any clinical advantage especially with the empiric use of antibiotics and the short hospital stay. (author)
Defrère, S; Lousse, J C; González-Ramos, R; Colette, S; Donnez, J; Van Langendonckt, A
The aim of this study is to review the current literature associating endometriosis with iron and to discuss the potential causes and consequences of iron overload in the pelvic cavity. Indeed, iron is essential for all living organisms. However, excess iron can result in toxicity and is associated with pathological disorders. In endometriosis patients, iron overload has been demonstrated in the different components of the peritoneal cavity (peritoneal fluid, endometriotic lesions, peritoneum and macrophages). Animal models allow us to gather essential information on the origin, metabolism and effect of iron overload in endometriosis, which may originate from erythrocytes carried into the pelvic cavity mainly by retrograde menstruation. Peritoneal macrophages play an important role in the degradation of these erythrocytes and in subsequent peritoneal iron metabolism. Iron overload could affect a wide range of mechanisms involved in endometriosis development, such as oxidative stress or lesion proliferation. In conclusion, excess iron accumulation can result in toxicity and may be one of the factors contributing to the development of endometriosis. Treatment with an iron chelator could thus be beneficial in endometriosis patients to prevent iron overload in the pelvic cavity, thereby diminishing its deleterious effect.
Wampach, H.; Canivet, E.; Chanard, J.; Liehn, J.C.
The ambulatory continuous peritoneal dialysis (ACPD) is a means of treatment of terminal chronic renal insufficiency. It implies an optimal filling up and clearing of peritoneal cavity without hernial leakage,nor fistulas with gliding fluids. The aim of this study was to evidence the badly-drained peritoneal regions or the extra-peritoneal communications, as sources of complications of ACPD. The study was conducted on 18 patients without abdominal surgical antecedents, treated by ACPD. The group contained 2 patients with recent clinical inguinal hernias, subject to ACPD and 2 patients presenting an inguinal weighting without clinically discernible hernia. Two static acquisitions, in dorsal decubitus, of the abdomen were successively performed with a frontal anterior incidence of 300 s duration: one, immediately after infusion, and the other after the dialyzer clearing, labelled by 37 MBq of colloid-Tc. The following results were obtained: confirmation of 2 known hernias, discovery of a hernia implying surgical treatment in two patients with inguinal weighting and a bad visualisation of the Douglas' trap, favoring a bad drain, in case one patient. In conclusion, this technically simple examination allowed to detect two cases of inguinal hernia, otherwise not evidenced, sources of later complication of ACPD. Consequently, an earlier and simple surgical treatment has been performed. This examination could be useful in patients before being subject to ACPD
Nirgianakis, K; Bersinger, N A; McKinnon, B; Kostov, P; Imboden, S; Mueller, M D
To investigate the effect of gonadotropin-releasing hormone analogues (GnRHa) on the peritoneal fluid microenvironment in women with endometriosis. Peritoneal fluid was collected from 85 women with severe endometriosis (rAFS stage III and IV) during laparoscopic surgery during the proliferative phase. Prior to surgery clinical data were collected. The concentrations of specific markers for endometriosis in the peritoneal fluid were determined using an ELISA and a comparison between peritoneal fluid markers in women using GnRHa and no hormonal treatment was performed using a non-parametric Mann-Whitney U test. The study included peritoneal fluid from 39 patients who had been administered GnRHa (Zoladex(®)) in the three months prior to surgery and 46 from women with no hormonal treatment in this period. Concentrations of IL-8, PAPP-A, glycodelin-A and midkine were significantly reduced in the GnRHa treatment group compared to women receiving no hormonal treatment. RANTES, MCP-1, ENA-78, TNF-α, OPG, IP-10 and defensin showed no significant change between the two groups. GnRHa mediate a significant regression in the inflammatory nature of the peritoneal microenvironment in women with endometriosis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
van Esch, Sadie; Krediet, Raymond T.; Struijk, Dirk G.
Peritonitis in peritoneal dialysis (PD) patients can lead to technique failure and contributes to infection-related mortality. Peritonitis prevention and optimization of treatment are therefore important in the care for PD patients. In the present study, we analyzed the incidence of peritonitis,
Hestand, Matthew S.; Kalbfleisch, Theodore S.; Coleman, Stephen J.
Current gene annotation of the horse genome is largely derived from in silico predictions and cross-species alignments. Only a small number of genes are annotated based on equine EST and mRNA sequences. To expand the number of equine genes annotated from equine experimental evidence, we sequenced m...... and appear to be small errors in the equine reference genome, since they are also identified as homozygous variants by genomic DNA resequencing of the reference horse. Taken together, we provide a resource of equine mRNA structures and protein coding variants that will enhance equine and cross...
A complete radiographic examination of the equine foot consists of properly exposed, processed, and positioned radiographs. For radiographic interpretation, in addition to knowing radiographic signs of disease, a knowledge of normal radiographic anatomy and possible insignificant anatomic variations is necessary
deGraaf, JS; van Goor, Harry; Bleichrodt, RP
Objective: To find out if primary small bowel anastomosis of the bowel is safe in patients with generalised peritonitis who are treated by planned relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects. 10 Patients with generalised purulent peritonitis
Rodríguez, M J; Agut, A; Soler, M; López-Albors, O; Arredondo, J; Querol, M; Latorre, R
In human medicine, magnetic resonance imaging (MRI) is considered the 'gold standard' imaging procedure to assess the temporomandibular joint (TMJ). However, there is no information regarding MRI evaluation of equine TMJ. To describe the normal sectional MRI anatomy of equine TMJ by using frozen and plastinated anatomical sections as reference; and determine the best imaging planes and sequences to visualise TMJ components. TMJs from 6 Spanish Purebred horse cadavers (4 immature and 2 mature) underwent MRI examination. Spin-echo T1-weighting (SE T1W), T2*W, fat-suppressed (FS) proton density-weighting (PDW) and fast spin-echo T2-weighting (FSE T2W) sequences were obtained in oblique sagittal, transverse and dorsal planes. Anatomical sections were procured on the same planes for a thorough interpretation. The oblique sagittal and transverse planes were the most informative anatomical planes. SE T1W images showed excellent spatial resolution and resulted in superior anatomic detail when comparing to other sequences. FSE T2W sequence provided an acceptable anatomical depiction but T2*W and fat-suppressed PDW demonstrated higher contrast in visualisation of the disc, synovial fluid, synovial pouches and articular cartilage. The SE T1W sequence in oblique sagittal and transverse plane should be the baseline to identify anatomy. The T2*W and fat-suppressed PDW sequences enhance the study of the articular cartilage and synovial pouches better than FSE T2W. The information provided in this paper should aid clinicians in the interpretation of MRI images of equine TMJ and assist in the early diagnosis of those problems that could not be diagnosed by other means.
Kyama, Cleophas M; Mihalyi, Attila; Simsa, Peter; Falconer, Henrik; Fulop, Vilmos; Mwenda, Jason M; Peeraer, Karen; Tomassetti, Carla; Meuleman, Christel; D'Hooghe, Thomas M
A clear picture of the dynamic relationship between the endometrium and peritoneum is emerging as both tissues may participate in the spontaneous development of endometriosis. Various adhesion molecules, pro-inflammatory cytokines and chemoattractants cytokines have emerged as central coordinators of endometrial-peritoneal interactions. The peritoneal microenvironment which consists of the peritoneal fluid, normal peritoneum and peritoneal endometriotic lesions may play an active role in the pathogenesis of endometriosis, by harbouring most inflammatory responses that are triggered by the presence of endometrial cells, leading to recruitment of activated macrophages and leukocytes locally. Menstrual endometrium has the ability to bond and invade the peritoneal tissue. In baboons intrapelvic injection of menstrual endometrium permits the study of early endometrial-peritoneal interaction in an in vivo culture microenvironment and can lead to important insight in the early development of endometriotic lesions. In this review, we discuss the roles of the endometrial-peritoneal interactions, not only in disease development but also in the broader process of aetiopathogenesis.
Saito, Suruga; Ito, Katsuhiro; Matsumoto, Keiyu; Tajima, Motofumi; Goto, Takayuki; Ito, Haruki; Manabe, Yumi; Mishina, Mutsuki; Okuno, Hiroshi
Background: Peritoneal tuberculosis (TB) is a relatively uncommon presentation of extrapulmonary TB. Early diagnosis of peritoneal TB is difficult because of its nonspecific clinical manifestation such as abdominal pain, fever, or ascites. Especially early after surgery of abdomen or pelvis, these symptoms can be misdiagnosed as septic peritonitis. There are few reports of peritoneal TB as a postoperative complication of laparoscopic surgery. Here, we describe a first case of peritoneal TB after robot-assisted laparoscopic prostatectomy (RALP) with extended lymph node dissection. Case Presentation: A 78-year-old man presented 25 days after this surgery with fever and abdominal distension. Ultrasonography and computed tomography (CT) revealed massive abdominal ascites. Ascites sample was cloudy, with increased white blood cells and normal creatinine level. No anastomotic leak was found. Bacterial infection of a lymphocele was considered, and cefmetazole 2 g/day for 3 days was prescribed. Despite antibacterial therapy, fever persisted. Polymerase chain reaction testing of ascitic fluid was positive for Mycobacterium tuberculosis . The patient was effectively treated with anti-TB therapy. Conclusion: This is the first report of peritoneal TB as a postoperative complication of RALP with extended lymph node dissection. His preoperative chest CT showed granular shadows in left upper lung, indicating his old asymptomatic TB infection. Flare-up of TB can happen even after robot-assisted laparoscopic surgery, which is minimally invasive. Peritoneal TB must be considered especially when there is unexplained ascites unresponsive to antibiotics.
Full Text Available The equine periodontal ligament (PDL is a fibrous connective tissue that covers the intra-alveolar parts of the tooth and anchors it to the alveolar bone—it, therefore, provides a similar function to a tendinous structure. While several studies have considered the formation and structure of tendons, there is insufficient information particularly on the molecular composition of the PDL. Especially for the equine PDL, there is limited knowledge concerning the expression of genes commonly regarded as typical for tendon tissue. In this study, the gene expression of, e.g., collagen type 1 alpha 1 (COL1, collagen type 3 alpha 1 (COL3, scleraxis (SCX, and fibrocartilage markers was examined in the functional mature equine PDL compared with immature and mature equine tendon tissue. PDL samples were obtained from incisor, premolar, and molar teeth from seven adult horses. Additionally, tendon samples were collected from four adult horses and five foals at different sampling locations. Analyses of gene expression were performed using real-time quantitative polymerase chain reaction (qRT-PCR. Significantly higher expression levels of COL1 and 3 were found in the mature equine PDL in comparison with mature tendon, indicating higher rates of collagen production and turnover in the mature equine PDL. The expression levels of SCX, a specific marker for tenogenic-differentiated cells, were on a similar level in functional mature PDL and in mature tendon tissue. Evidence of chondrogenic metaplasia, often found in tendon entheses or in pressurized regions of tendons, was not found in the mature equine PDL. The obtained results justify further experiments focused on the possible use of equine PDL cells for cell-based regenerative therapies.
Gordon, K.; Lee, W.K.; Hennessy, O.
The peritoneal cavity is a potential space that is divided by the peritoneal reflections into various complex subspaces. It can be involved in many disease processes including developmental, inflammatory, neoplastic and traumatic conditions. Computed tomography is highly sensitive and consistent in detecting peritoneal pathology. This pictorial essay aims to emphasize and illustrate the CT features of the spectrum of peritoneal diseases. Copyright (2005) Blackwell Science Pty Ltd
Jeong, Seong Ki; Jung, Hae Jong; Kang, Sung Hag; Shin, Sung Ran; Lee, Kil Jun; Lee, Min Jin; Lee, Sang Chun
To compare the CT findings of peritoneal tuberculosis (PT) and peritoneal carcinomatosis (PC) based on the morphologic features of the peritoneum and assess the relationship between the degree of peritoneal thickness and the severity of omental infiltration in PT and PC. We retrospectively reviewed the CT findings of 15 patients with PT and 14 with PC. We checked morphologic changes of the peritoneum as seen on CT, for the following points: 1) the presence of peritoneal change: 2) the pattern of any change-diffuse thickening, plaque or nodularity, combined thickening (diffuse and plaque, or nodularity) 3) the degree of thickness on the whole peritoneum - mild (grossly definite, but not more than 3mm), moderate (more than 3mm); 4) the presence of irregularity on the peritoneal surface. We also evaluated the significance of the relationship between peritoneal thickness and omental infiltration in both disease entities. The degree of omental infiltration was described as follows : grade 1 (no change or focal smudge pattern); grade 2 (diffuse smudge), grade 3 (omental cake regardless extent). Peritoneal change was seen in 12 of 15 PT patients and in 7 of 14 PC patients. In all 12 PT patients, the pattern of change was diffuse thickening, and among the seven PC patients, there was diffuse thickening in one, plaque or nodular thickening in four, and combined thickening in two. In PT patients, the degree of thickness on the whole peritoneum was mild in six and moderate in six, and in PC patients it was mild in two and moderate in one. An irregular peritoneum surface was seen in one patient with PT and in two with PC. The degree of omental infiltration in PT was grade 1 in four patients, grade 2 in six and grade 3 in five. In PC, it was grade 1 in six patients, grade 2 in two and grade 3 in six. Smooth diffuse thickening of the peritoneum was seen in 11 of 15 PT cases and in one of 14 PC (P 0.5). In PT and PC different CT findings based on peritoneal morphologic changes
Matthews, H.K.; Toal, R.L.
Radiography has a limited role in the evaluation of the kidneys in foals and adult horses. Ultrasonography is the current method of choice for structural evaluation of the kidneys in horses as it provides additional information to standard serum chemistry and urinalysis evaluation. A variety of structural abnormalities have been identified in diseased equine kidneys with the use of ultrasound. Ultrasound guided renal biopsy is the preferred method for performing renal biopsy in the horse. The use of Duplex Doppler ultrasound may allow for the characterization of regional hemodynamics of the equine kidney, but is currently an untapped method for evaluation of equine renal hemodynamics. Radionuclide methods including scintigraphy and quantitative renal function measurement can be used to provide further information about equine renal function. Scintigraphy can provide structural and possibly functional information. Quantitative methods using radiopharmaceuticals can provide precise measurement of glomerular filtration rate and effective renal blood flow. This method is especially helpful in identifying acute renal failure and in guiding response to treatment. All equine renal imaging techniques should be a supplement to the physical examination and standard laboratory tests. Additional diagnostic aids such as urinary tract endoscopy should also be considered in horses with hematuria, hydroureter, and suspected calculi. Taken together, all these modalities provide a thorough evaluation of the equine renal system and provide a basis for the clinician to select treatment options and provide prognostic information to the owner
Sangrasi, Ahmed Khan; Talpu, K Altaf Hussain; Kella, Nandlal; Laghari, Abdul Aziz; Rehman Abbasi, Mujeeb; Naeem Qureshi, Jawaid
Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. Laparoscopic management is feasible, safe and effective surgical option for
Gravito-Soares, Marta; Gravito-Soares, Elisa; Lopes, Sandra; Ribeiro, Graça; Figueiredo, Pedro
Spontaneous bacterial peritonitis is the most common infectious complication in cirrhosis. Spontaneous fungal peritonitis is rare and remains unknown. In this work, spontaneous fungal peritonitis as well as risk factors and prognosis are characterized. A retrospective case-control study of 253 consecutive admissions by peritonitis in cirrhotic patients was carried out between 2006 and 2015. Comparison of patients with spontaneous fungal peritonitis (cases) and spontaneous bacterial peritonitis with positive microbiologic ascitic fluid culture (controls) was performed. Variables such as sociodemographic and clinical features, cirrhosis etiology, liver dysfunction scores, ascitic and laboratory parameters, invasive procedures, and prognosis were evaluated. Of the 231 patients, eight (3.5%) developed spontaneous fungal peritonitis, 62.5% of cases being coinfected with bacteria. Candida spp. was isolated in 87.5% of cases, mainly Candida albicans (37.5%) and C. krusei (25.0%). Patients with spontaneous fungal peritonitis had higher ascitic fluid lactate dehydrogenase (288.4±266.6 vs. 161.0±179.5; P=0.011), blood leukocyte count (15187.5±5432.3 vs. 10969.8±6949.5; P=0.028), blood urea nitrogen (69.8±3.1 vs. 36.3±25.5; P=0.001), higher number of invasive procedures (colonoscopy: 25.0 vs. 0.8%, P=0.001; urinary catheterization: 87.5 vs. 49.6%, P=0.038; nasogastric intubation: 87.5 vs. 26.9%, P=0.001), and longer duration of hospital stay (30.0±32.9 vs. 18.9±17.0 days; P=0.031). No statistical difference was found between the two groups for Model for End-Stage Liver Disease, Model for End-Stage Liver Disease-sodium, and Child-Pugh scores. Spontaneous fungal peritonitis was associated with a worse prognosis, particularly severe sepsis/septic shock (87.5 vs. 42.8%, P=0.023), admission in the gastroenterology intensive care unit (87.5 vs. 24.4%; P=0.001), and overall (62.5 vs. 31.9%; P=0.039) or 30-day mortality (50.0 vs. 24.4%; P=0.034), with a mean diagnosis
Ti, Joanna P
OBJECTIVE: The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION: Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.
Pereira, Tiago Assis; Vizinho, Ricardo; Branco, Patricia; Gaspar, Augusta; Barata, José Diogo
Peritonitis and catheter-related infections are a frequent complication in peritoneal dialysis, usually driven by commensal microorganisms. They carry a significant morbidity and mortality burden and have known consequences on viability of peritoneal dialysis and patient survival. This article describes three clinical cases, in which three different peritoneal dialysis patients presented pneumococcal peritonitis, two of which were related with obvious previous or concomitant respiratory sympt...
Novovic, Srdan; Semb, Synne; Olsen, Henrik
Abstract Objective. Spontaneous bacterial peritonitis is a common infection in cirrhosis, associated with a high mortality. Third-generation cephalosporins are recommended as first-line treatment. The aim was to evaluate the epidemiology of microbiological ascitic fluid findings and antimicrobial...... resistance in Denmark. Material and Methods. All patients with cirrhosis and a positive ascitic fluid culture, at three university hospitals in the Copenhagen area during a 7-year period, were retrospectively evaluated. Patients with apparent secondary peritonitis were excluded from the study. Results. One...
Steeil, James; Schumacher, Juergen; Seibert, Rachel; Tobias, Karen
An 8-yr-old intact female African lion (Panthera leo) presented with a 3-day history of lethargy, anorexia, and vomiting. Hematologic and biochemical abnormalities included a leukocytosis, 41,700/microl (4,700-15,300) with a neutrophilia (37,530/microl; 2,000-9,200) and a left shift (1,250/microl bands; 0-300), and mild hypokalemia of 2.1 mEq/L (2.8-4.8). Abdominal radiographs revealed evidence of intestinal ileus, peritonitis, and the presence of effusion. An exploratory laparotomy was performed, and septic peritonitis due to a pyometra was diagnosed. The lion was treated with an ovariohysterectomy, abdominal lavage, fluid therapy, and a subcutaneous injection of cefovecin. The lion recovered, and clinical signs associated with septic peritonitis resolved within 36 hr. It was returned to conspecifics 3 wk later. Three months postoperatively, the lion showed no residual signs of septic peritonitis.
Lee, Dong Ho; Oh, C. H.; Koh, Y. T.; Lim, J. H. [Seoul National University College of Medicine, Seoul (Korea, Republic of)
Sonograms in forty two patients with tuberculous peritonitis of the wet-ascitic type were retrospectively analyzed. The ascites was clear in 24 patients (57%). There were septations, membranes and debris in 6 (14%), floating debris in 5 (12%), mobile strands or membranes in 4 (10%), and fixed septations in three(7%). Other findings were increased hepatic echogenicity, hepatosplenomegaly, pleural effusion, omental cake, thickened mesentery with adherent bowel loops, lymphadenopathy, thickening of the ileal wall, presented in order of frequency. The ultrasonographic findings are not specific for tuberculous peritonitis, but may give profitable information and protect the patient from unnecessary laparotomy
risk factors, by Wacha, 8 of these were of prognostic relevance and was currently ... The study was done in fifty patients with peritonitis who presented at Government ..... [German]. 5. Seiler CA, Brügger L, Forssmann U, Baer HU, Büchler MW.
Daniel K. Martin
Full Text Available Background: The management of ascites can be problematic. This is especially true in patients with diuretic refractory ascites who develop a tense abdomen. This often results in hypotension and decreased venous return with resulting renal failure. In this paper, we further examine the risks and benefits of utilizing an indwelling peritoneal catheter to remove large-volume ascites over a 72-h period while maintaining intravascular volume and preventing renal failure. Methods: We retrospectively reviewed charts and identified 36 consecutive patients undergoing continuous large-volume paracentesis with an indwelling peritoneal catheter. At the time of drain placement, no patients had signs or laboratory parameters suggestive of spontaneous bacterial peritonitis. The patients underwent ascitic fluid removal through an indwelling peritoneal catheter and were supported with scheduled albumin throughout the duration. The catheter was used to remove up to 3 L every 8 h for a maximum of 72 h. Regular laboratory and ascitic fluid testing was performed. All patients had a clinical follow-up within 3 months after the drain placement. Results: An average of 16.5 L was removed over the 72-h time frame of indwelling peritoneal catheter maintenance. The albumin infusion utilized correlated to 12 mg/L removed. The average creatinine trend improved in a statistically significant manner from 1.37 on the day of admission to 1.21 on the day of drain removal. No patients developed renal failure during the hospital course. There were no documented episodes of neutrocytic ascites or bacterial peritonitis throughout the study review. Conclusion: Large-volume peritoneal drainage with an indwelling peritoneal catheter is safe and effective for patients with tense ascites. Concomitant albumin infusion allows for maintenance of renal function, and no increase in infectious complications was noted.
Full Text Available To date, vaccination is one of the most efficient methods of prevention against equine infectious diseases. The vaccinology session, which was organised during the annual meeting of the French Equine Veterinarians Association (AVEF at Reims (France in 2016, aimed to approach three subjects of importance for the equine industry. Vaccination against three major equine diseases were used as examples: equine influenza (equine influenza virus, rhinopneumonitis (equine herpes virus 1/4, and tetanus (Clostridium tetani neuro-toxin. (1 Emergency vaccination: while it has been very successful to reduce the impact of equine influenza epizooties and it is also recommended for tetanus in case of surgery and accident, the benefit of emergency vaccination against equine herpes virus 1/4 remains arguable; (2 Compatibility of equine vaccines from different brands: despite being a frequent concerns for equine veterinarians, little information is available about the compatibility of equine vaccines from different commercial origins. The consequence of mixing different equine vaccines targeting the same disease is believed to be limited but scientific evidences are sparse; and, (3 Laps vaccination and vaccine shortage: they could have serious consequences in terms of protection and their impact should be evaluated on a case by case basis, taking into account the risk of contact with the pathogen and the effect on herd immunity.
Alyousef, Anas M; Abdou, Salah M; Mansour, Yasser S; Radi, Ahmad D
Peritoneal dialysis (PD) program was established in Farwaniya Hospital Kidney Center, Kuwait, in February 2011. Patient recruitment for this modality of treatment was growing steadily. One of the major complications of PD is peritonitis. There is a belief that PD therapy is inferior and carries more complications than hemodialysis, we aimed to show that PD is a good and a non-inferior option for dialysis therapy with comparable outcome in both patient and technique survival. This was a retrospective analysis of all patients who were on PD from February 2011 to December 2014. Peritonitis rate, exit site infection rate, and all-cause mortality rate were all assessed for this period. Peritonitis rate during the 1 st year, 2011, was 0.92 incidents/year. This number had progressively declined in the following years; in 2012, it was 0.65 incidents/year; in 2013, it was 0.58 incidents/year; and in 2014, it was 0.38 incidents/year. This improvement in the rate of peritonitis incidence could be explained by better education of patients and meticulous supervision of the nursing staff. Farwaniya Hospital Kidney Center had an all-cause mortality rate of 9.3% among patients on renal replacement therapy in 2011. In 2012, all-cause mortality rate increased to 17.1%. The following year, 2013, it decreased to 14.3%, and in 2014, all-cause mortality rate dropped further to 7.6%. All-cause mortality rate among PD patients was zero in 2011. In 2012, the all-cause mortality rate in PD was 11.54%, and in 2013, it decreased to 10.52%. Then, again in 2014, the all-cause mortality rate among PD patients was zero. This improvement in all-cause mortality rate could be explained by the better medical care offered to the end-stage renal disease patients, in particular PD patients, in Farwaniya Hospital Kidney Center.
Cavanagh, Jorunn Pauline; Granslo, Hildegunn Norbakken; Fredheim, Elizabeth Aarag
Objectives Biofilm-forming Staphylococcus epidermidis is a prevalent cause of peritonitis during peritoneal dialysis. We compared the efficacy of a synthetic antimicrobial peptidomimetic (Ltx21) versus vancomycin in a murine model mimicking a device-related peritonitis. Methods Silicone implants......, pre-colonized with an S. epidermidis biofilm, were inserted into the peritoneal cavity of BALB/c mice. Three groups (36 mice in each) with pre-colonized implants received intraperitoneal treatment with Ltx21, vancomycin or placebo. Mice were euthanized on day 3 (n = 12), day 6 (n = 12) or day 8 (n...... = 12) post-implantation. Controls were mice with sterile implants (n = 18) and mice without surgery (n = 6). Bacterial reductions in cfu were analysed from implants and peritoneal fluid (PF). Inflammatory responses in serum and PF were measured. Results Vancomycin resulted in a stronger reduction...
Chiu, Jainn-Shiun; Yu, Fu-Chiu; Chen, Chiou-An; Wang, Yuh-Feng
A 16-year-old female who had end-stage renal disease on 2-month continuous ambulatory peritoneal dialysis (CAPD) presented with perineal pain 4 days before admission. The physical examination revealed bilateral labial edema. Peritoneal scintigraphy was requested after infusing 2 L peritoneal dialysate with direct administration of 370 MBq (10mCi) technetium-99m diethylenetriamine pentra-acetic acid into peritoneal cavity via Tenckhoff catheter. Radioactive uptake from right inguinal to labial region was clearly demonstrated, and this indicated the site of peritoneal leakage. After surgical intervention unilaterally, she continued CAPD without any recurrence (au)
Szeto, Cheuk Chun; Johnson, David W
Long-term exposure to a high glucose concentration in conventional peritoneal dialysis (PD) solution has a number of direct and indirect (via glucose degradation products [GDP]) detrimental effects on the peritoneal membrane, as well as systemic metabolism. Glucose- or GDP-sparing strategies often are hypothesized to confer clinical benefits to PD patients. Icodextrin (glucose polymer) solution improves peritoneal ultrafiltration and reduces the risk of fluid overload, but these beneficial effects are probably the result of better fluid removal rather than being glucose sparing. Although frequently used for glucose sparing, the role of amino acid-based solution in this regard has not been tested thoroughly. When glucose-free solutions are used in a combination regimen, published studies showed that glycemic control was improved significantly in diabetic PD patients, and there probably are beneficial effects on peritoneal function. However, the long-term effects of glucose-free solutions, used either alone or as a combination regimen, require further studies. On the other hand, neutral pH-low GDP fluids have been shown convincingly to preserve residual renal function and urine volume. The cost effectiveness of these solutions supports the regular use of neutral pH-low GDP solutions. Nevertheless, further studies are required to determine whether neutral pH-low GDP solutions exert beneficial effects on patient-level outcomes, such as peritonitis, technique survival, and patient survival. Copyright © 2017 Elsevier Inc. All rights reserved.
... infused dialysis solution and how much urea and creatinine have entered into the solution during a 4-hour dwell. The peritoneal transport rate varies from person to person. People who have a high rate of transport absorb dextrose from the dialysis ...
Struijk, Dirk G.
Peritoneal dialysis (PD) for the treatment of end-stage renal failure was introduced in the 1960s. Nowadays it has evolved to an established therapy that is complementary to hemodialysis (HD), representing 11% of all patients treated worldwide with dialysis. Despite good clinical outcomes and
Davies, Simon J
The speed with which small solutes cross the peritoneal membrane, termed peritoneal solute transport rate (PSTR), is a key measure of individual membrane performance. PSTR can be quantified easily by using the 4-hour dialysate to plasma creatinine ratio, which, although only an approximation to the diffusive characteristics of the membrane, has been well validated clinically in terms of its relationship to patient survival and changes in longitudinal membrane function. This has led to changes in peritoneal dialysis modality use and dialysis prescription. An important determinant of PSTR is intraperitoneal inflammation, as exemplified by local interleukin 6 production, which is largely independent of systemic inflammation and its relationship to comorbid conditions and increased mortality. There is no strong evidence to support the contention that the peritoneal membrane in some individuals with high PSTR is qualitatively different at the start of treatment; rather, it represents a spectrum that is determined in part by genetic factors. Both clinical and experimental evidence support the view that persistent intraperitoneal inflammation, detected as a continuously high or increasing PSTR, may predispose the membrane to progressive fibrosis. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
McIlwraith, C Wayne; Kawcak, Christopher E; Frisbie, David D; Little, Christopher B; Clegg, Peter D; Peffers, Mandy J; Karsdal, Morten A; Ekman, Stina; Laverty, Sheila; Slayden, Richard A; Sandell, Linda J; Lohmander, L S; Kraus, Virginia B
We report the results of a symposium aimed at identifying validated biomarkers that can be used to complement clinical observations for diagnosis and prognosis of joint injury leading to equine osteoarthritis (OA). Biomarkers might also predict pre-fracture change that could lead to catastrophic bone failure in equine athletes. The workshop was attended by leading scientists in the fields of equine and human musculoskeletal biomarkers to enable cross-disciplinary exchange and improve knowledge in both. Detailed proceedings with strategic planning was written, added to, edited and referenced to develop this manuscript. The most recent information from work in equine and human osteoarthritic biomarkers was accumulated, including the use of personalized healthcare to stratify OA phenotypes, transcriptome analysis of anterior cruciate ligament (ACL) and meniscal injuries in the human knee. The spectrum of "wet" biomarker assays that are antibody based that have achieved usefulness in both humans and horses, imaging biomarkers and the role they can play in equine and human OA was discussed. Prediction of musculoskeletal injury in the horse remains a challenge, and the potential usefulness of spectroscopy, metabolomics, proteomics, and development of biobanks to classify biomarkers in different stages of equine and human OA were reviewed. The participants concluded that new information and studies in equine musculoskeletal biomarkers have potential translational value for humans and vice versa. OA is equally important in humans and horses, and the welfare issues associated with catastrophic musculoskeletal injury in horses add further emphasis to the need for good validated biomarkers in the horse. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:823-831, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Gökçe, Ali Murat; Özel, Leyla; İbişoğlu, Sevinç; Ata, Pınar; Şahin, Gülizar; Gücün, Murat; Kara, V Melih; Özdemir, Ebru; Titiz, M İzzet
Encapsulating peritoneal sclerosis is a rare complication of long-term peritoneal dialysis ranging from moderate inflammation of peritoneal structures to severe sclerosing peritonitis and encapsulating peritoneal sclerosis. Complicated it, ileus may occur during or after peritoneal dialysis treatment or after kidney transplant. We sought to evaluate 3 posttransplant encapsulating peritoneal sclerosis through clinical presentation, radiologic findings, and outcomes. We analyzed 3 renal transplant patients with symptoms of encapsulating peritoneal sclerosis admitted posttransplant to our hospital with ileus between 2012 and 2013. Conservative treatment was applied to the patients whenever necessary to avoid surgery. One patient improved with medical therapy. Surgical treatment was delayed and we decided it as a last resort, in 2 cases with no response to conservative treatment for a long time. Finally, patients with peritoneal dialysis history should be searched carefully before renal transplant for intermittent bowel obstruction story.
Yung, Susan; Chan, Tak Mao
The success of peritoneal dialysis (PD) is dependent on the structural and functional integrity of the peritoneal membrane. The mesothelium lines the peritoneal membrane and is the first line of defense against chemical and/or bacterial insult. Peritonitis remains a major complication of PD and is a predominant cause of technique failure, morbidity and mortality amongst PD patients. With appropriate antibiotic treatment, peritonitis resolves without further complications, but in some PD patients excessive peritoneal inflammatory responses lead to mesothelial cell exfoliation and thickening of the submesothelium, resulting in peritoneal fibrosis and sclerosis. The detrimental changes in the peritoneal membrane structure and function correlate with the number and severity of peritonitis episodes and the need for catheter removal. There is evidence that despite clinical resolution of peritonitis, increased levels of inflammatory and fibrotic mediators may persist in the peritoneal cavity, signifying persistent injury to the mesothelial cells. This review will describe the structural and functional changes that occur in the peritoneal membrane during peritonitis and how mesothelial cells contribute to these changes and respond to infection. The latter part of the review discusses the potential of mesothelial cell transplantation and genetic manipulation in the preservation of the peritoneal membrane. PMID:22577250
Anderson, Kathleen P.; Stauffer, Gary; Stauffer, Monte; Anderson, Doug; Biodrowski, Kristie
The occurrence of equine abuse/neglect cases is an ongoing issue. However, officials responding to equine cases are rarely experienced in handling horses. Therefore, workshops teaching basic horse husbandry were offered to better equip and prepare officials to respond to equine cases. Trainings consisted of both classroom and hands-on sessions.…
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Labeling of equine products. 317.9... INSPECTION AND CERTIFICATION LABELING, MARKING DEVICES, AND CONTAINERS General § 317.9 Labeling of equine products. The immediate containers of any equine products shall be labeled to show the kinds of animals...
The presence of antibodies against Equine Infectious Anemia Virus (EIAV), Equine Herpes Virus 1 and 4 (EHV-1 and EHV-4), West Nile Virus (WNV), Influenza A Virus (IAV), Equine Viral Arteritis Virus (EVAV), Babesia caballi, Theileria equi, Neospora caninum and Chlamydia abortus was determined using commercial ...
Nam Ho Kim
Full Text Available Bioimpedance analysis is a reliable technique for determining post dialysis target weight. Using this technique, we can understand body fluid status easier and conveniently. Moreover this technique can be used for check nutrition status and nutritional status of dialysis patients. We compared the body fluid status and nutrition status between hemodialysis (HD patients and peritoneal dialysis (PD patients by BCM (Body composition monitor technique. We studied 48 (30 males and 18 females PD patients, 21 (10 males and 11 females HD patients. Body composition monitoring (BCM, Fesenitus Medical Care, Germany was used as a tool for the analysis of bioimpedance. Extracellular water, Total body water, Intracellular water, Overhydration, E/I, Lean tissue mass, Fat Tissue mass was measured and those results were compared between two groups. HD patients were more hydrated than PD patients (61.9% vs. 35.4% and nutritional status such as LTI was poorer than peritoneal dialysis patients (11.7±1.7 vs. 15.3±2.6. Although total body water is more abundant in peritoneal patients (29.4±5.5L vs. 35.9±6.2L, Extracellular water and intracellular water ratio was relatively higher in Hemodialysis patients (E/I 0.98±0.13 vs. 0.87±0.12. The nutrition status was better in PD patients by comparing the percent of lean tissue mass (LTM% between two groups (LTM% 52.1±10.6% vs. 66.8±11.3. In conclusions, Hemodialysis patients were more hydrated with poorer nutrition status than peritoneal dialysis patients, but, due to the significant difference of age between two groups, further study should be required.
Kwon, Ji Eun; Koh, Seong-Joon; Chun, Jaeyoung; Kim, Ji Won; Kim, Byeong Gwan; Lee, Kook Lae; Im, Jong Pil; Kim, Joo Sung; Jung, Hyun Chae
AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis (PD) patients. METHODS: This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis (peritonitis group, group A) to patients who never had peritonitis (no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms. RESULTS: Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode of peritonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients (39.3%) in group A and 15 of 59 patients (25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker (H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis (EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients. CONCLUSION: The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis. PMID:25057226
Terabayashi, Takeshi; Ito, Yasuhiko; Mizuno, Masashi; Suzuki, Yasuhiro; Kinashi, Hiroshi; Sakata, Fumiko; Tomita, Takako; Iguchi, Daiki; Tawada, Mitsuhiro; Nishio, Ryosuke; Maruyama, Shoichi; Imai, Enyu; Matsuo, Seiichi; Takei, Yoshifumi
Appropriate fluid balance is important for good clinical outcomes and survival in patients on peritoneal dialysis. We recently reported that lymphangiogenesis associated with fibrosis developed in the peritoneal cavity via the transforming growth factor-β1-vascular endothelial growth factor-C (VEGF-C) pathway. We investigated whether VEGF receptor-3 (VEGFR-3), the receptor for VEGF-C and -D, might be a new target to improve net ultrafiltration by using adenovirus-expressing soluble VEGFR-3 (Adeno-sVEGFR-3) in rodent models of peritoneal injury induced by methylglyoxal (MGO). We demonstrated that lymphangiogenesis developed in these MGO models, especially in the diaphragm, indicating that lymphangiogenesis is a common feature in the peritoneal cavity with inflammation and fibrosis. In MGO models, VEGF-D was significantly increased in the diaphragm; however, VEGF-C was not significantly upregulated. Adeno-sVEGFR-3, which was detected on day 50 after administration via tail vein injections, successfully suppressed lymphangiogenesis in the diaphragm and parietal peritoneum in mouse MGO models without significant effects on fibrosis, inflammation, or neoangiogenesis. Drained volume in the peritoneal equilibration test using a 7.5% icodextrin peritoneal dialysis solution (the 7.5% icodextrin peritoneal equilibration test) was improved by Adeno-sVEGFR-3 on day 22 (Ptarget to improve net ultrafiltration by suppressing lymphatic absorption and that the 7.5% icodextrin peritoneal equilibration test is useful for estimation of lymphatic absorption.
Acute peritonitis remains the most common complication of peritoneal dialysis (PD), with coagulase-negative staphylococci (CoNS) reported to account for more than 25% of peritonitis episodes (1). Staphylococcus capitis is a gram-positive, catalase-positive CoNS that was originally identified as a commensal on the skin of the human scalp (2). Advancement of microbiological technologies for bacterial identification enables diagnosis of previously unknown causes of acute peritonitis. This is the first reported case of acute peritonitis in a PD patient caused by S. capitis. Copyright © 2017 International Society for Peritoneal Dialysis.
Paula Alessandra Di Filippo
Full Text Available As one of the most frequently performed surgical techniques and the constant association with complications, ten animals were submitted to castration and physical, chemical and cytological peritoneal fluid characteristics were evaluated. The peritoneal fluid samples were obtained before surgery and after castration. It was evaluated the color and turbidity, total concentration and count of differential leukocyte, lactate, protein and phosphorus, as well as the activity of CK, AST, LDH and FA. After castration, the peritoneal fluid has become reddish and cloudy, there was an increase in protein, lactate and phosphorus as well the activity of CK, AST, AP and LDH. The changes were not associated with the development of postoperative complications and were due to inflammatory response triggered by surgical trauma. The analysis of peritoneal fluid can assist in post castration monitoring to the aiming the early and efficiently resolution of possible complications.
Struijk, Dirk G
Peritoneal dialysis (PD) for the treatment of end-stage renal failure was introduced in the 1960s. Nowadays it has evolved to an established therapy that is complementary to hemodialysis (HD), representing 11% of all patients treated worldwide with dialysis. Despite good clinical outcomes and similar results in patient survival between PD and HD, the penetration of PD is decreasing in the Western world. First the major events in the history of the development of PD are described. Then important insights into the physiology of peritoneal transport are discussed and linked to the changes in time observed in biopsies of the peritoneal membrane. Furthermore, the developments in peritoneal access, more biocompatible dialysate solutions, automated PD at home, the establishment of parameters for dialysis adequacy and strategies to prevent infectious complications are mentioned. Finally non-medical issues responsible for the declining penetration in the Western world are analyzed. Only after introduction of the concept of continuous ambulatory PD by Moncrief and Popovich has this treatment evolved in time to a renal replacement therapy. Of all structures present in the peritoneal membrane, the capillary endothelium offers the rate-limiting hindrance for solute and water transport for the diffusive and convective transport of solutes and osmosis. The functional and anatomical changes in the peritoneal membrane in time can be monitored by the peritoneal equilibrium test. Peritonitis incidence decreased by introduction of the Y-set and prophylaxis using mupirocin on the exit site. The decrease in the proportion of patients treated with PD in the Western world can be explained by non-medical issues such as inadequate predialysis patient education, physician experience and training, ease of HD initiation, overcapacity of in-center HD, lack of adequate infrastructure for PD treatment, costs and reimbursement issues of the treatment. (1) PD is cheaper than HD and provides a
Li, Philip Kam-Tao; Szeto, Cheuk Chun; Piraino, Beth; de Arteaga, Javier; Fan, Stanley; Figueiredo, Ana E.; Fish, Douglas N.; Goffin, Eric; Kim, Yong-Lim; Salzer, William; Struijk, Dirk G.; Teitelbaum, Isaac; Johnson, David W.
Peritonitis is a common and serious complication of peritoneal dialysis (PD). Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause of death in around 16% of PD patients (1-6). In addition, severe or prolonged peritonitis leads to
Hsieh, Yao-Peng; Wang, Shu-Chuan; Chang, Chia-Chu; Wen, Yao-Ko; Chiu, Ping-Fang; Yang, Yu
♦ Background: Peritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD). ♦ Methods: A retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes. ♦ Results: Early peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 - 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 - 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 - 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 - 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 - 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 - 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = -0
Dik, K.J.; Kalsbeek, H.C.
To obtain radiographic information concerning the equine stomach, a gastrographic contrast examination is required. This study describes this procedure in detail. A powerful radiographic unit, the tubehead linked to an image intensifier and suspended by an electromechanical overhead gantry system, is required. To obtain accurately positioned radiographs during the fluoroscopic examination, a cassette holder with a stationary grid is mounted at the entrance window of the image intensifier. The examination is performed in the unsedated standing horse after 24 hours of starvation, using a combination of survey radiography and fluoroscopic viewing after the inflation of air, followed by the administration of barium sulphate suspension by stomach tube. The gastrographic contrast examination is performed in three experimental animals and 23 abnormal horses. Pneumogastrophy appeared to be valuable to diagnose gastric tumors, to differentiate between gastric tumors and other masses in the cranial abdomen, and to visualize gastric parasites, even in large horses. The use of barium sulphate suspension does not result in an adequate double contrast of the stomach, but it may aid to diagnose esophagogastric or pyloric stenosis and gastric or duodenal ulcers
Wood, A.K.W.; Reynolds, K.M.; Leith, I.S.; Burns, P.A.
During radiography of the carpus of horses calcium fluoride thermoluminescent dosemeters were used to measure the radiation exposure to the hand of an assistant positioning the x-ray film. Three portable x-ray machines and a mobile machine were used during the recordings. The effects of x-ray machine, radiographic technique, and lead rubber gloves upon radiation exposure to the hand were investigated. The size of the primary beam of the x-ray machine was found to be the major factor in determining the dose of radiation received by the hand. The highest radiation exposures were recorded when using two portable machines which were fitted with beam limiting devices that permitted only one primary beam size. The lowest exposures were measured when radiographs were taken with the mobile machine that was fitted with a light beam diaphragm. The control of primary beam size with a light beam diaphragm was found to be the most effective method of reducing radiation dosage to the hand. It is strongly recommended that for equine radiography a light beam diaphragm be fitted to and used on all x-ray machines, and a cassette holder be used to keep the hands out of the primary beam. (author)
Full Text Available Our research aimed to assess the effectiveness of four benzimidazoles: albendazole, fenbendazole, mebendazole and thiabendazole against equine strongyles. The tests were performed between March 2015 and May 2016, on samples collected from 20 horses and 8 donkeys living in Harghita County. In vivo, Faecal Egg Count Reduction Test (FECRT was used to evaluate fenbendazole pharmacodynamics. In vitro, Egg hatch assay (EHA and Larval development assay (LDA were used to evaluate the effectiveness of albendazole, fenbendazole, mebendazole and thiabendazole. The predominance of small strongyle species was observed, mostly Cyathostomum type A. In the horse group, before treatment, the average intensity was 1595.5 EPG, the maximum value being 4000, and extensivity 55%. Tested again at 14 days after treatment, all samples were negative. In the donkey group, before treatment, the total number was 6550 EPG, intensity of 935.7 and extensivity of 87.5%. 14 days after treatment, the average intensity was 150 and the extensivity 50%. In the horse group, EHA proved the efficacy of fenbendazole (0.0192%, albendazole (0.3740% and thiabendazole (11.62% and a major risk of inducing adaptive phenomena for mebendazole (Y parameter 1009.92. In the donkey group, all benzimidazoles had limited effectiveness: thiabendazole (73.93%, mebendazole (87.51%, fenbendazole (94.05%, albendazole (111.67%. All benzimidazoles inhibited larval development. For all tested benzimidazoles, the resistance induction predictive comparative risk analysis highlighted the benefit of their use, provided that the treatment protocol allows sufficient contact time.
Dik, K.J.; Kalsbeek, H.C.
To obtain radiographic information concerning the equine stomach, a gastrographic contrast examination is required. This study describes this procedure in detail. A powerful radiographic unit, the tubehead linked to an image intensifier and suspended by an electromechanical overhead gantry system, is required. To obtain accurately positioned radiographs during the fluoroscopic examination, a cassette holder with a stationary grid is mounted at the entrance window of the image intensifier. The examination is performed in the unsedated standing horse after 24 hours of starvation, using a combination of survey radiography and fluoroscopic viewing after the inflation of air, followed by the administration of barium sulphate suspension by stomach tube. The gastrographic contrast examination is performed in three experimental animals and 23 abnormal horses. Pneumogastrophy appeared to be valuable to diagnose gastric tumors, to differentiate between gastric tumors and other masses in the cranial abdomen, and to visualize gastric parasites, even in large horses. The use of barium sulphate suspension does not result in an adequate double contrast of the stomach, but it may aid to diagnose esophagogastric or pyloric stenosis and gastric or duodenal ulcers
Schnabel, Christiane L; Babasyan, Susanna; Freer, Heather; Wagner, Bettina
Only few quantitative reports exist about the concentrations and induction of immunoglobulin A (IgA) in mucosal secretions of horses. Despite this, it is widely assumed that IgA is the predominant immunoglobulin on mucosal surfaces in the horse. Here, two new monoclonal antibodies (mAbs) against equine IgA, clones 84-1 and 161-1, were developed and characterized in detail. Both IgA mAbs specifically bound monomeric and dimeric equine IgA in different applications, such as Western blots and fluorescent bead-based assays. Cross-reactivity with other equine immunoglobulin isotypes was not observed. The new IgA mAb 84-1 was used in combination with the previously characterized anti-equine IgA mAb BVS2 for the development and validation of a fluorescent bead-based assay to quantify total IgA in equine serum and various secretions. The IgA assay's linear detection ranged from 64pg/ml to 1000ng/ml. For the quantification of IgA in serum or in secretions an IgA standard was purified from serum or nasal wash fluid (secretory IgA), respectively. The different standards were needed for accurate IgA quantification in the respective samples taking the different signal intensities of monomeric and dimeric IgA on the florescent bead-based assay into account. IgA was quantified by the bead-based assay established here in different equine samples of healthy adult individuals. In serum the median total IgA was 0.45mg/ml for Thoroughbred horses (TB, n=10) and 1.16mg/ml in Icelandic horses (ICH, n=12). In nasopharyngeal secretions of TB (n=7) 0.13mg/ml median total IgA was measured, and 0.25mg/ml for ICH (n=12). Saliva of ICH (n=6) contained a median of 0.15mg/ml, colostrum of Warmbloods (n=8) a median of 1.89mg/ml IgA. Compared to IgG1 and IgG4/7 quantified in the same samples, IgA appeared as the major immunoglobulin isotype in nasopharyngeal secretions and saliva while it is a minor isotype in serum and colostrum. The newly developed monoclonal antibodies against equine IgA and the
Madenci, Arin L; Stetson, Alyssa; Weldon, Christopher B; Lehmann, Leslie E
Hepatic VOD (veno-occlusive disease) is a serious complication of HSCT (hematopoietic stem cell transplantation) and has historically been associated with high mortality. This obstruction to hepatic flow often results in fluid collections in the peritoneal and pleural cavities. Catheter placement to drain ascites or pleural fluid may reduce intra-abdominal hypertension and/or improve respiratory parameters. The safety of these interventions among critically ill, immunocompromised children is unknown. Among 32 HSCT recipients (2000-2012) with severe VOD, we assessed the primary outcome of procedural complication from peritoneal drain placement. Twenty-four (75%) patients underwent peritoneal drain placement. No patient sustained visceral perforation or hemorrhage with drain placement. Overall mortality was 47% (n = 15). The procedure was not associated with increased overall mortality (p > 0.99). Eight (25%) peritoneal drains required replacement for malfunction. Of 24 patients with peritoneal drains, one (4%) patient had a positive culture from ascitic fluid. Eight (25%) patients underwent pleural drain placement. No pleural drain-related procedural complication or infection occurred. Four (50%) of the eight patients with pleural drains had de-escalation in oxygen requirement at drain removal, compared to time of placement. In this study, peritoneal and pleural drains were safe interventions for children with severe VOD. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Ring-Larsen, H; Henriksen, Jens Henrik Sahl
Plasma-to-peritoneal transport rate of albumin (TERperit.space) was determined in eighteen patients with decompensated cirrhosis by sampling ascitic fluid after i.v. injection of 125I-labelled serum albumin. Median TERperit.space was 0.30% of the intravascular albumin mass (IVM) per hour (range 0...
Full Text Available Peritoneal dialysis (PD is a well-established modality for treatment of patients with end-stage renal disease, giving excellent patient and technique survival rates. In Saudi Arabia, data collected by the Saudi Center for Organ Transplantation showed that in 2008, patients on PD accounted for a mere 4.8% of total patients on renal replacement therapy, including hemodialysis and renal transplantation. This study was conducted to identify the characteristics of membrane per-meability in the Saudi population and to assess the role of various factors affecting solute transport across the peritoneal membrane. We followed up a total of 52 patients on Continuous Ambulatory Peritoneal Dialysis (CAPD as well as Automated Peritoneal Dialysis (APD, being treated in the PD unit of the King Khalid University Hospital, Riyadh. There were 30 female and 22 male patients; 14 patients were using CAPD while 38 patients were on APD. The mean age of the patients was 50.5 years, with a range of 14-86 years. The average body mass index (BMI was 27.1 kg/m 2 and the mean body surface area (BSA of the study patients was 1.71 m 2 . A standardized PET test was performed on all patients, 4-6 weeks after initiation of regular PD. The Kt/V and creatinine clearance measured 6-8 weeks after initiation of dialysis were 1.96 and 56.59 L/week, respectively. Residual renal function was assessed on the basis of daily urine output, using 24-hour urine collection. The mean serum urea con-centration was 16.91 mmol/L and mean serum creatinine was 702 μmol/L. According to the Peritoneal Equiliberation Test (PET, 8% of the subjects belonged to the high trans-porter category, 44% patients belonged to the high-average transport group, 46% to the low-average category and 2% came in the low transporter category. Our study suggests that the patient characteristics and demographic para-meters seen in the Saudi population are comparable to those seen in other studies from the Middle East and
Gayathri Prabhu S
Full Text Available Visceral and peritoneal anomalies are frequently encountered during cadaveric dissections and surgical procedures of abdomen. A thorough knowledge of the same is required for the success of diagnostic, surgical and radiological procedures of abdomen. We report multiple peritoneal and visceral anomalies noted during dissection classes for medical undergraduates. The anomalies were found in an adult male cadaver aged approximately 70 years. The right iliac fossa was empty due to the sub-hepatic position of caecum and appendix. The sigmoid colon formed an inverted “U” shaped loop above the sacral promontory in the median position. It entered the pelvis from the right side and descended along the lateral wall of the pelvis. The sigmoid mesocolon was attached obliquely to the posterior abdominal wall, just above the sacral promontory. Further there was a cysto-colic fold of peritoneum extending from the right colic flexure. We discuss the clinical significance of the variations.
Duquennoy, Simon; Béchade, Clémence; Verger, Christian; Ficheux, Maxence; Ryckelynck, Jean-Philippe; Lobbedez, Thierry
♦ This study was carried out to examine whether or not elderly patients on peritoneal dialysis (PD) had an increased risk of peritonitis. ♦ This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 8,396 incident patients starting PD between January 2003 and December 2010. The end of the observation period was 31 December 2012. Patients were separated into 2 age groups: up to 75 and over of 75 years old. ♦ Among 8,396 patients starting dialysis there were 3,173 patients older than 75. When using a Cox model, no association was found between age greater than 75 years and increased risk of peritonitis (hazard ratio [HR]: 0.97 [0.88 - 1.07]). Diabetes (HR: 1.14 [1.01 - 1.28] and continuous ambulatory PD (HR: 1.13 [1.04 - 1.23]) were significantly associated with a higher risk of peritoneal infection whereas nurse-assisted PD was associated with a lower risk of peritonitis (HR: 0.85 [0.78 - 0.94]. In the analysis restricted to the 3,840 self-care PD patients, there was no association between age older than 75 years and risk of peritonitis. ♦ The risk of peritonitis is not increased in elderly patients on PD in a country where assisted PD is available. Copyright © 2016 International Society for Peritoneal Dialysis.
Cheuk Chun Szeto
Full Text Available Background/Aims: Enterococcal peritonitis in peritoneal dialysis (PD patients is associated with a high complication rate. The optimal treatment regimen of PD-related enterococcal peritonitis is controversial. The latest international guideline recommends intra-peritoneal (IP vancomycin. Although ampicillin is often effective for systemic enterococcal infections, they have little in vitro activity when added to common PD solutions. Since oral amoxicillin achieves therapeutic drug level in the peritoneal cavity, we explore the efficacy of oral amoxicillin for enterococcal peritonitis. Methods: We studied 105 episodes of enterococcal peritonitis over 20 years in our unit; 43 (41.0% were treated with oral amoxicillin, and 62 (59.0% with IP vancomycin. Their clinical outcome was reviewed. Result: The overall primary response rate to oral amoxicillin and IP vancomycin was 76.4% and 85.5%, respectively (p = 0.3. The complete cure rate of oral amoxicillin and IP vancomycin was 55.8% and 54.8%, respectively (p = 0.8. When the 5 episodes of ampicillin-resistant Enterococcus episodes were excluded, the primary response rate and complete cure rate of oral amoxicillin were 86.8% and 63.2%, respectively. Conclusion: Oral amoxicillin has an excellent primary response rate and complete cure rate for PD-related peritonitis episodes caused by Enterococcus species, indicating that oral amoxicillin is a valid and convenient therapeutic option for enterococcal peritonitis episodes.
Magnussen, Eyð Tausen; Vang, Amanda Gratton; á Steig, Torkil
We present a case where Bacillus cereus was determined to be the causative agent of relapsing peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). The patient, a 70-year-old man from the Faroe Islands, was admitted with relapsing peritonitis four times over a 3-month period....... Peritoneal cultures were positive for growth of B. cereus, a rare bacterial cause of peritonitis. The cultures demonstrated susceptibility to vancomycin, and therefore the patient was treated with intraperitoneal vancomycin, intraperitoneal gentamycin and oral ciprofloxacin. As a result of the relapsing B....... cereus peritonitis diagnosis and a CT scan showing contraction of the peritoneum after longstanding inflammation, the peritoneal catheter was removed and the patient converted to haemodialysis. To date, the patient has not been readmitted due to peritonitis. A lack of proper hygiene when changing...
Blach, Edward L
This article explores customer service in equine veterinary medicine. It begins with a discussion about the differences between customers and clients in veterinary medicine. An overview of the nature of the veterinary-client-patient relationship and its effects on the veterinarian's services sheds light on how to evaluate your customer service. The author reviews a study performed in 2007 that evaluated 24 attributes of customer service and their importance to clients of equine veterinarians in their decision to select a specific veterinarian or hospital. The article concludes with an overview of how to evaluate your customer service in an effort to optimize your service to achieve customer loyalty.
Stroescu, C; Negulescu, Raluca; Herlea, V; David, L; Ivanov, B; Nitipir, Cornelia; Popescu, I
The benign cystic peritoneal mesothelioma (BCPM) is a rare neoplasm affecting mainly females at reproductive age. The natural history and physiopathology of the BCPM are not entirely known. It is mainly characterized by the lack of malignant elements, no tendency to metastasis and by a pervasive tendency to generate local recurrences after surgical removal. The clinical manifestations are insidious, uncharacteristic; the benign cystic peritoneal mesothelioma is often discovered during a surgical procedure addressing another condition. Imaging tests can raise the suspicion of BCPM but the diagnostic can only be confirmed by histopathological examination corroborated with an immunohistochemical analysis. There are no long term studies dictating a single therapeutic attitude but a high risk of local recurrences and the possibility of transformation into malignant mesothelioma have lead to the current tendency towards an aggressive treatment of the tumor. We present the case of a recurrent benign cystic peritoneal mesothelioma in a 40 years old female patient, emphasizing the therapeutic approach and the role of radical surgery in the treatment of BPCM.
Lederman, G.; Recht, A.
The role of radiation therapy in the treatment of peritoneal mesotheliomas remains ill-defined despite its association with the few long-term survivals reported for this disease. The rationale for local therapy is clear as the disease most often is confined to the peritoneal cavity at the time of initial diagnosis and remains there for much of the subsequent course. Effective local treatment of this intra-abdominal disease would likely improve survival. The absence of randomized studies has made analysis of the various treatments of the disease and the few reported success difficult. Nonetheless, scrutiny of the available data may offer insights and guide future clinical trials, as well as the clinician responsible for the treatment of current patients with peritoneal mesothelioma. The radiotherapeutic approach to oncology stresses anatomic considerations in an attempt to understand the patterns of spread of the primary tumor. The observed location and bulk of disease by clinical examination, radiologic study, surgical exploration, and autopsy suggest mechanisms of metastases (direct extension, lymphatic or hematogenous). This dictates the administration of radiation that best achieves a successful outcome
The equine industries in Ireland are vibrant and growing. They are broadly classified into two sectors: Thoroughbred racing, and sports and leisure. This paper describes these sectors in terms of governance, education and training in equine welfare, and available data concerning horse numbers, identification, traceability and disposal. Animal welfare, and specifically equine welfare, has received increasing attention internationally. There is general acceptance of concepts such as animal needs and persons' responsibilities toward animals in their care, as expressed in the 'Five Freedoms'. As yet, little has been published on standards of equine welfare pertaining to Ireland, or on measures to address welfare issues here. This paper highlights the central role of horse identification and legal registration of ownership to safeguard the health and welfare of horses. PMID:21851704
Cui, Jiannan; Zhao, Yongkun; Wang, Hualei; Qiu, Boning; Cao, Zengguo; Li, Qian; Zhang, Yanbo; Yan, Feihu; Jin, Hongli; Wang, Tiecheng; Sun, Weiyang; Feng, Na; Gao, Yuwei; Sun, Jing; Wang, Yanqun; Perlman, Stanley; Zhao, Jincun; Yang, Songtao; Xia, Xianzhu
West Nile virus (WNV) is prevalent in Africa, Europe, the Middle East, West Asia, and North America, and causes epidemic encephalitis. To date, no effective therapy for WNV infection has been developed; therefore, there is urgent need to find an efficient method to prevent WNV disease. In this study, we prepared and evaluated the protective efficacy of immune serum IgG and pepsin-digested F(ab')₂ fragments from horses immunized with the WNV virus-like particles (VLP) expressing the WNV M and E proteins. Immune equine F(ab')₂ fragments and immune horse sera efficiently neutralized WNV infection in tissue culture. The passive transfer of equine immune antibodies significantly accelerated the virus clearance in the spleens and brains of WNV infected mice, and reduced mortality. Thus, equine immunoglobulin or equine neutralizing F(ab')₂ passive immunotherapy is a potential strategy for the prophylactic or therapeutic treatment of patients infected with WNV.
Full Text Available West Nile virus (WNV is prevalent in Africa, Europe, the Middle East, West Asia, and North America, and causes epidemic encephalitis. To date, no effective therapy for WNV infection has been developed; therefore, there is urgent need to find an efficient method to prevent WNV disease. In this study, we prepared and evaluated the protective efficacy of immune serum IgG and pepsin-digested F(ab′2 fragments from horses immunized with the WNV virus-like particles (VLP expressing the WNV M and E proteins. Immune equine F(ab′2 fragments and immune horse sera efficiently neutralized WNV infection in tissue culture. The passive transfer of equine immune antibodies significantly accelerated the virus clearance in the spleens and brains of WNV infected mice, and reduced mortality. Thus, equine immunoglobulin or equine neutralizing F(ab′2 passive immunotherapy is a potential strategy for the prophylactic or therapeutic treatment of patients infected with WNV.
Full Text Available Abstract The equine industries in Ireland are vibrant and growing. They are broadly classified into two sectors: Thoroughbred racing, and sports and leisure. This paper describes these sectors in terms of governance, education and training in equine welfare, and available data concerning horse numbers, identification, traceability and disposal. Animal welfare, and specifically equine welfare, has received increasing attention internationally. There is general acceptance of concepts such as animal needs and persons' responsibilities toward animals in their care, as expressed in the 'Five Freedoms'. As yet, little has been published on standards of equine welfare pertaining to Ireland, or on measures to address welfare issues here. This paper highlights the central role of horse identification and legal registration of ownership to safeguard the health and welfare of horses.
Wu, Haishan; Huang, Rong; Yi, Chunyan; Wu, Juan; Guo, Qunying; Zhou, Qian; Yu, Xueqing; Yang, Xiao
♦ BACKGROUND: Early peritonitis was confirmed to be associated with a higher risk of early technique failure. However, literature concerning peritonitis within the first 3 months of peritoneal dialysis (PD) initiation is scarce. The present study was to investigate risk factors associated with early-onset peritonitis in PD patients. ♦ METHODS: In this retrospective observational cohort study, all incident PD patients from January 1, 2006, to December 31, 2013, were recruited and followed up until December 31, 2014. According to time-to-first episode of peritonitis, patients were divided into early-onset (≤ 3 months) peritonitis and late-onset (> 3 months) peritonitis. Baseline demographic, clinical, and laboratory data, as well as episodes of peritonitis, were collected. Risk factors associated with early-onset peritonitis were evaluated using logistic regression model. ♦ RESULTS: Of 1,690 patients on PD, 503 (29.8%) developed at least 1 episode of peritonitis and 118 (7.0%) patients presented the first episodes of peritonitis within the first 3 months. A multivariate logistic analysis showed that higher body mass index (BMI) (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01 - 1.15, p = 0.034), hypoalbuminemia (OR 1.75, 95% CI 1.11 - 2.78, p = 0.017), and catheter exit-site infection (OR 4.14, 95% CI 2.45 - 7.00, p peritonitis. Compared to those with late-onset, patients with early-onset peritonitis had a higher overall peritonitis rate (0.76 vs 0.38 per patient-year, p 0.05). ♦ CONCLUSIONS: Higher BMI, hypoalbuminemia, and catheter exit-site infection were the risk factors associated with early-onset peritonitis in PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.
Wiesholzer, Martin; Winter, Alexandra; Kussmann, Manuel; Zeitlinger, Markus; Pichler, Petra; Burgmann, Heinz; Reznicek, Gottfried; Poeppl, Wolfgang
♦ BACKGROUND: Intraperitoneal administration of antimicrobial agents is recommended for the treatment of peritoneal dialysis (PD)-related peritonitis. For home-based antimicrobial therapy it is common to supply patients with PD fluid bags with admixed antibiotic. Thus, the compatibility of meropenem with different PD fluids (PDFs), namely Extraneal, Physioneal 1.36% and Physioneal 2.27% (all Baxter Healthcare Corp., Deerfield, IL, USA), was investigated under varying storage conditions. ♦ METHODS: Meropenem (Venus Pharma, Werne, Germany) was stored at 6°C and 25°C over 14 days and at 37°C over 24 hours. Drug concentration over time was determined using high performance liquid chromatography, drug activity by a diffusion disk method, diluent stability by visual inspection and drug adsorption was calculated. Blank PD fluids and deionized water were used as comparator solutions. ♦ RESULTS: Compared to water, the stability of meropenem was minimally lower in Extraneal but markedly reduced in both Physioneal solutions. No significant drug adsorption was detected for any PDF investigated. ♦ CONCLUSIONS: Meropenem is stable and compatible with Extraneal and might be stored for up to a week at refrigeration temperature (6°C). A loss of ~20% of meropenem after 2 days at room temperature should be considered. Mixed Physioneal appears not suitable for storage at any temperature after meropenem has been admixed. A considerable drug degradation due to the warming up to body temperature through heating plates should further be taken into account in clinical practice. Copyright © 2017 International Society for Peritoneal Dialysis.
Candido, Paula de Castro Menezes; Werner, Andrea de Freitas; Pereira, Izabela Machado Flores; Matos, Breno Assuncao; Pfeilsticker, Rudolf Moreira; Silva Filho, Raul, E-mail: email@example.com [Hospital Felicio Rocho, Belo Horizonte, MG (Brazil)
Sclerosing encapsulating peritonitis, a rare cause of bowel obstruction, was described as a complication associated with peritoneal dialysis which is much feared because of its severity. The authors report a case where radiological findings in association with clinical symptoms have allowed for a noninvasive diagnosis of sclerosing encapsulating peritonitis, emphasizing the high sensitivity and specificity of computed tomography to demonstrate the characteristic findings of such a condition. (author)
Grefe , Gwenaëlle; Pickel-Chevalier , Sylvine
International audience; A social revolution in riding has created incredible growth in the equine-product market. This new equine economy is, in fact, characterized by the range of activities available (32 riding styles are listed by the FFE 1), by riders' needs (equipment for both riders and their horses including fences, water troughs, horse-boxes etc.), by product ranges (from entry-level to luxury goods), but also by fashion which, thanks to the profile of today's horse-riders (predominan...
Full Text Available Residual renal function (RRF in patients with end-stage renal disease (ESRD receiving renal replacement therapy is defined as the ability of native kidneys to eliminate water and uremic toxins. Preserved RRF improves survival and quality of life in adult ESRD patients treated with peritoneal dialysis. In children, RRF was shown not only to help preserve adequacy of renal replacement therapy but also to accelerate growth rate, improve nutrition and blood pressure control, reduce the risk of adverse myocardial changes, facilitate treatment of anemia and calcium-phosphorus balance abnormalities, and result in reduced serum and dialysate fluid levels of advanced glycation end-products. Factors contributing to RRF loss in children treated with peritoneal dialysis include the underlying renal disease such as hemolytic-uremic syndrome and hereditary nephropathy, small urine volume, severe proteinuria at the initiation of renal replacement therapy, and hypertension. Several approaches can be suggested to decrease the rate of RRF loss in pediatric patients treated with chronic peritoneal dialysis: potentially nephrotoxic drugs (e.g., aminoglycosides, episodes of hypotension, and uncontrolled hypertension should be avoided, urinary tract infections should be treated promptly, and loop diuretics may be used to increase salt and water excretion.
Full Text Available Fungal peritonitis is a serious complication of peritoneal dialysis (PD leading to loss of ultrafiltration and discontinuation of PD treatment. The most frequently isolated fungi are Candida albicans and, filamentous fungi such Alternaria alternata species are found only rarely. We report the case of a 75-year-old woman who developed peritonitis due to this black fungus.
Kemp, Anna; Clayton, Philip; Lim, Wai; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Wiggins, Kathryn J.; Bannister, Kym M.; Brown, Fiona G.; Johnson, David W.
Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days. PMID:22626818
Raaijmakers, R.; Gajjar, P.; Schroder, C.; Nourse, P.
Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and
van Esch, Sadie; Struijk, Dirk G.; Krediet, Raymond T.
♦ The quality of the peritoneal membrane can deteriorate over time. Exposure to glucose-based dialysis solutions is the most likely culprit. Because peritonitis is a common complication of peritoneal dialysis (PD), distinguishing between the effect of glucose exposure and a possible additive effect
George, C.; Al-Zwae, K.; Nair, S.; Cast, J.E.I.
Sclerosing encapsulating peritonitis (SEP) is a serious complication of peritoneal dialysis (PD) characterized by thickened peritoneal membranes, which lead to decreased ultra-filtration and intestinal obstruction. Its early clinical features are nonspecific, and it is often diagnosed late following laparotomy and peritoneal biopsy, when the patient develops small bowel obstruction, which can be a life-threatening complication. However, this is changing with increasing awareness of computed tomography (CT) findings in SEP. CT can yield an early, non-invasive diagnosis that may improve patient outcome. We present a review of the CT appearances of SEP
George, C. [Department of Radiology, Hull Royal Infirmary, Hull (United Kingdom)]. E-mail: firstname.lastname@example.org; Al-Zwae, K. [Department of Radiology, Hull Royal Infirmary, Hull (United Kingdom); Nair, S. [Department of Radiology, Hull Royal Infirmary, Hull (United Kingdom); Cast, J.E.I. [Department of Radiology, Hull Royal Infirmary, Hull (United Kingdom)
Sclerosing encapsulating peritonitis (SEP) is a serious complication of peritoneal dialysis (PD) characterized by thickened peritoneal membranes, which lead to decreased ultra-filtration and intestinal obstruction. Its early clinical features are nonspecific, and it is often diagnosed late following laparotomy and peritoneal biopsy, when the patient develops small bowel obstruction, which can be a life-threatening complication. However, this is changing with increasing awareness of computed tomography (CT) findings in SEP. CT can yield an early, non-invasive diagnosis that may improve patient outcome. We present a review of the CT appearances of SEP.
Vicente PÃ©rez DÃaz
Full Text Available The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with âYâ system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10â16Â cmÂ H2O, intraperitoneal pressure should never exceed 18Â cmÂ H2O. With basal values that depend on body mass index, it increases 1â3Â cmÂ H2O/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis. Resumen: La medida de la presiÃ³n intraperitoneal en diÃ¡lisis peritoneal es muy sencilla y aporta claros beneficios terapÃ©uticos. Sin embargo, su monitorizaciÃ³n todavÃa no se ha generalizado en las unidades de diÃ¡lisis peritoneal de adultos. Esta revisiÃ³n pretende divulgar su conocimiento y la utilidad de su medida. Se realiza en decÃºbito antes de iniciar el drenaje de un intercambio manual con bolsa en Y, elevando la bolsa de
Katalinić, Lea; Blaslov, Kristina; Pasini, Eva; Kes, Petar; Bašić-Jukić, Nikolina
When compared to hemodialysis, peritoneal dialysis is very simple yet low cost method of renal replacement therapy. Series of studies have shown its superiority in preserving residual renal function, postponing uremic complications, maintaining the acid-base balance and achieving better post-transplant outcome in patients treated with this method. Despite obvious advantages, its role in the treatment of chronic kidney disease is still not as important as it should be. Metabolic acidosis is an inevitable complication associated with progressive loss of kidney function. Its impact on mineral and muscle metabolism, residual renal function, allograft function and anemia is very complex but can be successfully managed. The aim of our study was to evaluate the efficiency in preserving the acid-base balance in patients undergoing peritoneal dialysis at Zagreb University Hospital Center. Twenty-eight patients were enrolled in the study. The mean time spent on the treatment was 32.39 ± 43.43 months. Only lactate-buffered peritoneal dialysis fluids were used in the treatment. Acid-base balance was completely maintained in 73.07% of patients; 11.54% of patients were found in the state of mild metabolic acidosis, and the same percentage of patients were in the state of mild metabolic alkalosis. In one patient, mixed alkalosis with respiratory and metabolic component was present. The results of this study showed that acid-base balance could be maintained successfully in patients undergoing peritoneal dialysis, even only with lactate-buffered solutions included in the treatment, although they were continuously proclaimed as inferior in comparison with bicarbonate-buffered ones. In well educated and informed patients who carefully use this method, accompanied by the attentive and thorough care of their physicians, this method can provide quality continuous replacement of lost renal function as well as better quality of life.
Vijai Datta Upadhyaya
Full Text Available Background: Spontaneous biliary peritonitis is a rare cause of acute abdomen. In spontaneous biliary peritonitis there is perforation in the wall of the extra-hepatic or intra-hepatic duct occurs without any traumatic or iatrogenic injury and have been described more often in neonates. The symptoms may be acute or insidious delaying the diagnosis. Present manuscript deals with diagnosis and management of these cases. Materials and Methods: This is a prospective study and all patients of suspected biliary peritonitis presented during Dec 2010 to Feb 2012 were included in the study. After preliminary investigations in all patients abdominal paracentesis was done and in cases where intra-abdominal fluid bilirubin level was several fold higher than serum bilirubin level were subjected to exploratory laparotomy. Further investigation like T-tube cholangiogram and magnetic resonance cholangiopancreatography (MRCP was done to rule out choledochal cyst before leveling these cases as SPBD. Results: A total of 6 patients were included in present series commonest presenting symptom was progressive abdominal distension without signs of overt peritonitis followed by progressive jaundice, fever and abdominal pain. On exploration site of perforation was observed in 50% of cases and in 50% of cases bile duct was not dilated. Second surgery was not required in 34% of cases. There was no mortality or significant morbidity in our series. Conclusion: Spontaneous perforation of bile duct is rare disease and high index of suspicion is required for diagnosis. Simple bed side test can help in diagnosis but T tube cholangiogram or MRCP are must to rule out choledochal cyst.
Andersson, R.; Schalen, C.; Tranberg, K.G.
The effect of intraperitoneal bile on growth, peritoneal absorption, and clearance of Escherichia coli was determined in E coli peritonitis in the rat. In E coli peritonitis, intraperitoneal bacterial counts gradually decreased, whereas they increased (after 2 hours) with subsequent development of bacteremia in E coli plus bile peritonitis. After an intraperitoneal injection of labeled bacteria, blood radioactivity was only initially lower in E coli plus bile peritonitis compared with E coli peritonitis. Clearance from blood was lower in E coli plus bile peritonitis than in E coli peritonitis. Organ localization was similar in E coli peritonitis and E coli plus bile peritonitis with decreased splenic, increased pulmonary, and unchanged hepatic uptakes compared with controls. Impaired peritoneal absorption of bacteria, together with impaired local host defense, is likely to enhance the noxious effect of bile in E coli peritonitis
Virzì, Grazia Maria; Milan Manani, Sabrina; Brocca, Alessandra; Cantaluppi, Vincenzo; de Cal, Massimo; Pastori, Silvia; Tantillo, Ilaria; Zambon, Roberto; Crepaldi, Carlo; Ronco, Claudio
Cell-free DNA (cfDNA) is present in the peritoneal effluent of stable peritoneal dialysis (PD) patients, but there are no data on cfDNA in PD patients with peritonitis. We investigated the variation of peritoneal cfDNA levels subsequent to peritonitis in PD patients. We enrolled 53 PD patients: 30 without any history of systemic inflammation or peritonitis in the last 3 months (group A) and 23 with acute peritonitis (group B). CfDNA was quantified in the peritoneal effluent. Peritoneal samples on days 1, 3, 10, 30 and until day 120 from the start of peritonitis were collected for white blood cells (WBC) count and cfDNA evaluation in group B. Quantitative analysis of cfDNA showed significantly higher levels in group B on day 1, 3, 10 and 30 compared with group A (p peritoneal cfDNA levels tended to progressively decline during follow-up of peritonitis. From this decreasing curve, we estimated that 49 days are necessary to reach the value of 51 genome equivalents (GE)/ml (75th percentile in controls) and 63 days to reach 31 GE/ml (median). Our results demonstrate that cfDNA increases in peritoneal effluent of PD patients with peritonitis and tends to progressively decline in step with peritonitis resolution and membrane repair process. Peritoneal cfDNA quantification could be an innovative method to determine acute damage and an inverse index of the repair process.
Tian, Yuanshi; Xie, Xishao; Xiang, Shilong; Yang, Xin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua
Abstract Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients’ technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients. This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes. During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality. We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality. These results may help to identify and target patients who are at higher risk of HPR at the start
Hautem, Nicolas; Morelle, Johann; Sow, Amadou; Corbet, Cyril; Feron, Olivier; Goffin, Eric; Huaux, François; Devuyst, Olivier
Bacterial peritonitis remains the main cause of technique failure in peritoneal dialysis (PD). During peritonitis, the peritoneal membrane undergoes structural and functional alterations that are mediated by IL-1 β The NLRP3 inflammasome is a caspase-1-activating multiprotein complex that links sensing of microbial and stress products to activation of proinflammatory cytokines, including IL-1 β The potential roles of the NLRP3 inflammasome and IL-1 β in the peritoneal membrane during acute peritonitis have not been investigated. Here, we show that the NLRP3 inflammasome is activated during acute bacterial peritonitis in patients on PD, and this activation associates with the release of IL-1 β in the dialysate. In mice, lipopolysaccharide- or Escherichia coli -induced peritonitis led to IL-1 β release in the peritoneal membrane. The genetic deletion of Nalp3 , which encodes NLRP3, abrogated defects in solute transport during acute peritonitis and restored ultrafiltration. In human umbilical vein endothelial cells, IL-1 β treatment directly enhanced endothelial cell proliferation and increased microvascular permeability. These in vitro effects require endothelial IL-1 receptors, shown by immunofluorescence to be expressed in peritoneal capillaries in mice. Furthermore, administration of the IL-1 β receptor antagonist, anakinra, efficiently decreased nitric oxide production and vascular proliferation and restored peritoneal function in mouse models of peritonitis, even in mice treated with standard-of-care antibiotherapy. These data demonstrate that NLRP3 activation and IL-1 β release have a critical role in solute transport defects and tissue remodeling during PD-related peritonitis. Blockade of the NLRP3/IL-1 β axis offers a novel method for rescuing morphologic alterations and transport defects during acute peritonitis. Copyright © 2017 by the American Society of Nephrology.
Jackman, Brad R; McCafferty, Owen E
This article discusses mergers and acquisitions involving equine veterinary practices. Combining practices can be professionally and economically advantageous but requires a great deal of thought, planning, and implementation. If due diligence is performed and true business teamwork is undertaken, the benefits can be enormous and rewarding.
This report introduces an autoradiographic method of studying the growth of entire equine hoof sections. It has the advantage that accurate measurements can be made of changes in the rate of growth before and after treatment such as dietary supplementation with biotin on the development of laminitis
Rudolph, James A.
This basic core of instruction for equine management and production is designed to assist instructors in preparing students for successful employment or management of a one- or two-horse operation. Contents include seven instructional areas totaling seventeen units of instruction: (1) Orientation (basic horse production; handling and grooming;…
Sonea, I.M.; Wilson, D.V.; Bowker, R.M.; Robinson, N.E.
Tachykinins, of which substance P (SP) is the prototype, are neuropeptides which are widely distributed in the nervous systems. In the equine gut, SP is present in enteric nerves and is a powerful constrictor of enteric muscle; in other species, SP is also known to have potent vasodilatory and pro-inflammatory effects. The specific effects of SP are determined by the subtype of receptor present in the target tissue. There are 3 known subtypes of tachykinin receptors, distinguished by their relative affinities for SP and other tachykinins. The distribution of SP binding sites in the equine pelvic flexure was determined using 125I-Bolton Hunter SP (I-BHSP) autoradiography. Most I-BHSP binding sites were determined to be saturable and specific, therefore presumably representing tachykinin receptors. The greatest degree of I-BHSP binding occurred over very small vessels, and over the muscularis mucosae; I-BHSP binding was also intense over the circular muscle of the muscularis externa and mucosa, and present, although less intense, over the longitudinal muscle of the muscularis externa. Competition of I-BHSP with specific receptor agonists for binding sites in the equine pelvic flexure were used to determine the subtypes of tachykinin receptors present. The neurokinin-1 receptor subtype predominated in the equine pelvic flexure, followed by the neurokinin-3 receptor subtype
The principles of radiological protection are summarised and consideration is then given to problems, which may confront the equine practitioner, in the fulfillment of these principles during diagnostic radiography of the limbs, head, and spine of the horse. The place of anaesthesia in such procedures is discussed and the special problems associated with therapeutic radiography of the horse are considered.
Peixoto Filho, Anibal Araujo Alves; Peixoto, Mila Correia Gois [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Setor de US/TC/RM; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: email@example.com
The peritoneum is a frequent site of involvement by peritoneal tuberculosis. Generally, computed tomography appears to be the imaging modality of choice in the detection and assessment of abdominal tuberculosis. The computed tomography findings can help in the diagnosis of peritoneal tuberculosis, that is confirmed by a positive culture or hystologic analysis of biopsy obtained through laparoscopic examination. Peritoneal carcinomatosis is the main differential diagnosis. In this article we present the spectrum of tomographic manifestation of peritoneal tuberculosis and how we can differentiate it from peritoneal carcinomatosis. (author)
Zhang, Yun-Fang; Zou, Xun-Liang; Wu, Jun; Yu, Xue-Qing; Yang, Xiao
We assessed the anti-inflammatory effect of peroxisome proliferator-activated receptor (PPAR)-γ agonist, rosiglitazone, in a lipopolysaccharide (LPS)-induced peritonitis rat model. LPS was intraperitoneally injected into rats to establish peritonitis model. Male Sprague-Dawley (SD) rats were assigned to normal saline (the solvent of LPS), LPS, rosiglitazone plus LPS, and rosiglitazone alone. A simple peritoneal equilibrium test was performed with 20 ml 4.25 % peritoneal dialysis fluid. We measured the leukocyte count in dialysate and ultrafiltration volume. Peritoneal membrane histochemical staining was performed, and peritoneal thickness was assessed. CD40 and intercellular adhesion molecule-1 messenger RNA (ICAM-1 mRNA) levels in rat visceral peritoneum were detected by reverse transcription (RT)-PCR. IL-6 in rat peritoneal dialysis effluent was measured using enzyme-linked immunosorbent assay. The phosphorylation of NF-κB-p65 and IκBα was analyzed by Western blot. LPS administration resulted in increased peritoneal thickness and decreased ultrafiltration volume. Rosiglitazone pretreatment significantly decreased peritoneal thickness. In addition to CD40 and ICAM-1 mRNA expression, the IL-6, p-p65, and p-IκBα protein expressions were enhanced in LPS-administered animals. Rosiglitazone pretreatment significantly decreased ICAM-1 mRNA upregulation, secretion of IL-6 protein, and phosphorylation of NF-κB-p65 and IκBα without decreasing CD40 mRNA expression. Rosiglitazone has a protective effect in peritonitis, simultaneously decreasing NF-κB phosphorylation, suggesting that NF-κB signaling pathway mediated peritoneal inflammation induced by LPS. PPAR-γ might be considered a potential therapeutic target against peritonitis.
Young, Vicky J; Ahmad, Syed F; Brown, Jeremy K; Duncan, W Colin; Horne, Andrew W
VEGF-A, an angiogenic factor, is increased in the peritoneal fluid of women with endometriosis. The cytokine TGF-β1 is thought to play a role in the establishment of endometriosis lesions. Inhibitor of DNA binding (ID) proteins are transcriptional targets of TGF-β1 and ID1 has been implicated in VEGF-A regulation during tumor angiogenesis. Herein, we determined whether peritoneal expression of VEGF-A is regulated by TGF-β1 through the ID1 pathway in women with endometriosis. VEGF-A was measured in peritoneal fluid by ELISA (n = 16). VEGF-A and ID1 expression was examined in peritoneal biopsies (n = 13), and primary peritoneal and immortalized mesothelial cells (MeT5A) by immunohistochemistry, qRT-PCR and ELISA. VEGF-A was increased in peritoneal fluid from women with endometriosis and levels correlated with TGF-β1 concentrations (P peritoneal mesothelium and TGF-β1 increased VEGFA mRNA (P endometriosis and TGF-β1 increased concentrations of ID1 mRNA (P endometriosis, as an effector of TGFβ1 dependent upregulation of VEGF-A, and highlights a novel potential therapeutic target.
Penelitian ini dilakukan dengan tujuan untuk menentukan konsentrasi interleukin- 15 (IL-18) pada cairan peritoneal dan serum penderita endometriosis yang -bandingkan dengan kelompok control( tidak menderita endometriosis). Metode penelitian yang digunakan adalah kajian analitik prospektif. Subyek yang terlibat sebanyak 44 penderita yang melakukan bedah laparoscopic pada penyakit ginekologi ringan. Pengambilan cairan peritoneal dan serum sebagai specimen ulakukan sebelum dan sesudah tindakan b...
Schwensen, Jakob Ferløv; Bulut, Mustafa; Nordholm-Carstensen, Andreas
and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...... peritoneal tuberculosis....
Stouthard, J. M.; Krediet, R. T.; Arisz, L.
A 41-year-old CAPD patient developed Grey-Turner's sign during the course of bacterial peritonitis due to Pseudomonas aeruginosa. At the same time a diagnosis of sclerosing peritonitis was made by CT-scanning of the abdomen. We think that Grey-Turner's flank staining could either have been caused by
Martin, A.; Alvarado, E.; Marcos, A.; Palacios, E.; Gomez, A.
We describe a special treatment for the malignant peritoneal pseudomyxoma as suggested by Sugarbaker. Shortly, it is a combination of surgical cytoreduction with a curative aim, completed with inmediate postoperative intraperitoneal chemotherapy. Having in mind the lack of metastasic danger of these tumours, as well as its lack of infiltrative character, by this surgical technique which consists in five different ''peritonectomies'', one may be able to free the patient of macroscopic tumour. The additional intraperitoneal chemotherapy might contribute to increase the survival of these patients and, perhaps, even to cure them. (Author) 12 refs
Graff, J; Joffe, P; Fugleberg, S
Possible relationships between the dialysate-to-plasma creatinine equilibration ratio (D/Pcreatinine 4 hour), duration of peritoneal dialysis treatment, number of peritonitis episodes, and mass appearance rates of three connective tissue markers [carboxyterminal propeptide of type I procollagen...... (PICP), aminoterminal propeptide of type III procollagen (PIIINP), and carboxyterminal telopeptide of type I collagen (ICTP)] were studied in 19 nondiabetic peritoneal dialysis patients. The absence of correlation between the mass appearance rates of the markers and the duration of dialysis treatment...... as well as the number of peritonitis episodes supports the concept that peritoneal dialysis does not cause persistent changes in the deposition and degradation rates of collagen. A correlation between the D/Pcreatinine 4 hr and the PICP mass appearance rates was found. Since it is unlikely...
Puvaneswary, M.; Chen, S.; Proietto, T.
Two patients with histologically proven diagnosis of peritoneal mesothelioma are presented. Both patients had CT scans of the abdomen. The second patient was also examined with MRI. Although imaging findings are striking, they are non-specific and diagnosing peritoneal mesothelioma in the absence of pleural calcification or pleural plaque on chest radiograph or CT is difficult. However, it is possible to suggest the correct diagnosis in a patient with the presence of non-calcified omental and peritoneal infiltration or masses without liver secondaries or lymphadenopathy. Magnetic resonance imaging with its multi-planar capabilities is a highly sensitive non-invasive modality in the evaluation of malignant peritoneal mesothelioma and can demonstrate the exact site and clarify whether the mass is arising from the peritoneal surface or within a visceral organ. Copyright (2002) Blackwell Science Pty Ltd
Baczyski, Daniel; Antosiewicz, Stefan; Waniewski, Jacek; Nowak, Zbigniew; Wakowicz, Zofia
Inadequate dialysis is still a major cause of technique failure in peritoneal dialysis (PD). Mathematical models provide the possibility of direct and precise assessment of peritoneal transport of urea and creatinine throughout the dwell and allow calculation of optimal schedules, dwell times, and predicted adequacy of a prescribed regimen. Kinetic modeling is particularly important for automated PD. If the effectiveness of uremic toxin removal that takes place during infusion and drainage of dialysis fluid is not taken into account, the predicted adequacy of the whole PD session may be underestimated. ♢ To estimate the efficacy of urea and creatinine removal during the dialysis fluid exchange procedure. ♢ 17 patients treated with PD were included in the study. PD effectiveness during dialysate exchange was defined as the quotient k of removed amount of creatinine/BUN during the infusion and drainage of dialysate and during a dwell of the same duration as the dialysate exchange. ♢ The effectiveness of creatinine and urea removal was reduced during the exchange procedure (k(creat) = 0.68 ± 0.43 and k(BUN) = 0.87 ± 0.44) and differed between these 2 solutes (p = 0.0009). The k coefficients for urea and creatinine were well correlated (R(2) = 0.83). ♢ The effectiveness of peritoneal transport of creatinine and BUN during the inflow/outflow phase was relatively high compared to that during the same dwell time (68% and 87% respectively). This real effectiveness of the dialysate exchange procedure should be taken into account in the process of planning automated PD sessions, otherwise the predicted overall efficacy of creatinine and urea removal throughout the session may be underestimated. This underestimation is proportional to the number of dwells per day.
Tawfik, O; Prather, J; Bhatia, P; Woodroof, J; Gunter, J; Webb, P
Vernix caseosa peritonitis is a rare complication of cesarean section with distinctive histopathologic findings. Vernix caseosa peritonitis occurred in a 28-year-old, pregnant woman following emergency cesarean section. Exploratory laparotomy revealed right subphrenic and perihepatic fluid collections with multiple small abdominal abscesses. Cytopathologic examination of the peritoneal lavage specimen showed a purulent inflammatory exudate admixed with occasional squamous debris, portions of hair shafts, meconium pigment, and foamy and multinucleated giant cells. During hospitalization the patient had developed Clostridium perfringens acute endometritis, presumably due to aggressive treatment with broad-spectrum antibiotics. Pathologists are in a unique position to make the correct diagnosis in an otherwise-ambiguous clinical presentation because of the distinctive histopathologic and cytopathologic findings of this entity. Computed tomography-guided fine needle aspiration cytologic evaluation can be diagnostic in such cases.
Turlakow, A.; Yeung, H.W.; Macapinlac, H.A.; Sanchez, A.F.; Larson, S.M.
Full text: Peritoneal carcinomatosis can be difficult to diagnose, as CT is insensitive, with peritoneal biopsy and lavage often subject to problems of sampling error. The aim of our study was to evaluate the role of FDG PET in detecting peritoneal carcinomatosis in patients with biopsy-proven metastases from stomach, ovarian and adrenal cancer and mesothelioma. 92 FDG-PET scans of patients with stomach (49), ovarian (14) adrenal cancer (7) and mesothelioma (22) were reviewed. Studies were performed 45 minutes following IV injection of 10 mCi of 18 F-FDG. Of this group 15 patients had biopsy-proven findings of peritoneal disease while 14 had PET studies reported as suspicious for peritoneal metastasis. Of the 15 biopsy-positive patients, FDG PET was positive in 7, CT in 6 and either PET or CT in 10 (sensitivities 46.6,40.0 and 66.6% respectively). In a further 4 patients without biopsies, where other imaging studies confirmed peritoneal disease, PET was also positive. 2 distinct abnormal scintigraphic patterns of focal and uniform FDG uptake were identified corresponding to nodular and diffuse peritoneal disease at pathology. Our study demonstrates that FDG PET adds to conventional imaging in the staging of peritoneal carcinomatosis. It is also a useful diagnostic tool when peritoneal biopsy is either unavailable or inappropriate. We have identified 2 distinct scintigraphic patterns which appear to predict the presence of either nodular or diffuse peritoneal pathology.Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc
Aalbæk, Bent; Østergaard, Stine; Buhl, Rikke
Microbiological and pathological data from a case of equine valvular endocarditis are reported. Limited information is available on the pathogenic potential of equine Actinobacillus species as several strains originate from apparently healthy horses. After the establishment of two subspecies within...... this species, this seems to be the first report of an etiological association between A. equuli subsp. equuli and equine endocarditis. Furthermore, new information on some phenotypical characteristics of this subspecies are reported, compared to previous findings...
Equine inflammatory airway disease (IAD) and recurrent airway obstruction (RAO) represent a spectrum of chronic inflammatory disease of the airways in horses resembling human asthma in many aspects. Therefore, both are now described as severity grades of equine asthma. Increasing evidence in horses and humans suggests that local pulmonary inflammation is influenced by systemic inflammatory processes and the other way around. Inflammation, coagulation, and fibrinolysis as well as extracellular remodeling show close interactions. Cytology of bronchoalveolar lavage fluid and tracheal wash is commonly used to evaluate the severity of local inflammation in the lung. Other mediators of inflammation, like interleukins involved in the chemotaxis of neutrophils, have been studied. Chronic obstructive pneumopathies lead to remodeling of bronchial walls and lung parenchyma, ultimately causing fibrosis. Matrix metalloproteinases (MMPs) are discussed as the most important proteolytic enzymes during remodeling in human medicine and increasing evidence exists for the horse as well. A systemic involvement has been shown for severe equine asthma by increased acute phase proteins like serum amyloid A and haptoglobin in peripheral blood during exacerbation. Studies focusing on these and further possible inflammatory markers for chronic respiratory disease in the horse are discussed in this review of the literature. PMID:28053371
Hsieh, Yao-Peng; Chang, Chia-Chu; Wen, Yao-Ko; Chiu, Ping-Fang; Yang, Yu
♦ Objective: Peritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes. ♦ Methods: Our retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality. ♦ Results: The peritonitis rate was 0.196 episodes per patient-year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis (p peritonitis tended to survive longer than the group that was peritonitis-free (p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD (p = 0.03). ♦ Conclusions: The peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified. PMID:24084840
TEDJA DANUDJA OEPOMO
Full Text Available The aim of this research was to expose the role of tumor necrotic factor alpha (TNF-α in the pathogenetic endometriosis. This research had been done in dr. Muwardi Hospital Surakarta. Twenty patients undergoing laparoscopic operation because of endometriosis indication (Group I, 20 women (aged 23 to 40 who undergo interval sterilization by means of laparoscopic technique (Group II. During laparoscopic operation, peritoneal fluid is taken to examine TNF-α by ELISA technique. The results indicated that by independent t-test, a significant difference of concentration of TNF-α in the peritoneal fluid is found between endometriosis patients and normal women (who are sterilized (P=0.00. By chi-square test, the Ratio Odds value 171 shows that the high concentration of TNF-α will increase the possibility of endometriosis 171 times rather than the low TNF-α. It could be concluded the high concentration of TNF-α is the risk factor of endometriosis in comparison with the low TNF-α. It shows that quite possibly TNF-α has a role in the pathogenic endometriosis.
Sarian, Mari; Brault, Diane; Perreault, Nathalie
The increasing prevalence of chronic illnesses and kidney disease, in particular, makes it necessary to adopt new approaches towards their management (Wagner, 1998). Evidence suggests that promoting self-management improves the health status of peritoneal dialysis (PD) patients, as they manage upwards of 90% of their own care. Patients who are unable to self-manage suffer from various complications. This project proposes an intervention aimed at improving self-management skills among PD patients. To promote self-management in peritoneal dialysis patients. This is achieved through the following objectives: (a) develop an algorithm that can improve patients' ability to solve the specific problem of fluid balance maintenance, (b) develop an educational session for patients on how to use the algorithm, and (c) develop an implementation strategy in collaboration with the PD nurse. Three measures evaluate the effectiveness of the intervention. First, a telephone call log shows that participating patients call the clinic less to inquire about fluid balance maintenance. Next, a pre- and post-intervention knowledge test measures definite knowledge increase. Finally, a Patient Satisfaction Questionnaire reveals overall satisfaction with the intervention. This project, which proved beneficial to our patient population, could be duplicated in other clinics. The algorithm "How do I choose a dialysis bag" and the slides of the educational sessions can be shared with PD nurses across the country for the benefit of PD patients.
Vendrig, J C; Coffeng, L E; Fink-Gremmels, J
Increasing evidence suggests that reactions to lipopolysaccharide (LPS), particularly in the gut, can be partly or completely mitigated by colostrum- and milk-derived oligosaccharides. Confirmation of this hypothesis could lead to the development of new therapeutic concepts. To demonstrate the influence of equine colostral carbohydrates on the inflammatory response in an in vitro model with equine peripheral blood mononuclear cells (PBMCs). Carbohydrates were extracted from mare colostrum, and then evaluated for their influence on LPS-induced inflammatory responses in PBMCs isolated from the same mares, mRNA expression of tumour necrosis factor-alpha, interleukin-6 and interleukin-10 was measured as well as the protein levels of tumour necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10). Equine colostral carbohydrates significantly reduced LPS-induced TNF-alpha protein at both times measured and significantly reduced LPS-induced TNF-alpha, IL-6 and IL-10 mRNA expression by PBMCs. Moreover, cell viability significantly increased in the presence of high concentrations of colostral carbohydrates. Carbohydrates derived from equine colostrum reduce LPS-induced inflammatory responses of equine PBMCs. Colostrum and milk-derived carbohydrates are promising candidates for new concepts in preventive and regenerative medicine.
... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES IMMUNOLOGY AND MICROBIOLOGY DEVICES Serological Reagents... these viruses. Equine encephalomyelitis viruses are transmitted to humans by the bite of insects, such...
McDonald Stephen P
Full Text Available Abstract Background There has not been a comprehensive, multi-centre study of streptococcal peritonitis in patients on peritoneal dialysis (PD to date. Methods The predictors, treatment and clinical outcomes of streptococcal peritonitis were examined by binary logistic regression and multilevel, multivariate poisson regression in all Australian PD patients involving 66 centres between 2003 and 2006. Results Two hundred and eighty-seven episodes of streptococcal peritonitis (4.6% of all peritonitis episodes occurred in 256 individuals. Its occurrence was independently predicted by Aboriginal or Torres Strait Islander racial origin. Compared with other organisms, streptococcal peritonitis was associated with significantly lower risks of relapse (3% vs 15%, catheter removal (10% vs 23% and permanent haemodialysis transfer (9% vs 18%, as well as a shorter duration of hospitalisation (5 vs 6 days. Overall, 249 (87% patients were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The majority of streptococcal peritonitis episodes were treated with either intraperitoneal vancomycin (most common or first-generation cephalosporins for a median period of 13 days (interquartile range 8–18 days. Initial empiric antibiotic choice did not influence outcomes. Conclusion Streptococcal peritonitis is a not infrequent complication of PD, which is more common in indigenous patients. When treated with either first-generation cephalosporins or vancomycin for a period of 2 weeks, streptococcal peritonitis is associated with lower risks of relapse, catheter removal and permanent haemodialysis transfer than other forms of PD-associated peritonitis.
Lee, Kyong Ok; Park, Se Jin; Kim, Ji Hong; Lee, Jae Seung; Kim, Pyung Kil
Purpose Relatively little is known on the microbiology, risk factors and outcomes of peritoneal dialysis (PD)-associated peritonitis in Korean children. We performed this study in order to evaluate the incidence, treatment and clinical outcomes of peritonitis in pediatric PD patients at Severance Hospital. Materials and Methods We analyzed data from 57 PD patients younger than 18 years during the period between June 1, 1986 and December 31, 2011. The collected data included gender, age at commencement of PD, age at peritonitis, incidence of peritonitis, underlying causes of end stage renal disease, microbiology of peritonitis episodes, antibiotics sensitivity, modality and outcomes of PD. Results We found 56 episodes of peritonitis in 23 of the 57 PD patients (0.43 episodes/patient-year). Gram-positive bacteria were the most commonly isolated organisms (40 episodes, 71.4%). Peritonitis developed in 17 patients during the first 6 months following initiation of PD (73.9%). Peritonitis episodes rarely resulted in relapse or the need for permanent hemodialysis and no patient deaths were directly attributable to peritonitis. Antibiotic regimens included cefazolin+tobramycin from the years of 1986 to 2000 and cefazolin+ceftazidime from the years of 2001 to 2011. While antibiotic therapy was successful in 48 episodes (85.7%), the treatment was ineffective in 8 episodes (14.3%). The rate of continuous ambulatory PD (CAPD) peritonitis was statistically higher than that of automated PD (APD) (p=0.025). Conclusion Peritonitis was an important complication of PD therapy and we observed a higher incidence of PD peritonitis in patients with CAPD when compared to APD. PMID:23709435
Full Text Available Abstract Background Peritoneal dissemination is one of the main causes of death in gastric cancer patients. Transforming growth factor-beta1 (TGF-β1, one of the most potent fibrotic stimuli for mesothelial cells, may play a key role in this processing. The purpose of this study is to elucidate the effects of TGF-β1 on regulation of gastric cancer adhesion to mesothelial cells. Methods Peritoneal tissues and peritoneal wash fluid were obtained for hematoxylin and eosin staining or ELISA to measure fibrosis and TGF-β1 levels, respectively. The peritoneal mesothelial cell line, HMrSV5, was used to determine the role of TGF-β1 in regulation of gastric cancer cell adhesion to mesothelial cells and expression of collagen, fibronectin, and Smad 2/3 by using adhesion assay, western blot, and RT-PCR. Results The data showed that TGF-β1 treatment was able to induce collagen III and fibronectin expression in the mesothelial cells, which was associated with an increased adhesion ability of gastric cancer cells, but knockdown of minimal sites of cell binding domain of extracellular matrix can partially inhibit these effects. Conclusion Peritoneal fibrosis induced by TGF-β1 may provide a favorable environment for the dissemination of gastric cancer.
Full Text Available Abstract Background Peritoneal dialysis (PD is the preferred dialysis modality in children. Its major drawback is the limited technique survival due to infections and progressive ultrafiltration failure. Conventional PD solutions exert marked acute and chronic toxicity to local tissues. Prolonged exposure is associated with severe histopathological alterations including vasculopathy, neoangiogenesis, submesothelial fibrosis and a gradual loss of the mesothelial cell layer. Recently, more biocompatible PD solutions containing reduced amounts of toxic glucose degradation products (GDPs and buffered at neutral pH have been introduced into clinical practice. These solutions contain lactate, bicarbonate or a combination of both as buffer substance. Increasing evidence from clinical trials in adults and children suggests that the new PD fluids may allow for better long-term preservation of peritoneal morphology and function. However, the relative importance of the buffer in neutral-pH, low-GDP fluids is still unclear. In vitro, lactate is cytotoxic and vasoactive at the concentrations used in PD fluids. The BIOKID trial is designed to clarify the clinical significance of the buffer choice in biocompatible PD fluids. Methods/design The objective of the study is to test the hypothesis that bicarbonate based PD solutions may allow for a better preservation of peritoneal transport characteristics in children than solutions containing lactate buffer. Secondary objectives are to assess any impact of the buffer system on acid-base status, peritoneal tissue integrity and the incidence and severity of peritonitis. After a run-in period of 2 months during which a targeted cohort of 60 patients is treated with a conventional, lactate buffered, acidic, GDP containing PD fluid, patients will be stratified according to residual renal function and type of phosphate binding medication and randomized to receive either the lactate-containing Balance solution or the
Nau, Barbara; Schmitt, Claus P; Almeida, Margarida; Arbeiter, Klaus; Ardissino, Gianluigi; Bonzel, Klaus E; Edefonti, Alberto; Fischbach, Michel; Haluany, Karin; Misselwitz, Joachim; Kemper, Markus J; Rönnholm, Kai; Wygoda, Simone; Schaefer, Franz
Peritoneal dialysis (PD) is the preferred dialysis modality in children. Its major drawback is the limited technique survival due to infections and progressive ultrafiltration failure. Conventional PD solutions exert marked acute and chronic toxicity to local tissues. Prolonged exposure is associated with severe histopathological alterations including vasculopathy, neoangiogenesis, submesothelial fibrosis and a gradual loss of the mesothelial cell layer. Recently, more biocompatible PD solutions containing reduced amounts of toxic glucose degradation products (GDPs) and buffered at neutral pH have been introduced into clinical practice. These solutions contain lactate, bicarbonate or a combination of both as buffer substance. Increasing evidence from clinical trials in adults and children suggests that the new PD fluids may allow for better long-term preservation of peritoneal morphology and function. However, the relative importance of the buffer in neutral-pH, low-GDP fluids is still unclear. In vitro, lactate is cytotoxic and vasoactive at the concentrations used in PD fluids. The BIOKID trial is designed to clarify the clinical significance of the buffer choice in biocompatible PD fluids. The objective of the study is to test the hypothesis that bicarbonate based PD solutions may allow for a better preservation of peritoneal transport characteristics in children than solutions containing lactate buffer. Secondary objectives are to assess any impact of the buffer system on acid-base status, peritoneal tissue integrity and the incidence and severity of peritonitis. After a run-in period of 2 months during which a targeted cohort of 60 patients is treated with a conventional, lactate buffered, acidic, GDP containing PD fluid, patients will be stratified according to residual renal function and type of phosphate binding medication and randomized to receive either the lactate-containing Balance solution or the bicarbonate-buffered Bicavera solution for a period of
Alexander, H Richard; Li, Claire Yue; Kennedy, Timothy J
Diffuse malignant peritoneal mesothelioma (MPM) is a rare and ultimately fatal cancer that was first described just over a century ago. It is a diffuse malignancy arising from the mesothelial lining of the peritoneum; morbidity and mortality from MPM is due to its propensity to progress locoregionally within the abdominal cavity. The purpose of this article is to review the current state-of-the-science related to the diagnosis, staging, and treatment of MPM. The condition afflicts men and women equally and the peak incidence is between 55 and 60 years of age although it can arise in the young and elderly. Patients afflicted with MPM most commonly present with nonspecific abdominal symptoms that usually lead to diagnosis when the condition is relatively advanced. Historically, median overall survival for MPM patients without treatment is < 1 year. The couplet of systemic pemetrexed and cisplatin has an overall response rate of approximately 25% and a median overall survival of approximately 1 year. The available data, almost all retrospective in nature, have shown that in selected patients, operative cytoreduction (CRS) and regional chemotherapy administered as hyperthermic intraoperative peritoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) is associated with long-term survival. Studies on the molecular biology of MPM have yielded new insights relating to the potentially important role of the phosphoinsitide-3-kinase/mammalian target of rapamycin (PI3 K/mTOR) pathways and immune checkpoint inhibitors that may translate into new therapeutic options for patients with diffuse MPM.
Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn
incision between January 1995 and June 2012 were reviewed. Horses with a laryngotomy incision closed in three layers for primary healing were included. Descriptive data on healing characteristics and complications of laryngotomy wounds were collected from the medical records and via follow......The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....
María Esther Raola Sánchez
Full Text Available Se reporta un caso de una paciente femenina, blanca, de 65 años de edad, con antecedentes de diabetes mellitus tipo I, a consecuencia de la cual evolucionó a insuficiencia renal crónica terminal, por lo que recibía tratamiento mediante diálisis peritoneal intermitente. A las 3 semanas de iniciado este método comenzó con cuadro de dolor abdominal difuso, náuseas y signos de irritación peritoneal. Se realizó cultivo del efluente peritoneal con eosinofilia mayor del 30 %. Se estableció diagnóstico de peritonitis eosinofílica y se inició tratamiento con hidrocortisona intraperitoneal en dosis de 5 mg/kg de peso durante 2 semanas. Se observó mejoría clínica y negativización del estudio del líquido peritonealThis paper reports a case of a white female patient aged 65 years who had a history of diabetes mellitus I which brought about terminal chronic renal failure that was treated with intermittent peritoneal dialysis. Three weeks after the application of this method, the patient began suffering diffuse abdominal pain, nausea and peritoneal irritation signs. Peritoneal fluid was cultured, showing eosinophilia over 30%. The diagnosis was eosinophilic peritonitis and she was treated with intraperitoneal hydrocortisone at dose of 5mg/kg of weight for 2 weeks. Clinical improvement and negative results in the peritoneal fluid study were observed
Recommendations for obtaining the flexed lateral radiographic view of the equine fetlock are provided. By tilting the X-ray tube in a 10-degrees dorsal direction, the angle of the flexed lateral fetlock joint is matched. While this view will not be effective on all horses, utilizing the flexed view aids in evaluating those horses that present an abnormal conformation when the fetlock joint is flexed
Radiographic examinations of the equine head can be performed with portable x-ray machines. The views comprising the examination depend on the area of the head being examined. With a knowledge of radiographic anatomy and radiographic signs of disease, valuable diagnostic information can be obtained from the radiographic examination. In addition, the radiographic information can also be used to develop a prognosis and determine the most appropriate therapy
Lahmer, Tobias; Brandl, Andreas; Rasch, Sebastian; Schmid, Roland M; Huber, Wolfgang
Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP). APACHE II and SOFA score were significantly higher in patients with SFP (26; 22-28; pperitonitis could be significantly more often found in patients with SFP (65%; pperitonitis was significantly more often in patients with SFP (85%; pperitonitis.
Deng Xueying; Chen Xiaoqi; Qi Le; Huang Feng
Objective: To study the CT findings and diagnosis of peritoneal metastasis. Methods: The CT findings of 17 cases with surgical- pathologically proved peritoneal metastasis were analyzed retrospectively. Results The CT findings of peritoneal metastasis included: (1)ascites (12 cases ); (2)the aternation of parietal peritoneum including broad band thickening (7 cases), nodular sign (2 cases), and massive thickening (1 cases); (3) the involved omentum and mesenterium: 'smut' appearances (7 cases), nodular sign (2 cases), 'omental cake' (5 cases); (4) the invlovement of mesenteric vessels; (5) single-or multi-cystic lesions within peritoneum (1 case) . Conclusion: CT scan is the first choice for metastasis of peritoneum. (authors)
Ferreira, Joel; Teixeira e Costa, Fernando; Ramos, Aura
Introduction: Corynebacterium is a component of normal skin flora and it is responsible for an increasing incidence of nosocomial infections in the last decades. Peritonitis and exit-site infections caused by this microorganism are uncommon but have a significant clinical impact due to their high relapsing rate. The ideal therapeutic approach in these situations is not yet clearly defined. Methods: Retrospective analysis of Corynebacterium spp peritonitis in a peritoneal dialysis unit between...
Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S
Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.
Full Text Available Preservation of peritoneal cavity homeostasis and peritoneal membrane function is critical for long-term peritoneal dialysis (PD treatment. Several microRNAs (miRNAs have been implicated in the regulation of key molecular pathways driving peritoneal membrane alterations leading to PD failure. miRNAs regulate the expression of the majority of protein coding genes in the human genome, thereby affecting most biochemical pathways implicated in cellular homeostasis. In this review, we report published findings on miRNAs and PD therapy, with emphasis on evidence for changes in peritoneal miRNA expression during long-term PD treatment. Recent work indicates that PD effluent- (PDE- derived cells change their miRNA expression throughout the course of PD therapy, contributing to the loss of peritoneal cavity homeostasis and peritoneal membrane function. Changes in miRNA expression profiles will alter regulation of key molecular pathways, with the potential to cause profound effects on peritoneal cavity homeostasis during PD treatment. However, research to date has mainly adopted a literature-based miRNA-candidate methodology drawing conclusions from modest numbers of patient-derived samples. Therefore, the study of miRNA expression during PD therapy remains a promising field of research to understand the mechanisms involved in basic peritoneal cell homeostasis and PD failure.
Full Text Available Abstract Background Antibiotics are preferentially delivered via the peritoneal route to treat peritonitis, a major complication of peritoneal dialysis (PD, so that maximal concentrations are delivered at the site of infection. However, drugs administered intraperitoneally can be absorbed into the systemic circulation. Drugs excreted by the kidneys accumulate in PD patients, increasing the risk of toxicity. The aim of this study is to examine a model of gentamicin pharmacokinetics and to develop an intraperitoneal drug dosing regime that maximises bacterial killing and minimises toxicity. Methods/Design This is an observational pharmacokinetic study of consecutive PD patients presenting to the Royal Brisbane and Women's Hospital with PD peritonitis and who meet the inclusion criteria. Participants will be allocated to either group 1, if anuric as defined by urine output less than 100 ml/day, or group 2: if non-anuric, as defined by urine output more than 100 ml/day. Recruitment will be limited to 15 participants in each group. Gentamicin dosing will be based on the present Royal Brisbane & Women's Hospital guidelines, which reflect the current International Society for Peritoneal Dialysis Peritonitis Treatment Recommendations. The primary endpoint is to describe the pharmacokinetics of gentamicin administered intraperitoneally in PD patients with peritonitis based on serial blood and dialysate drug levels. Discussion The study will develop improved dosing recommendations for intraperitoneally administered gentamicin in PD patients with peritonitis. This will guide clinicians and pharmacists in selecting the most appropriate dosing regime of intraperitoneal gentamicin to treat peritonitis. Trial Registration ACTRN12609000446268
Poulsen, Hanna Bjarkhamar; Á Steig, Torkil; Björkman, Jonas T
We present a case where Listeria monocytogenesserotype 1/2a was determined to be the causative agent of peritonitis in a patient on automated peritoneal dialysis. The patient, a 53-year-old Caucasian woman from the Faroe Islands was admitted to the National Hospital reporting of constant abdominal...... pain and a fever. Peritoneal cultures were positive for growth of L. monocytogenes. The patient was successfully treated with oral amoxicillin for 2 weeks and intraperitoneal vancomycin for 3 weeks. To date, the patient has not been readmitted due to peritonitis. The Faroese salmon was the suspected...
van Esch, Sadie; Krediet, Raymond T.; Struijk, Dirk G.
♦ Background: Peritonitis in peritoneal dialysis (PD) patients can lead to technique failure and contributes to infection-related mortality. Peritonitis prevention and optimization of treatment are therefore important in the care for PD patients. In the present study, we analyzed the incidence of peritonitis, causative pathogens, clinical outcomes, and trends in relation to three major treatment changes that occurred from 1979 onward: use of a disconnect system since 1988, daily mupirocin at the exit-site since 2001, and exclusive use of biocompatible dialysis solutions since 2004. ♦ Methods: In this analysis of prospectively collected data, we included peritonitis episodes from the start of PD at our center in August 1979 to July 2010. Incident PD patients were allocated to one of four groups: Group 1 - 182 patients experiencing 148 first peritonitis episodes between 1979 and 1987, before the introduction of the disconnect system; Group 2 - 352 patients experiencing 239 first episodes of peritonitis between 1988 and 2000, before implementation of daily mupirocin application at the catheter exit-site; Group 3 - 79 patients experiencing 50 first peritonitis episodes between 2001 and 2003, before the switch to biocompatible solutions; and Group 4-118 patients experiencing 91 first peritonitis episodes after 2004. Cephradine was used as initial antibiotic treatment. ♦ Results: In 32 years, 731 adult patients started PD, and 2234 episodes of peritonitis in total were diagnosed and treated. Of those episodes, 88% were cured with medical treatment only, and 10% resulted in catheter removal. In 3% of the episodes, the patient died during peritonitis. Median time to a first peritonitis episode increased from 40 days for group 1 to 150 for group 2, 269 for group 3, and 274 for group 4. The overall peritonitis rate and the gram-positive and gram-negative peritonitis rates showed a time-trend of decline. However, the duration of antibiotic treatment increased over time
Martino, Francesca; Scalzotto, Elisa; Giavarina, Davide; Rodighiero, Maria Pia; Crepaldi, Carlo; Day, Sonya; Ronco, Claudio
Peritoneal dialysis (PD) is frequently complicated by high rates of peritonitis, which result in hospitalization, technique failure, transfer to hemodialysis, and increased mortality. Early diagnosis, and identification of contributing factors are essential components to increasing effectiveness of care. In previous reports, neutrophil gelatinase-associated lipocalin (NGAL), a lipocalin which is a key player in innate immunity and rapidly detectable in peritoneal dialysis effluent (PDE), has been demonstrated to be a useful tool in the early diagnosis of peritonitis. This study investigates predictive value of PDE NGAL concentration as a prognostic indicator for PD-related peritonitis. A case-control study with 182 PD patients was conducted. Plasma and PDE were analyzed for the following biomarkers: C-reactive protein (CRP), blood procalcitonin (PCT), leucocytes and NGAL in PDE. The cases consisted of patients with suspected peritonitis, while controls were the patients who came to our ambulatory clinic for routine visits without any sign of peritonitis. The episodes of peritonitis were defined in agreement with International Society for Peritoneal Dialysis guidelines. Continuous variables were presented as the median values and interquartile range (IQR). Mann-Whitney U test was used to compare continuous variables. Univariate and multivariate logistic regression were used to evaluate the association of biomarkers with peritonitis. Receiver operating characteristic (ROC) curve analysis was used to calculate area under curve (AUC) for biomarkers. Finally we evaluated sensitivity, and specificity for each biomarker. All statistical analyses were performed with SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). During the 19-month study, of the 182 patients, 80 had a clinical diagnosis of peritonitis. C-reactive protein levels (p peritonitis. In univariate analysis, CRP (odds ratio [OR] 1,339; p = 0.001), PCT (OR 2,473; p peritonitis. In multivariate regression analysis
Murphy, Lynne; Wilson, Jacqueline; Greenberg, Stacey
Equine-assisted occupational therapy (EAOT) employs horse and human cooperation in activities that facilitate social, emotional, and cognitive development. The potential benefits of equine-assisted activities for students may influence the development of these types of skills in professional occupational therapy practice. This study explored the…
Ratcliffe, Katherine T.; Sanekane, Cindy
Equine-assisted therapies are interventions that use the unique qualities of a horse to assist persons with disabilities to improve their gross motor, language, social, and self-help skills. Programs offering these services are varied and operate on all major continents across the world. The effectiveness of equine-assisted therapies is generally…
Lanning, Beth A.; Baier, Margaret E. Matyastik; Ivey-Hatz, Julie; Krenek, Nancy; Tubbs, Jack D.
Quality of life assessments were used in this study to determine the behavioral changes of children diagnosed with autism spectrum disorder (ASD) who participated in equine assisted activities. Behavioral changes of children with ASD participating in 9 weeks of equines assisted activities (EAA) (N = 10) were compared to behavioral changes of…
Equine infectious diseases continue to be one of the most important threats to the overall health of domesticated horses and proper vaccination is one the most important preventive measure against such infectious diseases. This study assessed the knowledge, attitude and practice of equine vaccination among horse ...
Cottle, Lena; D'Angelo, Nicole
The Nebraska Equine Advancement Level Leader Certification Program is an online learning tool that clarifies principles of the Nebraska 4-H Equine Advancement Programs. Through an online Moodle course through eXtension.org, 4-H leaders and Extension educators are able to fulfill the certification requirement from any location before allowing youth…
McDaniel Peters, B. Caitlin; Wood, Wendy
This systematic mapping review mapped current knowledge of equine-assisted interventions for people with autism to help guide future practice and research. Thirty-three studies including children and adolescents with autism, 3 of which confirmed diagnoses, were reviewed. Five types of equine-assisted activities were identified across 25 studies,…
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Marking of equine carcasses and parts... equine carcasses and parts thereof. (a) All inspected and passed equine carcasses and parts thereof... marking products in this part. (b) All equine carcasses and meat and other parts thereof shall be marked...
Amany Talaat Kamal
Feb 29, 2012 ... blood glucose, complete blood count, prothrombin concentra- tion and INR were ... P-value of less than 0.05 was considered significant. 3. Results ..... References.  Garcia Tsao G. Bacterial infection in cirrhosis: treatment and prophylaxis. J Hepatol 2005;42:585–92.  Saadeh S, Davis GL. Management ...
Marchand, Eva; Hequet, Delphine; Thoury, Anne; Barranger, Emmanuel
A 63-year-old woman with no medical history underwent an abdominal surgery with hysterectomy and bilateral salpingo-oophorectomy for a 10 cm peritoneal cyst with increased cancer antigene-125. A large suspicious tumour of the Douglas space, with contact to the uterus and the rectal wall was described. The rest of the exploration was normal, specially the rest of the peritoneum. Histopathology revealed a malignant transformation of a superficial peritoneal endometriosis. Secondary surgery was thus completed by laparoscopy with bilateral pelvic and para-aortic lymph node dissections, omentectomy and multiple peritoneal biopsies. All staging samples were free of cancer; therefore no complementary therapy was administered. After 18 months of follow-up, consisting of clinical examination and pelvis magnetic resonance imaging every 6 months, we did not observe any recurrence. Malignant transformation of superficial peritoneal endometriosis is a rare disease and surgical management seems to be the main treatment.
Lebedev, N V; Klimov, A E; Agrba, S B; Gaidukevich, E K
To create a reliable system for assessing of severity and prediction of the outcome of peritonitis. Critical analysis of the systems for peritonitis severity assessment is presented. The study included outcomes of 347 patients who admitted at the Department of Faculty Surgery of Peoples' Friendship University of Russia in 2015-2016. The cause of peritonitis were destructive forms of acute appendicitis, cholecystitis, perforated gastroduodenal ulcer, various perforation of small and large intestines (including tumor). Combined forecasting system for peritonitis severity assessment is created. The system includes clinical, laboratory data, assessment of systemic inflammatory response (SIRS) and severity of organ failure (qSOFA). The authors focused on easily identifiable parameters which are available in virtually any surgical hospital. Threshold value (lethal outcome probability over 50%) is 8 scores in this system. Sensitivity, specificity and accuracy were 93.3, 99.7 and 98.9%, respectively according to ROC-curve that exceeds those parameters of MPI and APACHE II.
... connect the bags of dialysis solution place the drain tube If you choose automated peritoneal dialysis, you also ... from the new bag of solution into the drain bag. Clamp the tube that goes to the drain bag. Open or ...
Roser, J.F.; Chang, Y.S.; Papkoff, H.; Li, C.H.
A specific and sensitive homologous radioimmunoassay has been developed for equine prolactin, suitable for measuring prolactin concentrations in serum of horses. The sensitivity of the assay ranged from 0.4 to 0.6 ng/ml and the intra- and inter-assay coefficients of variation averaged 6.9 and 15.4%, respectively, for five doses of hormone. Cross-reactivity with other mammalian and nonmammalian prolactins and growth hormones was less than 20 and 0.3%, respectively. Cross-reactivity with equine growth hormone was less than 0.07%. Equine serum and pituitary extracts showed parallel dilution-response curves with equine prolactin. The percentage recovery of exogenous equine prolactin in serum was 89%. Preliminary analysis of several physiological samples (stallions, pregnant, and nonpregnant mares) yielded values from 0.6 to 12.0 ng/ml
Koch, Thomas Gadegaard; Heerkens, Tammy; Thomsen, Preben Dybdahl
. The hypothesis of this study was that equine MSCs could be isolated from fresh whole equine cord blood. Results: Cord blood was collected from 7 foals immediately after foaling. The mononuclear cell fraction was isolated by Ficoll density centrifugation and cultured in a DMEM low glucose based media at 38.5o......Background: There are no published studies on stem cells from equine cord blood although commercial storage of equine cord blood for future autologous stem cell transplantations is available. Mesenchymal stem cells (MSC) have been isolated from fresh umbilical cord blood of humans collected non......-invasively at the time of birth and from sheep cord blood collected invasively by a surgical intrauterine approach. Mesenchymal stem cells isolation percentage from frozen-thawed human cord blood is low and the future isolation percentage of MSCs from cryopreserved equine cord blood is therefore expectedly low...
Daskalogiannaki, M.; Prassopoulos, P.; Raissaki, M.; Gourtsoyiannis, N. [Dept. of Radiology, University Hospital of Heraklion (Greece); Tsardi, M. [Dept. of Pathology, University Hospital of Heraklion (Greece)
Malignant peritoneal mesothelioma is a rare disease associated with mild, nonspecific abdominal symptoms and a wide spectrum of imaging findings, with thickened mesentery and peritoneum being the most common ones. A case of a malignant peritoneal mesothelioma presenting with manifestations of pulmonary disease is reported. Imaging evaluation revealed pleural, lung and pericardial involvement together with retroperitoneal lymphadenopathy, little ascites and extensive omental, but only subtle, mesenteric thickening. (orig.)
Ong, Loke Meng; Ch'ng, Chin Chin; Wee, Hong Chin; Supramaniam, Premaa; Zainal, Hadzlinda; Goh, Bak Leong; Bavanandan, Sunita; Mushahar, Lily; Hooi, Lai Seong; Ahmad, Ghazali
♦ BACKGROUND: Peritonitis is one of the most common complications of peritoneal dialysis (PD). Understanding the risk factors of peritonitis in a multi-racial Asian population may help to improve outcomes on PD. ♦ METHODS: We conducted a prospective observational study to identify risk factors for PD-related peritonitis over a 1-year period in 15 adult PD centers. All peritonitis episodes were independently adjudicated. ♦ RESULTS: A total of 1,603 participants with a mean age of 51.6 years comprising 52.7% females, 62.6% ethnic Malays, 27.0% Chinese, and 8.1% Indians were recruited. The overall peritonitis rate was 1 episode per 44.0 patient-months with 354 episodes recorded in 282 (17.6%) patients over 15,588 patient-months. Significant risk factors of peritonitis were severe obesity (incidence-rate ratio [IRR] 3.32, 95% confidence interval [CI]: 1.30, 8.45), hypoalbuminemia (IRR 1.61, 95% CI: 1.06, 2.46), Staphylococcus aureus nasal carriage (IRR 2.26, 95% CI: 1.46, 3.50), and use of Fresenius system (Fresenius Medical Care North America, Waltham, MA, USA) (IRR 2.49, 95% CI: 1.27, 4.89). The risk of peritonitis was lower in those on automated PD compared with standard PD (IRR 0.43, 95% CI: 0.25, 0.74), and in centers with a patient-staff ratio of 15 to 29.9 (IRR 0.67, 95% CI: 0.49, 0.90) and ≥ 30 (IRR 0.52, 95% CI: 0.34, 0.80). Prevalent patients and exit-site care with topical antibiotics were also protective against peritonitis. Peritonitis rates varied between racial groups. The IRRs of overall peritonitis and gram-positive peritonitis in Chinese versus other racial groups were 0.65 (95% CI: 0.46, 0.90) and 0.47 (95% CI: 0.24, 0.91), respectively. ♦ CONCLUSIONS: Multiple patient, center, and PD-system factors influence the risk of peritonitis. In the Asian population, there are racial differences in the risk of peritonitis. Copyright © 2017 International Society for Peritoneal Dialysis.
Zielonka, Jörg; Bravo, Ignacio G.; Marino, Daniela; Conrad, Elea; Perković, Mario; Battenberg, Marion; Cichutek, Klaus; Münk, Carsten
The mammalian APOBEC3 (A3) proteins comprise a multigene family of cytidine deaminases that act as potent inhibitors of retroviruses and retrotransposons. The A3 locus on the chromosome 28 of the horse genome contains multiple A3 genes: two copies of A3Z1, five copies of A3Z2, and a single copy of A3Z3, indicating a complex evolution of multiple gene duplications. We have cloned and analyzed for expression the different equine A3 genes and examined as well the subcellular distribution of the corresponding proteins. Additionally, we have tested the functional antiretroviral activity of the equine and of several of the human and nonprimate A3 proteins against the Equine infectious anemia virus (EIAV), the Simian immunodeficiency virus (SIV), and the Adeno-associated virus type 2 (AAV-2). Hematopoietic cells of horses express at least five different A3s: A3Z1b, A3Z2a-Z2b, A3Z2c-Z2d, A3Z2e, and A3Z3, whereas circulating macrophages, the natural target of EIAV, express only part of the A3 repertoire. The five A3Z2 tandem copies arose after three consecutive, recent duplication events in the horse lineage, after the split between Equidae and Carnivora. The duplicated genes show different antiviral activities against different viruses: equine A3Z3 and A3Z2c-Z2d are potent inhibitors of EIAV while equine A3Z1b, A3Z2a-Z2b, A3Z2e showed only weak anti-EIAV activity. Equine A3Z1b and A3Z3 restricted AAV and all equine A3s, except A3Z1b, inhibited SIV. We hypothesize that the horse A3 genes are undergoing a process of subfunctionalization in their respective viral specificities, which might provide the evolutionary advantage for keeping five copies of the original gene. PMID:19458006
Young, Vicky J; Brown, Jeremy K; Maybin, Jacqueline; Saunders, Philippa T K; Duncan, W Colin; Horne, Andrew W
TGF-β is believed to play a major role in the etiology of peritoneal endometriosis. In tumors, TGF-β induces the metabolic conversion of glucose to lactate via glycolysis, a process referred to as the "Warburg effect." Lactate increases cell invasion, angiogenesis, and immune suppression, all crucial steps in the development of endometriosis. The aim of this study was to determine whether TGF-β induces a "Warburg-like" effect in peritoneal endometriosis. The study was informed by human tissue analysis and cel culture. The study was conducted at the university research institute. We studied women undergoing surgical investigation for endometriosis. Concentrations of lactate and TGF-β1 in peritoneal fluid (n = 16) were measured by commercial assay. Expression of genes implicated in glycolysis was measured in endometrial and peritoneal biopsies (n = 31) by quantitative RT-PCR and immunohistochemistry. The effect of TGF-β1 on primary human peritoneal mesothelial cells (n = 6) and immortalized mesothelial (MeT-5A) cells (n = 3) was assessed by quantitative RT-PCR, Western blot, and commercial assays. Lactate, TGF-β1, and markers of glycolysis were measured. Concentrations of lactate in peritoneal fluid paralleled those of TGF-β1, being significantly higher in women with endometriosis compared to women without (P Endometriosis lesions expressed higher levels of glycolysis-associated genes HIF1A, PDK1, and LDHA than eutopic endometrium, and adjacent peritoneum had higher levels of HIF1A and SLC2A1 than peritoneum from women without disease (P endometriosis lesions and peritoneal mesothelium in women with endometriosis may favor development of endometriosis.
Kang, Seok Hui; Choi, Eun Woo; Park, Jong Won; Cho, Kyu Hyang; Do, Jun Young
Background Proper monitoring for volume overload is important to improve prognosis in peritoneal dialysis (PD) patients. The association between volume status and residual renal function (RRF) remains an unresolved issue. The aim of the present study was to evaluate the association between the edema index and survival or RRF in incident PD patients. Patients and Methods We identified all adults who underwent PD. The edema index was defined as the ratio of extracellular fluid to total body flu...
Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P.
Background: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non...
Hahn, H H; Char, D C; Postel, W B; Wood, W B
Macrophages from oil-induced peritoneal exudates in rabbits produce endogenous pyrogen when first activated by incubation in 4 hr exudate fluid and then stimulated by incubation in potassium-free isotonic sodium chloride solution. The failure of earlier investigators to obtain pyrogen from macrophages is explained, and the relevance of macrophage pyrogen to fevers of agranulocytosis and other diseases, in which mononuclear rather than granulocytic exudates predominate, is discussed.
Lee, Jae Tae; Lee, Kyu Bo; Whang, Kee Suk; Kim, Gwang Won; Chung, Byung Chun; Cho, Dong Kyu; Chung, Joon Mo
Simultaneous presence of ascites and pleural effusion has been documented in patients with cirrhosis of the liver, renal disease, Meigs' syndrome and in patients undergoing peritoneal dialysis. Mechanisms proposed in the formation of pleural effusion in most of the above diseases are lymphatic drainage and diaphragmatic defect. But sometimes, hepatic hydrothoraxes in the absence of clinical ascites and pleural effusion secondary to pulmonary or cardiac disease are noted. It is not always possible to differentiate between pleural effusion caused by transdiaphragmatic migration of ascites and by other causes based solely on biochemical analysis. Authors performed radionuclide scintigraphy after intraperitoneal administration of 99m Tc-labeled colloid in 23 patients with both ascites and pleural effusion in order to discriminate causative mechanisms responsible for pleural effusion. Scintigraphy demonstrated the transdiaphtagmatic flow of fluid from the peritoneum to pleural cavities in 13 patients correctly. In contrast, in 5 patients with pleural effusion secondary to pulmonary, pleural and cardiac diseases, radiotracers fail to traverse the diaphragm and localize in the pleural space. Ascites draining to mediastinal lymph nodes and blocked passage of lymphatic drainage were also clarified, additionally. Conclusively, radionuclide peritoneal scintigraphy is an accurate, rapid and easy diagnostic tool in patients with both ascites and pleural effusion. It enables the causes of pleural effusion to be elucidated, as well as providing valuable information required when determining the appropriate therapy.
Akahane, T; Kawakami, Y; Oana, K
On January 17, 2001, a 39-year old female with sudden abdominal pain was admitted to her neighboring outpatient clinic and diagnosed as suspicious of infectious enteritis. However, on the next day (January 18, 2001) she was soon transferred to Toyoshina Red Cross Hospital with the chief complaint of severe abdominal pain, high fever, and of conspicuous leucocytosis. Laboratory data on her admission demonstrated apparent signs of inflammation and she was soon undergone an emergency operation. Neisseria gonorrhoeae was recovered from her ascetic fluid, otherwise Chlamydia EIA was negative. The antibiotic chemotherapy of minocycline (200 mg/day) was continued for the first 9 days and sulbactam/cefoperazone (2 g/day) had been administered for the first 5 days. Her symptoms were discontinued on her 10th hospital day, and she was discharged on the 14th hospital day. There have been few reported cases in Japan of bacterial peritonitis due to N. gonorrhoeae. This is, to the best of our knowledge, the first reported case of N. gonorrhoeae peritonitis in Japan.
Tuba Elif Şenel
Full Text Available Cardiorenal syndrome (CRS is a general term that can reflect different clinical conditions in which cardiac and renal dysfunctions coexist. The main pathogenetic mechanisms playing a role in heart failure (HF and CRS are neurohumoral adaptation, right ventricular dilatation and dysfunction and systemic inflammation. Persistence of these factors cause focal and segmental glomerulosclerosis, and tubulointerstitial fibrosis in the renal parenchyma. Diuretics, beta blockers, renin-angiotensin-aldosterone system inhibitors, and vasodilators are the main medical treatments besides conventional approach, such as salt and water restriction and quitting smoking, in HF treatment. Diuretic resistance is the main problem emerging during diuretic treatments. Two renal replacement treatments have become prominent for removal of excess fluids via ultrafiltration in HF patients with diuretic resistance extracorporeal ultrafiltration with hemodialysis and peritoneal dialysis (PD. Herein, the role of these two ultrafiltration modalities, especially peritoneal ultrafiltration (PUF in the treatment of HF is discussed. The main studies and advantages of PUF in HF treatment were discussed. Moreover, effects of PD on glomerular filtration rate, hospitalization and mortality were investigated. In conclusion, PD is an alternative cheap, practical and convenient therapy in reducing cardiac volume burden in HF patients who do not respond well to standard treatments and/or require frequent hospitalization.
Zemel, D.; ten Berge, R. J.; Struijk, D. G.; Bloemena, E.; Koomen, G. C.; Krediet, R. T.
We investigated whether day to day changes in the transport characteristics of the peritoneal membrane to macromolecules in patients treated with CAPD, were related to the levels of interleukin-6 (IL-6) in the effluent of an overnight dwell. Four stable CAPD patients without peritonitis collected
Bibashi, Evangelia; Sofianou, Danai; Kontopoulou, Konstantina; Mitsopoulos, Efstathios; Kokolina, Elisabeth
Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis. PMID:10618142
Ho-Dac-Pannekeet, M. M.; Atasever, B.; Struijk, D. G.; Krediet, R. T.
BACKGROUND: Ultrafiltration failure (UFF) is a complication of peritoneal dialysis (PD) treatment that occurs especially in long-term patients. Etiological factors include a large effective peritoneal surface area [measured as high mass transfer area coefficient (MTAC) of creatinine], a high
Balafa, Olga; Halbesma, Nynke; Struijk, Dirk G.; Dekker, Friedo W.; Krediet, Raymond T.
Background and objectives Peritoneal clearance of albumin unlike the transport of small molecules is defined by both vascular surface area and size-selective permeability. Few studies have supported a positive correlation between peritoneal albumin loss and mortality. The aim of this study was to
Redpath Mahon, Allison; Neu, Alicia M
Peritonitis is a leading cause of hospitalizations, morbidity, and modality change in pediatric chronic peritoneal dialysis (CPD) patients. Despite guidelines published by the International Society for Peritoneal Dialysis aimed at reducing the risk of peritonitis, registry data have revealed significant variability in peritonitis rates among centers caring for children on CPD, which suggests variability in practice. Improvement science methods have been used to reduce a variety of healthcare-associated infections and are also being applied successfully to decrease rates of peritonitis in children. A successful quality improvement program with the goal of decreasing peritonitis will not only include primary drivers directly linked to the outcome of peritonitis, but will also direct attention to secondary drivers that are important for the achievement of primary drivers, such as health literacy and patient and family engagement strategies. In this review, we describe a comprehensive improvement science model for the reduction of peritonitis in pediatric patients on CPD.
van Diepen, Anouk T N; van Esch, Sadie; Struijk, Dirk G; Krediet, Raymond T
♦ Little or no clinical evidence is available on the association between glucose exposure and peritoneal host defense in peritoneal dialysis (PD) patients. The objective of the present study was to quantify the exposure to glucose during the first year on PD and investigate the association with subsequent peritonitis. ♦ We analyzed prospectively collected demographic and peritonitis data from incident adult PD patients between 1990 and 2010. For the present study, we conducted a review of both in- and outpatient medical records of all patients to obtain their day-to-day dialysis schemes during the first year on PD. From these data, the average exposure to glucose was quantified. The exposure was stratified into low- and high-glucose groups based on the median, analyzed per standard deviation and in quartiles. Cox proportional hazard models were used to calculate crude and adjusted hazard ratios (HRs) and 95% confidence intervals for the association between glucose exposure and peritonitis. Adjustments were made for age, sex, primary kidney disease, diabetes mellitus, Davies comorbidity score and the treatment period. ♦ In total, 230 patients were included in the study of whom 151 (66%) experienced a first peritonitis episode. The median follow-up time was 2.6 years (interquartile range [IQR]: 1.9 - 3.8) in the low-glucose group and 3.1 (IQR: 2.1 - 4.2) in the high-glucose group. After adjustment for confounding factors, no association between high glucose exposure and the risk of peritonitis was found (HR: 0.81; 0.55 - 1.17). No association was present when glucose exposure was analyzed per standard deviation (SD) (HR: 0.98; 0.79 - 1.21) or patient quartiles were applied. No association was identified between glucose exposure and severe peritonitis, Staphylococcus aureus peritonitis, or a peritonitis episode that lasted more than 14 days. ♦ Exposure to glucose is not associated with an increased risk of peritonitis. The equilibrium between glycemic harm to
Bass, L D; Denniston, D J; Maclellan, L J; McCue, P M; Seidel, G E; Squires, E L
Equine embryos (n=43) were recovered nonsurgically 7-8 days after ovulation and randomly assigned to be cryopreserved in one of two cryoprotectants: 48% (15M) methanol (n=22) or 10% (136 M) glycerol (n=21). Embryos (300-1000 microm) were measured at five intervals after exposure to glycerol (0, 2, 5, 10 and 15 min) or methanol (0, 15, 35, 75 and 10 min) to determine changes (%) in diameter over time (+/-S.D.). Embryos were loaded into 0.25-ml plastic straws, sealed, placed in a programmable cell freezer and cooled from room temperature (22 degrees C) to -6 degrees C. Straws were then seeded, held at -6 degrees C for 10 min and then cooled to -33 degrees C before being plunged into liquid nitrogen. Two or three embryos within a treatment group were thawed and assigned to be either cultured for 12 h prior to transfer or immediately nonsurgically transferred to a single mare. Embryo diameter decreased in all embryos upon initial exposure to cryoprotectant. Embryos in methanol shrank and recovered slightly to 76+/-8 % of their original diameter; however, embryos in glycerol continued to shrink, reaching 57+/-6 % of their original diameter prior to cryopreservation. Survival rates of embryos through Day 16 of pregnancy were 38 and 23%, respectively (P>0.05) for embryos cryopreserved in the presence of glycerol or methanol. There was no difference in pregnancy rates of mares receiving embryos that were cultured prior to transfer or not cultured (P>0.05). Preliminary experiments indicated that 48% methanol was not toxic to fresh equine embryos but methanol provided no advantage over glycerol as a cryoprotectant for equine blastocysts.
Corona, A; Cherchi, R
Bacteriological surveillance is little applied in management of equine frozen semen but it is quite important to verify the microbial contamination in order to find out the chance of transmission of pathology to the mare in AI. Authors describe a qualitative and quantitative analysis for bacterial contamination on long time (3-17 years) equine frozen semen stored in liquid nitrogen. The semen checked, produced in Italy and in another Europe country, was cryopreserved in liquid nitrogen inside sealed plastic straws. One hundred and ten straws were checked out for pathogenic and no pathogenic bacteria, aerobes and anaerobes and fungi (moulds and yeasts). The Total Microbial Charge was quite variable with an average of about 1.4 x 10(5)CFU/ml. Mostly the microbial agents identified were fungi (17.5%), Enterobacter-coccus spp. (15%), Pseudomonas spp. (6.25%), Stenothophomonas maltophila (6.25%) and anaerobic bacteria like Propionibacterium granulosum (7.5%) and Clostridium spp. (3.75%). 3.75% were unidentified Gram-negative rod and cocci. Streptococcus spp., Staph. aureus, E. coli, Th. equigenitalis and Mycoplasma spp. were not detected. The most represented species were Enterobacter-coccus spp. (1.1 x 10(5)CFU/ml), St. maltophila (8 x 10(4)CFU/ml) and Pr. granulosum (7 x 10(4)CFU/ml) while yeast and even more moulds were little abundant (4.7 x 10(4) and 3.4 x 10(4)CFU/ml respectively). The knowledge of equine frozen semen microbial quality is essential to check out transmission of venereal disease and improve the quality of cryopreserved germplasm.
Martinez-Quinones, Patricia A; McCarthy, Cameron G; Mentzer, Caleb J; Wenceslau, Camilla F; Holsten, Steven B; Webb, R Clinton; O'Malley, Keith
Mitochondrial damage-associated molecular patterns (mtDAMPs), such as mitochondrial DNA and N-formylated peptides, are endogenous molecules released from tissue after traumatic injury. mtDAMPs are potent activators of the innate immune system. They have similarities with bacteria, which allow mtDAMPs to interact with the same pattern recognition receptors and mediate the development of systemic inflammatory response syndrome (SIRS). Current recommendations for management of an open abdomen include returning to the operating room every 48 hours for peritoneal cavity lavage until definitive procedure. These patients are often critically ill and develop SIRS. We hypothesized that mitochondrial DAMPs are present in the peritoneal cavity fluid in this setting, and that they accumulate in the interval between washouts. We conducted a prospective pilot study of critically ill adult patients undergoing open abdomen management in the surgical and trauma intensive care units. Peritoneal fluid was collected daily from 10 open abdomen patients. Specimens were analyzed via quantitative polymerase chain reaction (qPCR) for mitochondrial DNA (mtDNA), via enzyme immunoassay for DNAse activity and via Western blot analysis for the ND6 subunit of the NADH: ubiquinone oxidoreductase, an N-formylated peptide. We observed a reduction in the expression of ND6 the day after lavage of the peritoneal cavity, that was statistically different from the days with no lavage (% change in ND6 expression, postoperative from washout: -50 ± 11 vs. no washout day, 42 ± 9; p abdomen. It is possible that increased frequency of peritoneal cavity lavage may lead to decreased systemic absorption of mtDAMPs, thereby reducing the risk of SIRS. Prospective study, Case Series, Level V.
Maninchedda, Ugo; Lepage, Olivier M; Gangl, Monika; Hilairet, Sandrine; Remandet, Bernard; Meot, Francoise; Penarier, Geraldine; Segard, Emilie; Cortez, Pierre; Jorgensen, Christian; Steinberg, Régis
The aim of this work was to develop an equine metacarpophalangeal joint model that induces osteoarthritis that is not primarily mediated by instability or inflammation. The study involved six Standardbred horses. Standardized cartilage surface damage or "grooves" were created arthroscopically on the distal dorsal aspect of the lateral and medial metacarpal condyles of a randomly chosen limb. The contralateral limb was sham operated. After 2 weeks of stall rest, horses were trotted 30 minutes every other day for 8 weeks, then evaluated for lameness and radiographed. Synovial fluid was analyzed for cytology and biomarkers. At 10 weeks post-surgery, horses were euthanized for macroscopic and histologic joint evaluation. Arthroscopic grooving allowed precise and identical damage to the cartilage of all animals. Under the controlled exercise regime, this osteoarthritis groove model displayed significant radiographic, macroscopic, and microscopic degenerative and reactive changes. Histology demonstrated consistent surgically induced grooves limited to non-calcified cartilage and accompanied by secondary adjacent cartilage lesions, chondrocyte necrosis, chondrocyte clusters, cartilage matrix softening, fissuring, mild subchondral bone inflammation, edema, and osteoblastic margination. Synovial fluid biochemistry and cytology demonstrated significantly elevated total protein without an increase in prostaglandin E2, neutrophils, or chondrocytes. This equine metacarpophalangeal groove model demonstrated that standardized non-calcified cartilage damage accompanied by exercise triggered altered osteochondral morphology and cartilage degeneration with minimal or inefficient repair and little inflammatory response. This model, if validated, would allow for assessment of disease processes and the effects of therapy.
Full Text Available The aim of this work was to develop an equine metacarpophalangeal joint model that induces osteoarthritis that is not primarily mediated by instability or inflammation. The study involved six Standardbred horses. Standardized cartilage surface damage or "grooves" were created arthroscopically on the distal dorsal aspect of the lateral and medial metacarpal condyles of a randomly chosen limb. The contralateral limb was sham operated. After 2 weeks of stall rest, horses were trotted 30 minutes every other day for 8 weeks, then evaluated for lameness and radiographed. Synovial fluid was analyzed for cytology and biomarkers. At 10 weeks post-surgery, horses were euthanized for macroscopic and histologic joint evaluation. Arthroscopic grooving allowed precise and identical damage to the cartilage of all animals. Under the controlled exercise regime, this osteoarthritis groove model displayed significant radiographic, macroscopic, and microscopic degenerative and reactive changes. Histology demonstrated consistent surgically induced grooves limited to non-calcified cartilage and accompanied by secondary adjacent cartilage lesions, chondrocyte necrosis, chondrocyte clusters, cartilage matrix softening, fissuring, mild subchondral bone inflammation, edema, and osteoblastic margination. Synovial fluid biochemistry and cytology demonstrated significantly elevated total protein without an increase in prostaglandin E2, neutrophils, or chondrocytes. This equine metacarpophalangeal groove model demonstrated that standardized non-calcified cartilage damage accompanied by exercise triggered altered osteochondral morphology and cartilage degeneration with minimal or inefficient repair and little inflammatory response. This model, if validated, would allow for assessment of disease processes and the effects of therapy.
Amanda L McGuire
Full Text Available A major complication of peritoneal dialysis is the development of peritonitis, which is associated with reduced technique and patient survival. The inflammatory response elicited by infection results in a fibrin and debris-rich environment within the peritoneal cavity, which may reduce the effectiveness of antimicrobial agents and predispose to recurrence or relapse of infection. Strategies to enhance responses to antimicrobial agents therefore have the potential to improve patient outcomes. This study presents pre-clinical data describing the compatibility of tPA and DNase in combination with antimicrobial agents used for the treatment of PD peritonitis. tPA and DNase were stable in standard dialysate solution and in the presence of antimicrobial agents, and were safe when given intraperitoneally in a mouse model with no evidence of local or systemic toxicity. Adjunctive tPA and DNase may have a role in the management of patients presenting with PD peritonitis.
Uzunoglu, E; Sahin, A M
Paecilomyces variotii (P. variotii) is an extremely rare cause of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. When diagnosed, it usually portends poor prognosis. Patient's survival depends on early laboratory diagnosis and proper treatment. We herein report a P. variotii peritonitis in a patient on CAPD which is a quite rare clinical entity. Laboratory diagnosis was confirmed via both morphological analysis and DNA sequencing. Antifungal susceptibility tests were performed and interpreted according to the Clinical Laboratory Standards Institute M38-A2 guidelines. After laboratory diagnosis, the patient was treated succesfully with liposomal amphotericin B and itraconazole combination and the peritoneal catheter was removed. This case is worthy of reporting since P. variotii is an uncommon cause of peritonitis and leads to dilemmas in both laboratory diagnosis and treatment strategies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Jeung, InCheul; Cheon, Keunyoung; Kim, Mee-Ran
Endometriosis causes significant chronic pelvic pain, dysmenorrhea, and infertility and affects 10% of all women. In endometriosis, ectopic endometrium surviving after retrograde menstruation exhibits an abnormal immune response characterized by increased levels of activated macrophages and inflammatory cytokines. Particularly, dysfunctional natural killer (NK) cells play an important role in the pathogenesis of the disease by either facilitating or inhibiting the survival, implantation, and proliferation of endometrial cells. NK cells in the peritoneum and peritoneal fluid exhibit reduced levels of cytotoxicity in women with endometriosis. Several cytokines and inhibitory factors in the serum and peritoneal fluid also dysregulate NK cell cytotoxicity. Additionally, increased numbers of immature peripheral NK cells and induction of NK cell apoptosis are evident in the peritoneal fluid of women with endometriosis. The high rate of endometriosis recurrence after pharmaceutical or surgical treatment, which is associated with dysfunctional NK cells, indicates that new immunomodulatory management strategies are required. A good understanding of immune dysfunction would enable improvement of current treatments for endometriosis.
Full Text Available Endometriosis causes significant chronic pelvic pain, dysmenorrhea, and infertility and affects 10% of all women. In endometriosis, ectopic endometrium surviving after retrograde menstruation exhibits an abnormal immune response characterized by increased levels of activated macrophages and inflammatory cytokines. Particularly, dysfunctional natural killer (NK cells play an important role in the pathogenesis of the disease by either facilitating or inhibiting the survival, implantation, and proliferation of endometrial cells. NK cells in the peritoneum and peritoneal fluid exhibit reduced levels of cytotoxicity in women with endometriosis. Several cytokines and inhibitory factors in the serum and peritoneal fluid also dysregulate NK cell cytotoxicity. Additionally, increased numbers of immature peripheral NK cells and induction of NK cell apoptosis are evident in the peritoneal fluid of women with endometriosis. The high rate of endometriosis recurrence after pharmaceutical or surgical treatment, which is associated with dysfunctional NK cells, indicates that new immunomodulatory management strategies are required. A good understanding of immune dysfunction would enable improvement of current treatments for endometriosis.
Clark, Andrew R
Current economic trends in equine practice are trends of weakness. Most practices, after a decade of double-digit growth, have migrated to survival mode within a few months. Understanding that all regions and disciplines are affected differently, using the Porter five forces model, we can identify changes that must be made in our business models first to survive and then to position ourselves to prosper when the recession ends. If we are to avoid long-term damage to our practices, we must use cost control and work efficiency in addition to price concessions.
Red cell mass and blood volume of 16 thoroughbred horse, 11 healthy and 5 with naturally acquired equine infectious anemia, were determined by means of 51 Cr-tagged erythrocytes. The mean values obtained in healthy thoroughbred horses were as follows: red cell mass 40,64 and blood volume 102,32 ml/kg body weight. The mean red cell mass and blood volume in anemic horses were respectively 21,13 and 107,71 ml/Kg body weight. The difference in red cell mass value between the two groups was statistically significant (P [pt
Zavoshti, Fereydon Rezazadeh; Andrews, Frank M
Equine gastric ulcer syndrome (EGUS) is an umbrella term used to describe ulcers in the nonglandular squamous and glandular mucosa, terminal esophagus, and proximal duodenum. Gastric ulcers in the squamous and glandular regions occur more often than esophageal or duodenal ulcers and likely have a different pathogenesis. At present, omeprazole is accepted globally as the best pharmacologic therapy for both regions of the stomach; however, the addition of coating agents and synthetic prostaglandins could add to its effectiveness in treatment of EGUS. Dietary and environmental management are necessary for prevention of recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.
The half-life of 51 Cr-tagged erythrocytes of 16 thoroughbred horses, 11 healthy and 5 naturally injected by equine infections anemia, was determined in Rio de Janeiro, BRAZIL. The half-life of 51 Cr-tagged erythrocytes of healthy horses was 15,5 (S.D. +- -+ 2,08) days, and of anemic horses 8,98 (S.D. +- -+ 1,20) days. The difference between the mean values of the two groups was statistically significant (P [pt
The Kinesio taping method was developed in Japan for use in humans in 1979. The use of complementary therapies is becoming common in equine athletes and the discovery of Kinesio taping potential brought it into the animal world. Kinesio taping can be used to treat a wide range of clinical conditions, from tendon injuries to neurologic disorders and from muscle contractures to postural insufficiencies. Its use in veterinary medicine is promising, but relies heavily on evidence-based clinical reports. Further scientific research is needed to fully understand the real effectiveness of application. Copyright © 2016 Elsevier Inc. All rights reserved.
Cervone, P; Boso Caretta, F; Painvain, E; Marchiani, E; Montanino, G
Cystic mesothelioma is a rare benign tumor of the abdominal and pelvic peritoneum, consisting of solitary or multiple cysts. No more than 130 cases are reported. Several risk factors such as chronic peritoneal irritation, caused by foreign bodies, infection or endometriosis, were hypothesized but the pathogenesis is still unknown. A 51-year menopausal woman was submitted to ultrasonography because of abnormal uterine bleeding. The scan revealed a right ovarian cyst (size 81 x 64 mm) with the feature of serous cyst. In the anamnesis a cystectomy of the right ovary and appendectomy were reported. At laparoscopy, then converted in laparotomy, a cyst arising from peritoneum of the posterior surface of the uterus was found. The right ovary was normal. The histopathological finding was: serous simple cyst of peritoneum. Ultrasonographic diagnosis was not confirmed by surgery; in fact, sometimes, it may be difficult to establish the origin of pelvic cystic mass, from ovary or peritoneum, by ultrasonography. It is mandatory to suggest a laparoscopy and/or laparotomy in case of pelvic cystic mass that does not regress in the time even after administration of oral contraceptives.
Pi, Hai-Chen; Ren, Ye-Ping; Wang, Qin; Xu, Rong; Dong, Jie
♦ As an immune system regulator, vitamin D is commonly deficient among patients on peritoneal dialysis (PD), which may contribute to their impaired immune function and increased risk for PD-related peritonitis. In this study, we aimed to investigate whether vitamin D deficiency could predict the risk of peritonitis in a prospective cohort of patients on PD. ♦ We collected 346 prevalent and incident PD patients from 2 hospitals. Baseline demographic data and clinical characteristics were recorded. Serum 25-hydroxyvitamin D (25[OH]D) was measured at baseline and prior to peritonitis. The mean doses of oral active vitamin D used during the study period were also recorded. The outcome was the occurrence of peritonitis. ♦ The mean age of patients and duration of PD were 58.95 ± 13.67 years and 28.45 (15.04 - 53.37) months, respectively. Baseline 25(OH)D level was 16.15 (12.13 - 21.16) nmol/L, which was closely associated with diabetic status, longer PD duration, malnutrition, and inflammation. Baseline serum 25(OH)D predicted the occurrence of peritonitis independently of active vitamin D supplementation with a hazard ratio (HR) of 0.94 (95% confidence interval [CI] 0.90 - 0.98) after adjusting for recognized confounders (age, gender, dialysis duration, diabetes, albumin, residual renal function, and history of peritonitis). Compared to the low tertile, middle and high 25(OH)D level tertiles were associated with a decreased risk for peritonitis with HRs of 0.54 (95% CI 0.31 - 0.94) and 0.39 (95% CI 0.20 - 0.75), respectively. ♦ Vitamin D deficiency evaluated by serum 25(OH)D rather than active vitamin D supplementation is closely associated with a higher risk of peritonitis. Copyright © 2015 International Society for Peritoneal Dialysis.
Fan, Xiaoguang; Huang, Rong; Wang, Juan; Ye, Hongjian; Guo, Qunying; Yi, Chunyan; Lin, Jianxiong; Zhou, Qian; Shao, Fengmin; Yu, Xueqing; Yang, Xiao
Background The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis. Results In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months) of 1117 CAPD patients, 309(27.7%) patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years) [hazard ratio (HR) = 1.427, 95% confidence interval (CI) = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030), lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004) and albumin peritonitis in Southern Chinese CAPD patients. PMID:25222609
Wu, Hsin-Hsu; Li, I-Jung; Weng, Cheng-Hao; Lee, Cheng-Chia; Chen, Yung-Chang; Chang, Ming-Yang; Fang, Ji-Tseng; Hung, Cheng-Chieh; Yang, Chih-Wei; Tian, Ya-Chung
Introduction Continuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients. Patients and methods We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012. Results Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p = 0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; pperitonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; pPeritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; pperitonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; pperitonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p = 0.10). Conclusion Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures
Padwal, Manreet Kaur; Cheng, Genyang; Liu, Limin; Boivin, Felix J; Gangji, Azim; Brimble, Kenneth Scott; Bridgewater, Darren; Margetts, Peter J
The WNT signaling pathway is involved in wound healing and fibrosis. We evaluated the WNT signaling pathway in peritoneal membrane injury. We assessed WNT1 protein expression in the peritoneal effluents of 54 stable peritoneal dialysis (PD) patients and WNT-related gene expression in ex vivo mesothelial cell cultures from 21 PD patients. In a transforming growth factor beta (TGFB) mediated animal model of peritoneal fibrosis, we evaluated regulation of the WNT pathway and the effect of WNT inhibition on peritoneal fibrosis and angiogenesis. WNT1 and WNT2 gene expression were positively correlated with peritoneal membrane solute transport in PD patients. In the mouse peritoneum, TGFΒ-induced peritoneal fibrosis was associated with increased expression of WNT2 and WNT4. Peritoneal b-catenin protein was significantly upregulated after infection with AdTGFB along with elements of the WNT signaling pathway. Treatment with a b-catenin inhibitor (ICG-001) in mice with AdTGFB-induced peritoneal fibrosis resulted in attenuation of peritoneal angiogenesis and reduced vascular endothelial growth factor. Similar results were also observed with the WNT antagonist Dickkopf related protein (DKK) 1. In addition to this, DKK-1 blocked epithelial to mesenchymal transition and increased levels of the cell adhesion protein E-cadherin. We provide evidence that WNT signaling is active in the setting of experimental peritoneal fibrosis and WNT1 correlates with patient peritoneal membrane solute transport in PD patients. Intervention in this pathway is a possible therapy for peritoneal membrane injury.
Naskou, Maria C; Norton, Natalie A; Copland, Ian B; Galipeau, Jacques; Peroni, John F
Platelet lysate (PL) has been extensively used for the laboratory expansion of human mesenchymal stem cells (MSC) in order to avoid fetal bovine serum (FBS) which has been associated with immune-mediated host reactions and transmission of bovine-origin microbial contaminants. Before suggesting the routine use of PL for MSC culture, we wanted to further investigate whether PL alone might trigger inflammatory responses when exposed to reactive white blood cells such as monocytes. Our objectives were to evaluate the inflammatory profile of equine monocytes cultured with equine PL (ePL) and to determine if ePL can modulate the expression of inflammatory cytokines in lipopolysaccharide (LPS)-stimulated monocytes. In a first experiment, equine monocytes were isolated and incubated with donor horse serum (DHS), FBS, six individual donors ePL or pooled ePL from all horses. In a second experiment, monocytes were stimulated with E. coli LPS in the presence of 1, 5 or 10% DHS and/or pooled ePL. After 6h of incubation, cell culture supernatants were assayed via ELISA for production of the pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α) and Interleukin 1β (IL-1β) as well as for the anti-inflammatory Interleukin 10 (IL-10). Equine monocytes incubated with pooled ePL produced significantly less TNF-α and significantly more IL-10 than monocytes incubated in FBS. A statistically significant difference was not identified for the production of IL-1β. The second experiment showed that pooled ePL added to LPS-stimulated equine monocytes resulted in a significant reduction in TNF-α and IL-1β production. IL-10 production was not significantly upregulated by the addition of ePL to LPS-stimulated monocytes. Finally, the addition of ePL to LPS-stimulated monocytes in the presence of various concentrations of DHS resulted to statistically significant decrease of TNF-α and IL-1β compared to the control groups. This is the first study to demonstrate that ePL suppresses
Full Text Available High mobility group box 1 (HMGB1, a DNA-binding nuclear protein, has been implicated as an endogenous danger signal in the pathogenesis of infection diseases. However, the potential role and source of HMGB1 in the peritoneal dialysis (PD effluence of patients with peritonitis are unknown. First, to evaluate HMDB1 levels in peritoneal dialysis effluence (PDE, a total of 61 PD patients were enrolled in this study, including 42 patients with peritonitis and 19 without peritonitis. Demographic characteristics, symptoms, physical examination findings and laboratory parameters were recorded. HMGB1 levels in PDE were determined by Western blot and ELISA. The concentrations of TNF-α and IL-6 in PDE were quantified by ELISA. By animal model, inhibition of HMGB1 with glycyrrhizin was performed to determine the effects of HMGB1 in LPS-induced mice peritonitis. In vitro, a human peritoneal mesothelial cell line (HMrSV5 was stimulated with lipopolysaccharide (LPS, HMGB1 extracellular content in the culture media and intracellular distribution in various cellular fractions were analyzed by Western blot or immunofluorescence. The results showed that the levels of HMGB1 in PDE were higher in patients with peritonitis than those in controls, and gradually declined during the period of effective antibiotic treatments. Furthermore, the levels of HMGB1 in PDE were positively correlated with white blood cells (WBCs count, TNF-α and IL-6 levels. However, pretreatment with glycyrrhizin attenuated LPS-induced acute peritoneal inflammation and dysfunction in mice. In cultured HMrSV5 cells, LPS actively induced HMGB1 nuclear-cytoplasmic translocation and release in a time and dose-dependent fashion. Moreover, cytosolic HMGB1 was located in lysosomes and secreted via a lysosome-mediated secretory pathway following LPS stimulation. Our study demonstrates that elevated HMGB1 levels in PDE during PD-related peritonitis, at least partially, from peritoneal mesothelial cells
Full Text Available INTRODUCTION: Continuous ambulatory peritoneal dialysis (CAPD peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients. PATIENTS AND METHODS: We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD, colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012. RESULTS: Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4% peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p=0.20. The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005. Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05. Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05. No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05. Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p=0.10. CONCLUSION: Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such
Moyer, William; O'Grady, Stephen E; Werner, Harry W
The importance of hoof care in maintaining the health and soundness of a horse cannot be overstated. The aphorism, “No foot, no horse” still holds true. For equine ambulatory practitioners, the time devoted to a thorough understanding of the equine digit and it’s care is well worth the investment. The effort devoted to developing good relationships with individuals who will likely be responsible for implementing the changes suggested as a result of that understanding will be rewarded many times over in the course of the equine ambulatory practitioner’s career.
Schiesser, E; Geyer, H; Kummer, M; Jackson, M
The interest in equine dentistry has significantly increased in the last 15 years. On the part of the veterinarians as well as of the horse owners there is a strong attention to the topic. The aim of the questionnaire was to investigate amongst horse owners what their level of information and preferences about dental treatment are and how they are implemented. The questionnaire was translated into the three national languages and included 20 questions about level and sources of information, frequency of treatments and the horse owner's stance over sedation of the animals. With a return rate of 45% (1'466 of 3'250 sent questionnaires) significant conclusions could be drawn. Horse owners showed a strong demand for clarification regarding tooth problems, the causes, consequences and methods of treatment. More than half of the owners considered themselves not well informed. The treating person was in 66.7% a veterinarian with a special education. Horse owners indicated that information circulated most frequently by word of mouth recommendations and they explicitly wished information from professional and reliable sources. The questionnaire provided a clear result about current equine dental treatments. We suggest that they should be performed by veterinarians only with a special education.
Brinkmann, J; Jagannathan, V; Drögemüller, C; Rieder, S; Leeb, T; Thaller, G; Tetens, J
The casein genes are known to be highly variable in typical dairy species, such as cattle and goat, but the knowledge about equine casein genes is limited. Nevertheless, mare milk production and consumption is gaining importance because of its high nutritive value, use in naturopathy, and hypoallergenic properties with respect to cow milk protein allergies. In the current study, the open reading frames of the 4 casein genes CSN1S1 (αS1-casein), CSN2 (β-casein), CSN1S2 (αS2-casein), and CSN3 (κ-casein) were resequenced in 253 horses of 14 breeds. The analysis revealed 21 nonsynonymous nucleotide exchanges, as well as 11 synonymous nucleotide exchanges, leading to a total of 31 putative protein isoforms predicted at the DNA level, 26 of which considered novel. Although the majority of the alleles need to be confirmed at the transcript and protein level, a preliminary nomenclature was established for the equine casein alleles. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
Nazirov, F N; Aripova, N U; Makhkamova, M N; Dzhamalov, S I; Pulatov, M M; Magzumov, I Kh; Isroilov, B N
Experience in treatment of 91 patients with peritonitis on various genesis using antiseptic Dekasan are presented. A marked clinical efficacy compared with that of other antiseptics in the complex treatment of peritonitis was noted.
Phelan, P J
Encapsulating peritoneal sclerosis (EPS) is arguably the most serious complication of chronic peritoneal dialysis (PD) therapy with extremely high mortality rates. We aimed to establish the rates of EPS and factors associated with its development in a single center.
... black women. Different factors increase or decrease the risk of getting ovarian, fallopian tube, and primary peritoneal ... decrease the number of deaths from ovarian cancer. Risks of Ovarian, Fallopian Tube, and Primary Peritoneal Cancer ...
Haliloglu, M.; Hoffer, F.A.; Fletcher, B.D.
Malignant mesothelioma is a rare tumor in childhood. We present two cases of malignant peritoneal mesothelioma in which contrast-enhanced, fat-saturated magnetic resonance (MR) imaging was used advantageously to detect peritoneal tumor involvement. (orig.)
Haliloglu, M. [Dept. of Diagnostic Imaging, St. Jude Children' s Research Hospital, St. Memphis, TN (United States); Hoffer, F.A. [Dept. of Diagnostic Imaging, St. Jude Children' s Research Hospital, St. Memphis, TN (United States); Dept. of Radiology, Univ. of Tennessee, Memphis, TN (United States); Fletcher, B.D. [Dept. of Diagnostic Imaging, St. Jude Children' s Research Hospital, St. Memphis, TN (United States); Dept. of Radiology, Univ. of Tennessee, Memphis, TN (United States); Dept. of Pediatrics, Univ. of Tennessee, Memphis (United States)
Malignant mesothelioma is a rare tumor in childhood. We present two cases of malignant peritoneal mesothelioma in which contrast-enhanced, fat-saturated magnetic resonance (MR) imaging was used advantageously to detect peritoneal tumor involvement. (orig.)
Shea, Yat Fung; Lam, Man-Fai; Lee, Mi Suen Connie; Mok, Ming Yee Maggie; Lui, Sing-Leung; Yip, Terence P S; Lo, Wai Kei; Chu, Leung Wing; Chan, Tak-Mao
Peritoneal dialysis (PD) exchange procedure is complex. Patients with cognitive impairment (CI) may require assistance. We studied the prevalence of CI among PD patients, its impact on PD-related peritonitis and the outcome of assisted PD. Cantonese version of Mini-Mental State examination (CMMSE) was performed in 151 patients newly started on PD. Data on patient characteristics including demographics, co-morbidities, blood parameters, medications, and number of PD-related peritonitis in the first 6 months were collected. 151 subjects were recruited. The age of studied patients was 60 ± 15.0 years, and 45% were female. The prevalence of CI was 13.9% using education-adjusted cut-off of CMMSE. Patients older than 65-year-old, female, and lower education level were independent risk factors for CI (OR 9.27 p = 0.001, OR 14.84 p = 0.005, and OR 6.10 p = 0.009, respectively). Age greater than 65-year old is an independent risk factor for PD-related peritonitis but CI was not. Patients requiring assisted PD were of older age (p peritonitis (p = 0.07). CI is common among local PD patients. Overall, CI could not be identified as an independent risk factor for PD peritonitis. There is a higher prevalence of CI among assisted PD patients but helpers may not completely eliminate the risk of PD-related peritonitis.
Eckel, C.G.; Davis, M.; Mettler, F.A. Jr.; Rosenberg, R.
Peritoneal spread of non-Hodgkin lymphoma is rare: fewer than three percent of persons afflicted with this disease develop peritoneal spread. Pericardial involvement by non-Hodgkin lymphoma is equally rare. We report an instance of peritoneal and pericardial spread in a patient with non-Hodgkin lymphoma that was detected only by CT scan. The peritoneal lesions were not visible by ultrasound examination. A pertinent review of the literature is presented. (author)
Yang, Zhikai; Xu, Rong; Zhuo, Min; Dong, Jie
We explored the relationship between the experience level of nurses and the peritonitis risk in peritoneal dialysis (PD) patients. Our observational cohort study followed 305 incident PD patients until a first episode of peritonitis, death, or censoring. Patients were divided into 3 groups according to the work experience in general medicine of their nurses-that is, least experience (biochemistry, and residual renal function were also recorded. Multivariate Cox regression was used to analyze the association of risks for all-cause and gram-positive peritonitis with patient training provided by nurses at different experience levels. Of the 305 patients, 91 were trained at the initiation of PD by nurses with advanced experience, 100 by nurses with moderate experience, and 114 by nurses with the least experience. Demographic and clinical variables did not vary significantly between the groups. During 13 582 patient-months of follow-up, 129 first episodes of peritonitis were observed, with 48 episodes being attributed to gram-positive organisms. Kaplan-Meier analysis showed that training by nurses with advanced experience predicted the longest period free of first-episode gram-positive peritonitis. After adjustment for some recognized confounders, the advanced experience group was still associated with the lowest risk for first-episode gram-positive peritonitis. The level of nursing experience was not significantly correlated with all-cause peritonitis risk. The experience in general medicine of nurses might help to lower the risk of gram-positive peritonitis among PD patients. These data are the first to indicate that nursing experience in areas other than PD practice can be vital in the training of PD patients.
Karaosmanoglu, Devrim; Karcaaltincaba, Musturay; Oguz, Berna; Akata, Deniz; Ozmen, Mustafa; Akhan, Okan
Purpose: We aimed to describe computed tomography (CT) findings in patients with peritoneal, omental and mesenteric lymphoma involvement. Materials and methods: We searched our archive retrospectively to find out patients with peritoneal, omental and mesenteric lymphoma involvement. We found 16 patients with non-hodgkin lymphoma meeting these criteria. CT studies of these patients were reevaluated for the presence of peritoneal involvement, ascites, omental mass, organomegaly, retroperitoneal lymphadenopathy, bowel wall thickening and other associated findings. Results: There were 14 males and 2 females with peritoneal and/or mesenteric and omental lymphoma involvement. Mean age was 39 (range 4-76). Subgroups of non-hodgkin lymphoma were diffuse large B-cell lymphoma (n = 11), small cell lymphocytic lymphoma (n = 2), small cleaved cell lymphoma (n = 1), T-cell lymphoma (n = 1) and Burkitt's lymphoma (n = 1). Peritoneal involvement was seen in 15 patients (93.8%) in the form of linear (n = 12) and nodular (n = 3) thickening. Ascites was seen in 12 (75%) patients. Omental and mesenteric masses were present in 10 (66.6%) and 10 (66.6%) patients, respectively. Bowel wall thickening, retroperitoneal lymphadenopathy and hepatosplenomegaly were also common and observed in 10, 10 and 11 patients, respectively. Solid organ involvement in the form of liver and splenic lesions was seen in 9 (56%) patients. Conclusion: Peritoneal involvement can be seen in many subtypes of lymphoma and most frequently in diffuse large B-cell lymphoma. Peritoneal lymphomatosis can mimic peritoneal carcinomatosis and should be included in the differential diagnosis list in patients with ascites, hepatosplenic lesions and unidentified cause of peritoneal thickening on CT in a male patient.
Vargas, Edgar; Blake, Peter G; Sanabria, Mauricio; Bunch, Alfonso; López, Patricia; Vesga, Jasmín; Buitrago, Alberto; Astudillo, Kindar; Devia, Martha; Sánchez, Ricardo
♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients. Copyright © 2017 International Society for Peritoneal Dialysis.
Tang, Wen; Grace, Blair; McDonald, Stephen P.; Hawley, Carmel M.; Badve, Sunil V.; Boudville, Neil C.; Brown, Fiona G.; Clayton, Philip A.; Johnson, David W.
♦ Background: The aim of the present study was to investigate the relationship between socio-economic status (SES) and peritoneal dialysis (PD)-related peritonitis. ♦ Methods: Associations between area SES and peritonitis risk and outcomes were examined in all non-indigenous patients who received PD in Australia between 1 October 2003 and 31 December 2010 (peritonitis outcomes). SES was assessed by deciles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Disadvantage (IRSD), Index of Relative Socio-economic Advantage and Disadvantage (IRSAD), Index of Economic Resources (IER) and Index of Education and Occupation (IEO). ♦ Results: 7,417 patients were included in the present study. Mixed-effects Poisson regression demonstrated that incident rate ratios for peritonitis were generally lower in the higher SEIFA-based deciles compared with the reference (decile 1), although the reductions were only statistically significant in some deciles (IRSAD deciles 2 and 4 – 9; IRSD deciles 4 – 6; IER deciles 4 and 6; IEO deciles 3 and 6). Mixed-effects logistic regression showed that lower probabilities of hospitalization were predicted by relatively higher SES, and lower probabilities of peritonitis-associated death were predicted by less SES disadvantage status and greater access to economic resources. No association was observed between SES and the risks of peritonitis cure, catheter removal and permanent hemodialysis (HD) transfer. ♦ Conclusions: In Australia, where there is universal free healthcare, higher SES was associated with lower risks of peritonitis-associated hospitalization and death, and a lower risk of peritonitis in some categories. PMID:24497587
Klevjer-Anderson, P.; Cheevers, W.P.; Crawford, T.B.
Equine dermal fibroblasts persistently infected with equine infectious anemia virus (EIAV) show no alterations in cell morphology or growth kinetics when compared to uninfected cells. The percentage of cells immunofluorescent positive for viral proteins fluctuated, depending upon the stage of the cell cycle, while production of extracellular virus was uniform throughout the cell cycle, increasing only as the cell number increased. This was shown in log versus stationary phase cultures as well as in cultures synchronized by serum starvation. The establishment of productive infection did not require host cell DNA synthesis. Normal levels of progeny virus were produced in cultures pretreated with mitomycin C and placed in serum-containing medium. Serum-starved cultures, however, did not support EIAV replication as well as other cultures, presumably because synthesis of provirus was inhibited. (author)
Merritt, R J; Atkinson, J B; Whalen, T V; Thomas, D W; Sinatra, F R; Roloson, G J
We provided partial peritoneal alimentation to a 1.69-kg 11-month-old premature infant who had no available central venous access, depleted peripheral venous access, and gastrointestinal dysfunction. A cuffed silastic catheter was surgically inserted into the suprahepatic space. An alimentation solution was continuously infused into the peritoneum for 28 days to supplement peripheral venous and nasogastric alimentation and contributed 42 +/- 15% of total calories daily. Weight gain was achieved, but complications included hypoglycemia, hypophosphatemia, intravascular dehydration, catheter site leakage, ascites, and hydrocele. At autopsy 11 months later, lipid accumulation was present in the upper peritoneum and the hilar regions of the lungs secondary to preexisting lymphatic obstruction. Partial peritoneal alimentation may be feasible when other access routes are inadequate, but lymphatic obstruction is a contraindication to the peritoneal administration of lipid emulsions.
Kusamura, Shigeki; Baratti, Dario; Zaffaroni, Nadia; Villa, Raffaella; Laterza, Barbara; Balestra, Maria Rosaria; Deraco, Marcello
Peritoneal carcinomatosis represents a devastating form of cancer progression with a very poor prognosis. Its complex pathogenesis is represented by a dynamic process comprising several steps. To the best of our knowledge pathogenesis can be partly explained by 3 major molecular pathways: (1) dissemination from the primary tumor; (2) primary tumor of peritoneum; and (3) independent origins of the primary tumor and peritoneal implants. These are not mutually exclusive and combinations of different mechanisms could occur inside a single case. There are still several aspects which need explanation by future studies. A comprehensive understanding of molecular events involved in peritoneal carcinomatosis is of paramount importance and should be systematically pursued not only to identify novel strategies for the prevention of the condition, but also to obtain therapeutic advances, through the identification of surrogate markers of prognosis and development of future molecular targeted therapies.
Full Text Available Abstract Introduction We report the case of a patient with a benign multicystic peritoneal mesothelioma and describe its appearance on computed tomography scans and ultrasonography, in correlation with gross clinical and pathological findings. Case presentation A 72-year-old Caucasian woman presented to our emergency department with acute abdomen signs and symptoms. A clinical examination revealed a painful palpable mass in her left abdomen. Abdominal ultrasonography and computed tomography demonstrated the presence of a large cystic mass in her left upper abdomen, adjacent to her left hemidiaphragm. The lower border of the mass extended to the upper margin of her pelvis. A complete resection of the lesion was performed. Pathological analysis showed a benign multicystic peritoneal mesothelioma. Conclusions Benign multicystic peritoneal mesothelioma is a rare lesion with a non-specific appearance on imaging. Its diagnosis always requires pathological analysis.
Deraco, M; Laterza, B; Kusamura, S; Baratti, D
Peritoneal surface malignancy (PSM) is a clinical entity with an unfavourable prognosis, which characterizes the evolution of neoplastic diseases from the abdominal and/or pelvic organs and could also be the terminal stage of extra-abdominal tumors. Examples of diseases that can spread mainly within the peritoneal cavity are appendiceal tumors, ovarian cancer, colorectal cancer, abdominal sarcomatosis, gastric cancer and peritoneal mesothelioma. The locoregional therapy is defined as the combination of cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). The rationale of this combined therapy for PSM is based on the natural history of this clinical entity that remains confined in the peritoneal cavity for most of its natural history. This pattern of spread would seem to indicate the potential usefulness of selectively increasing drug concentration in the tumour-bearing area by direct intraperitoneal chemotherapy instillation. This approach led to these outcomes: the median survival of colorectal carcinoma and ovarian cancer was 32 months; patients with peritoneal mesothelioma showed 57% survival at 5 years, while in patients with appendiceal mucinous tumors and pseudomyxoma peritonei (PMP) the 10 years overall survival was 78%. A significant improvement in survival was associated with hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with gastric cancer. Considering the constant increasing of diseases treatable with this procedure, more centres should be activated. The establishment of a clear policy and scientific guidelines is mandatory, in order to perform the CRS+HIPEC safely, minimizing treatment-related morbidity and mortality and maximizing the results in terms of survival and quality of life.
) performed mandatory testing on all remaining equines at the stud (n=30), resulting in a further 4 positive animals. All positive animals were treated and subsequently tested negative for T. equigenitalis. Since this outbreak, over 2000 genital ...
Roberto J. Barone
Full Text Available La diálisis peritoneal, como tratamiento sustitutivo de la función renal, se basa en la instilación dentro de la cavidad peritoneal de soluciones de diálisis con el objeto de aprovechar algunas de las propiedades del peritoneo como membrana biológica, con el fin de eliminar las sustancias de desecho generadas diariamente por nuestro organismo y contribuir entre otros con el control del balance hidrosalino alterado en la insuficiencia renal.
Hyun Deok Shin
Full Text Available Benign cystic mesothelioma (BCM is a rare benign disease that forms multicystic masses in the abdomen, pelvis, and retroperitoneum. It occurs predominantly in young to middle-aged women. The majority of cases were associated with a history of abdominal or pelvic operation, a history of endometriosis, and pelvic inflammatory disease. We present a unique case of BCM which is different to the previous cases. The patient was a 52-year-old man showing features of peritoneal carcinomatosis accompanied by ascites on abdominal computed tomography scans. We herein report a case of BCM misdiagnosed with peritoneal carcinomatosis.
Corbella, C.; Ares, J.; Rene, A.; Canales, L.; Marcos, J.A. de
Abdominal tuberculosis usually involves a combination of organs (hepatosplenic, intestinal and/or genitourinary), lymph nodes (peritoneal and mesenteric) and peritoneum, mesentery and omentum. It preferentially affects immuno compromised patients (diabetic, cirrhotic, HIV-positive individuals). We present four cases in which abdominal tuberculosis involved only peritoneum, mesentery and omentum, with no radiological evidence of retroperitoneal lymph node or hepatosplenic disease. Exclusively peritoneal involvement is rare and the radiologic findings are nonspecific as they are also observed in other more common disorders. Despite this fact, tuberculosis should be included in the differential diagnosis, especially in immunocompromised patients. (Author) 8 refs
Full Text Available The prognosis of malignant peritoneal mesothelioma is extremely poor with a mean survival time of 12 months. The initial symptoms are poor and atypical. Because of its rare entity and little knowledge of its treatments, there are few reports of long-term survival. We encountered a very unique case with strong impression on radiological findings of malignant peritoneal methothelioma. We had misdiagnosed it because of the findings and because the time course was similar to that of ischemic colitis. The radiological findings on CT and enema disappeared within one week after antibiotic therapy.
La Milia, Vincenzo; Pontoriero, Giuseppe; Virga, Giovambattista; Locatelli, Francesco
Peritoneal membrane function can be assessed using the peritoneal equilibration test (PET) and similar tests, but these are almost always complicated to use, require a considerable amount of working time and their results cannot always be easily interpreted. Ionic conductivity is a measure of the ability of an electrolyte solution to conduct electricity. We tested the hypothesis that the ionic conductivity of peritoneal dialysate can be used to evaluate peritoneal membrane function in peritoneal dialysis patients. We measured the ionic conductivity and classic biochemical parameters of peritoneal dialysate in 69 patients during a modified PET and compared their ability to evaluate peritoneal membrane function and to diagnose ultrafiltration failure (UFF). Ionic conductivity was correlated well with classical parameters of peritoneal transport as glucose reabsorption of glucose (D/D0: r(2) = 0.62, P conductivity area under the receiver-operating characteristic curve was 0.91 (95% confidence interval: 0.81-0.96) with sensitivity of 1.00 and specificity of 0.84 at a cut-off value of 12.75 mS/cm. These findings indicate that the ionic conductivity of peritoneal dialysate can be used as a new screening tool to evaluate peritoneal membrane function. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Schultz, D R; Barthal, J S; Garrett, G
A patient with confirmed western equine encephalitis had the rapid onset of postencephalitic parkinsonian sequelae. This observation corroborates similar previous but rare reports. Response to therapy with levodopa, dopa decarboxylase inhibitor, and trihexyphenidyl was dramatic. However, remission maintained for 12 months without medication suggests that the parkinsonism would have remitted spontaneously. In either case, this has not previously been reported with the western equine togavirus.
The concepts of balanced trimming and physiological shoeing of the equine hoof as a way to prevent asymmetrical weight bearing and related orthopedic problems are discussed in this paper. Suggestions are given for the technical training of the personnel involved. Considering the quantity and quality of the existing equine herd in Costa Rica, it is recommended to create a Farrier School as well as to coordinate the necessary efforts with other educational institutions related to the animal in...
The activity of equine growth puts many problems regarding the way of recognition, registration and valuation of equines as biological assets, but also regarding the way of calculation for the auction prices. Taking into consideration the ascendant trend of this sector, and also the diversification of its activities, accountancy faces new situations, which require to be solved in the conditions of the existent International Accounting Standards. In this respect, Romania came with certain impr...
Dalva Assunção Portari Mancini
Full Text Available Equines are susceptible to respiratory viruses such as influenza and parainfluenza. Respiratory diseases have adversely impacted economies all over the world. This study was intended to determine the presence of influenza and parainfluenza viruses in unvaccinated horses from some regions of the state of São Paulo, Brazil. Blood serum collected from 72 equines of different towns in this state was tested by hemagglutination inhibition test to detect antibodies for both viruses using the corresponding antigens. About 98.6% (71 and 97.2% (70 of the equines responded with antibody protective titers (≥ 80 HIU/25µL H7N7 and H3N8 subtypes of influenza A viruses, respectively. All horses (72 also responded with protective titers (≥ 80 HIU/25µL against the parainfluenza virus. The difference between mean antibody titers to H7N7 and H3N8 subtypes of influenza A viruses was not statistically significant (p > 0.05. The mean titers for influenza and parainfluenza viruses, on the other hand, showed a statistically significant difference (p < 0.001. These results indicate a better antibody response from equines to parainfluenza 3 virus than to the equine influenza viruses. No statistically significant differences in the responses against H7N7 and H3N8 subtypes of influenza A and parainfluenza 3 viruses were observed according to the gender (female, male or the age (≤ 2 to 20 years-old groups. This study provides evidence of the concomitant presence of two subtypes of the equine influenza A (H7N7 and H3N8 viruses and the parainfluenza 3 virus in equines in Brazil. Thus, it is advisable to vaccinate equines against these respiratory viruses.
Puchalski, Sarah M
Advances in equine computed tomography have been made as a result of improvements in software and hardware and an increasing body of knowledge. Contrast media can be administered intravascularly or intrathecally. Contrast media is useful to differentiate between tissues of similar density. Equine computed tomography can be used for many different clinical conditions, including lameness diagnosis, fracture identification and characterization, preoperative planning, and characterization of skull diseases. Copyright © 2012 Elsevier Inc. All rights reserved.
King, Melissa R
Hydrotherapy has become a key element within equine rehabilitation protocols and is used to address range of motion, proprioception, strength, neuromotor control, pain, and inflammation. Various forms of hydrotherapy can be tailored to the individual's injury and the expected return to athletic performance. This article describes the mechanisms of action of hydrotherapies and potential use in the clinical management of equine musculoskeletal injuries. Published by Elsevier Inc.
Krediet, R. T.; Zuyderhoudt, F. M.; Boeschoten, E. W.; Arisz, L.
The in situ intraperitoneal volume and the mass transfer area coefficients (MTC) of urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG were studied in eight continuous ambulatory peritoneal dialysis (CAPD) patients. All patients were studied during a 4-h
Igarashi, Yusuke; Morishita, Yoshiyuki; Yoshizawa, Hiromichi; Imai, Reika; Imai, Toshimi; Hirahara, Ichiro; Akimoto, Tetsu; Ookawara, Susumu; Ishibashi, Kenichi; Muto, Shigeaki; Nagata, Daisuke
Chronic inflammation of the peritoneum causes peritoneal injury in patients on peritoneal dialysis. Intercellular adhesion molecule-1 and its circulating form, soluble intercellular adhesion molecule-1, play pivotal roles in inflammation. However, their role in peritoneal injury is unclear. We measured changes in intercellular adhesion molecule-1 expression in the peritoneum of a peritoneal injury model in rats. The associations between soluble intercellular adhesion molecule-1 levels in drained dialysate and the solute transport rate (D/P-Cr and D/D0-glucose) determined by the peritoneal equilibration test, and matrix metalloproteinase-2 levels in drained dialysate were investigated in 94 peritoneal drained dialysate samples. Intercellular adhesion molecule-1 expression was increased in the peritoneum of rats with peritoneal injury. Soluble intercellular adhesion molecule-1 levels in drained dialysate were significantly positively correlated with D/P-Cr (r = .51, p molecule-1expression is increased in the peritoneum of a peritoneal injury model in the rat, and soluble intercellular adhesion molecule-1 levels in drained dialysate are associated with peritoneal injury in patients on peritoneal dialysis. These results suggest that soluble intercellular adhesion molecule-1 could be a novel biomarker of peritoneal injury in patients on peritoneal dialysis.
El-Reshaid, Wael; Al-Disawy, Hanan; Nassef, Hossameldeen; Alhelaly, Usama
Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.
Walther, Birgit; Janssen, Traute; Gehlen, Heidrun; Vincze, Szilvia; Borchers, Kerstin; Wieler, Lothar H; Barton, Ann Kristin; Lübke-Becker, Antina
With the rising importance of nosocomial infections in equine hospitals, increased efforts with regard to biosecurity and infection control are necessary. This even more since nosocomial infections are often associated with multi-drug resistant pathogens. Consequently, the implementation of targeted prevention programs is essential. Since nosocomial infections are usually multifactorial events, realization of only a single measure is rarely effective to overcome nosocomial spread in clinical practice. Equine patients may be colonized at admission with multi-drug resistant pathogens such as methicillin resistant Staphylococcus aureus (MRSA) and/or extended spectrum beta lactamase-producing (ESBL-) Enterobacteriaceae. Regardless of their individual resistance properties, these bacteria are common and usually unnoticed colonizers of either the nasopharynx or the intestinal tract. Also viral diseases caused by equine herpesvirus 1 (EHV-1) and EHV-4 may reach a clinic by patients which are latently infected or in the incubation period. To prevent nosocomal outbreaks, achieve an interruption in the infection chain and to eradicate infectious agents from the hospital environment, a professional hospital management is necessary. This should be adapted to both the wide range of pathogens causing nosocomial infections and the individual needs of equine patients. Amongst others, this approach includes a risk classification of equine patients at admission and information/enlightenment of the animal owners at discharge. An efficient management of inpatients, a targeted hygiene management and clear responsibilities with respect to biosecurity together with a surveillance of nosocomial infections form the cornerstone of infection control in equine hospitals.
Andoh, Kiyohiko; Hattori, Shiho; Mahmoud, Hassan Y A H; Takasugi, Maaya; Shimoda, Hiroshi; Bannai, Hiroshi; Tsujimura, Koji; Matsumura, Tomio; Kondo, Takashi; Kirisawa, Rikio; Mochizuki, Masami; Maeda, Ken
Equine herpesvirus type 1 (EHV-1) has haemagglutination (HA) activity toward equine red blood cells (RBCs), but the identity of its haemagglutinin is unknown. To identify the haemagglutinin of EHV-1, the major glycoproteins of EHV-1 were expressed in 293T cells, and the cells or cell lysates were mixed with equine RBCs. The results showed that only EHV-1 glycoprotein C (gC)-producing cells adsorbed equine RBCs, and that the lysate of EHV-1 gC-expressing cells agglutinated equine RBCs. EHV-1 lacking gC did not show HA activity. HA activity was inhibited by monoclonal antibodies (MAbs) specific for gC, but not by antibodies directed against other glycoproteins. In addition, HA activity was not inhibited by the addition of heparin. These results indicate that EHV-1 gC can bind equine RBCs irrespective of heparin, in contrast to other herpesvirus gC proteins. Copyright © 2014 Elsevier B.V. All rights reserved.
Nielsen, H; Espersen, F; Kharazmi, A
In a prospective study of intraperitoneal opsonins in 30 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), the IgG concentration, the fibronectin concentration, the specific antistaphylococcal antibody level, and the opsonic activity against Staphylococcus epidermidis were...... measured in peritoneal dialysis effluent from the initiation of CAPD and monthly for 6 months. Significant correlation was found between the four assays, but the interindividual and intraindividual variations were considerable. No statistically significant correlation was observed between susceptibility...... of the patients to CAPD-related infectious peritonitis and any of the above-mentioned parameters of humoral defense. We conclude that at the present time it is not feasible to use these assays for the establishment of prognosis with regard to peritonitis in CAPD....
El-Naggari, Mohamed; El Nour, Ibtisam; Al-Nabhani, Dana; Al Muharrmi, Zakaria; Gaafar, Heba; Abdelmogheth, Anas A W
Nocardia asteroides is a rare pathogen in peritoneal dialysis-related peritonitis. We report on a 13-year-old female with Nocardia asteroides peritonitis complicated by an intra-abdominal abscess. Linezolid was administered intravenously for 3 months and followed by oral therapy for an additional 5 months with close monitoring for adverse effects. The patient was discharged after 3 months of hospitalization on hemodialysis. The diagnosis and management of such cases can be problematic due to the slow growth and difficulty of identifying Nocardia species. The optimal duration of treatment for Nocardia peritonitis is not known. Linezolid can be used for prolonged periods in cases of trimethoprim/sulfamethoxazole-resistant cases with close monitoring for adverse effects. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
Johnson, David W.; Clayton, Philip; Cho, Yeoungjee; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen; Boudville, Neil; Wiggins, Kathryn J.; Bannister, Kym; Brown, Fiona
♦ Objective: Management of peritoneal dialysis (PD)-associated peritonitis requires timely intervention by experienced staff, which may not be uniformly available throughout the week. The aim of the present study was to examine the effects of weekend compared with weekday presentation on peritonitis outcomes. ♦ Methods: The study, which used data from the Australia and New Zealand Dialysis and Transplant Registry, included all Australian patients receiving PD between 1 October 2003 and 31 December 2008. The independent predictors of weekend presentation and subsequent peritonitis outcomes were assessed by multivariate logistic regression. ♦ Results: Peritonitis presentation rates were significantly lower on Saturdays [0.46 episodes per year; 95% confidence interval (CI): 0.42 to 0.49 episodes per year] and on Sundays (0.43 episodes per year; 95% CI: 0.40 to 0.47 episodes per year) than all other weekdays; they peaked on Mondays (0.76 episodes per year; 95% CI: 0.72 to 0.81 episodes per year). Weekend presentation with a first episode of peritonitis was independently associated with lower body mass index and residence less than 100 km away from the nearest PD unit. Patients presenting with peritonitis on the weekend were significantly more likely to be hospitalized [adjusted odds ratio (OR): 2.32; 95% CI: 1.85 to 2.90], although microbial profiles and empiric antimicrobial treatments were comparable between the weekend and weekday groups. Antimicrobial cure rates were also comparable (79% vs 79%, p = 0.9), with the exception of cure rates for culture-negative peritonitis, which were lower on the weekend (80% vs 88%, p = 0.047). Antifungal prophylaxis was less likely to be co-prescribed for first peritonitis episodes presenting on weekdays (OR: 0.68; 95% CI: 0.05 to 0.89). ♦ Conclusions: Patients on PD are less likely to present with peritonitis on the weekend. Nevertheless, the microbiology, treatment, and outcomes of weekend and weekday PD peritonitis
Choi, Hyuck Jae; Han, Joon Koo; Kim, Tae Kyoung; Kim, Ah Young; Lee, Joon Woo; Moon, Min Hoan; Yang, Han Kwang; Choi, Byung Ihn
To determine usefulness of spiral CT in the preoperative evaluation of peritoneal seeding from a gastric carcinoma. From a database of 411 consecutive patients with surgically proven advanced gastric cancinoma obtained over a six-month period, 17 with peritoneal seeding and a control group of 24 without peritoneal seeding underwent spiral CT scanning with 7-8 mm scan thickness and interval during the portal phase. Preoperative CT images were analyzed by two readers who reached a consensus with regard to the presence and location of the ascites, thickening of the parietal peritoneum, and changes in the omentum and mesentery. Ascites was present in 47% (8/17) of patients with peritoneal seeding the right subhepatic space (n=6, 35%) and right paracolic gutter (n=5, 29%)-but not the cul-de-sac (n=2, 12%)-were common sites of fluid collection. Permeative changes in the omentum and mesentery were seen in 18% (3/17) and 12% (2/17) of patients, respectively. Among five controls with false positive results, ascites in the cul-de-sac was present in three (two males and one female, 12%) while omental nodules and a thickened peritoneum were found in two (8%) and one (4%), respectively. In nine controls with false negative results, small disseminated nodules were seen in the mesentery and omentum at surgical field. The sensitivity and specificity of spiral CT were 47% (8/17) and 79% (19/24), respectively. In terms of sensitivity and specificity, spiral CT is not especially accurate in distinguishing peritoneal seeding from gastric carcinoma
Raquel Aparecida Sales da Cruz
Full Text Available ABSTRACT: Cryptococcus gattii is often associated with pulmonary and systemic infections in humans and animals. In this research we report a case of nasopharyngeal cryptococoma caused by C. gatti in an equine. A 10-year-old mare presented a mass obstructing the oropharynx. Macroscopically the mass was asymmetric, and was attached to the ethmoidal sinuses and obstructed the oropharynx. Histopathological examination of the mass revealed multiple yeast cells ranging from spherical to oval, 4-8μm in diameter, with some of them showing narrow base polar budding. Cryptococcus gattii growth in mycological culture (Sabouraud Dextrose Agar and was L-canavanine-glycine-bromothymol blue Agar positive. The molecular identification confirmed the isolate as C. gattii by means of the amplification of universal primers. C. gattii is considered an emerging fungal agent, as it affects human and animals and does not respond efficiently to commonly established treatments.