Peritoneal permeability and encapsulating peritonitis.
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Biomedical subjects
Publications and source records attributed to C Verger.
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When chick embryo fibroblasts were seeded in the presence of minimum essential medium supplemented with 1% (v/v) horse serum, the rate of cell attachment, after 1 hr incubation, was less than 5% at pH 6.5 and about 50% and 80% at pH 7.5 and pH 8.3, respectively. If, however, cultures were pretreated with fibronectin, a substance that promotes cell adhesion, a high rate of cell attachment was also observed at pH 6.5. Two other compounds of totally different chemical nature, cobalt-protoporphyrin (CoPP) and hemin, also enhanced cell attachment at pH 6.5. CoPP was shown to increase the synthesis of proteins, but it did not affect the intracellular heme content of cells incubated at pH 6.5. The possibility that CoPP, and presumably also hemin, induce cell attachment by promoting the synthesis of a fibronectin like protein is discussed.
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A retrospective survey has been undertaken in 7 different centers: 345 patients trained to CAPD between 1978 and 1983 were studied: technic success and survival rate were analysed using actuarial methods. Drop-out has dramatically decreased after May 1981 due to a lower mortality whatever the age. For all patients the actuarial survival at two years after 1981 is 87.1%. Related to a lower mortality, better results are obtained in patients younger than 55. However peritonitis is the main complication since they are involved in 1/3 of drop-out causes. It is concluded that CAPD might be used in almost 30% of chronic renal failure patients and that patients waiting for a kidney transplantation represent the best indication. In aged patients, nutritional status and psychosocial background must be carefully analysed before starting CAPD.
Thyroid hormone levels were measured in 12 patients on continuous ambulatory peritoneal dialysis and in 18 patients on haemodialysis, all in stable clinical status. Values in patients on peritoneal dialysis were not different from those found in controls, whereas a highly significant decrease in T3 and r T3 was observed in patients on haemodialysis. These results are in contrast with the low T3 syndrome and the high r T3 levels of systemic diseases and malnutrition. The difference between the two groups of patients on dialysis suggests that thyroid abnormalities do not result from renal failure alone, nor from malnutrition, but from a disturbance in the calorie/carbohydrate ratio of the ingesta.
The effects of hemin (Fe-protoporphyrin) and Co-protoporphyrin on cellular growth have been investigated principally in cultured fibroblasts, but also in myoblasts and hepatocytes from chick embryos. In the presence of horse serum in the culture medium, which by itself did not stimulate cell growth appreciably, Co-protoporphyrin stimulated cell attachment while hemin stimulated cell proliferation of fibroblasts. When Co-protoporphyrin and hemin were added together, the most potent stimulation of cell growth, consisting of increases in cell attachment and rapid cell proliferation, was observed. These findings indicate that the two metalloporphyrins have differential and complementary effects on cellular growth in culture, with synthetic Co-protoporphyrin principally affecting cellular attachment and Fe-protoporphyrin stimulating cellular proliferation.
Peritoneal clearance studies were performed in rats undergoing acute peritoneal dialysis. Some of these animals were then exposed to laparotomy and mechanical drying of the peritoneum. Peritoneal clearance studies were repeated at intervals up to 11 days. Another group of rats was placed on daily peritoneal dialysis and allowed to spontaneously develop peritonitis which was not treated. These rats underwent peritoneal transport studies at differing durations of infection. In all groups, animals were sacrificed at the time of the last transport studies for morphological assessment of the peritoneum by light microscopy, scanning electron microscopy, and transmission electron microscopy. The results showed similar decreases in drainage volume and increases in glucose absorption and protein losses with both infection and drying. Both types of injury resulted in extensive mesothelial structural changes. While drying caused mainly denudation of the mesothelial surface, infectious peritonitis was associated with separation of mesothelial cells, and the appearance of numerous white blood cells between and on mesothelial cells. Exposure to peritoneal dialysis alone had no obvious effects on anatomy. Although changes in the peritoneal microcirculation and deeper structures cannot be excluded as contributing to peritoneal transport alterations, the findings suggest that alterations of mesothelium might explain some of the changes in peritoneal transport properties under the conditions of these studies.
A new spectrofluorometric method for heme quantitation in cultured fibroblasts is described. The method includes: 1) heme extraction by methanol/sulfuric acid, 2) partial purification of heme by a microchromatographic method, and 3) treatment of the purified heme by oxalic acid followed by fluorometric quantitation. Using this method, heme concentration was determined in chick embryo fibroblasts cultured in a medium supplemented with either 7% fetal bovine serum (FBS) or 10% horse serum (HS). In the presence of FBS, cultured cells actively divided and cells contained 34-55 pmol heme/mg protein. In contrast, cultures maintained in HS proliferated at a slower rate and contained 23-25 pmol heme/mg protein. The addition of 40 microM FeSO4 to cultures maintained in the presence of HS stimulated cell proliferation, and the cellular heme concentration increased to 37-51 pmol/mg protein. These findings suggest that the cessation of growth in the presence of HS may be due to decreased heme content in the cells and that the stimulation of cell growth by iron is mediated by its stimulation of heme synthesis.
Normal and abnormal structure of the peritoneum is described in biopsies obtained from 15 cadavers and 13 patients on continuous ambulatory peritoneal dialysis (CAPD) at the onset of their treatment and after several months. In a few patients a loss of ultrafiltration due to a higher permeability of the peritoneum for glucose was observed. This hyperpermeability seems to be due to a patchy or total destruction of the mesothelium; it seems also to be dependent upon the thickness of the fibrous band separating capillaries from the peritoneal cavity. The endothelium of capillaries was normal in all the specimens examined.
Terminal chronic renal failure was discovered in a patient who had received CCNU 1 940 mg/m2 during the previous two years. The renal function was normal before treatment, and there was no evidence of other causes of renal failure. The clinical picture was identical with that observed in patients receiving such treatment and recently published. This case emphasizes the need for limiting the dose of nitrosyl-urea compounds to 1 200 mg/m2 and for monitoring the renal function very closely during and towards the end of the treatment.
Chick or bovine transferrin induces proliferation of chick embryo cells cultured in the presence of horse serum, which cannot itself assure their multiplication. Cell growth can also be induced by iron salts and iron complexes such as hemoglobin or hemin, but also by biliverdin which has no iron atom in its molecule.
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We have shown previously that hemoglobin greatly stimulates chick embryo cell proliferation in Eagle's minimal essential medium supplemented with horse serum. In the present study we compared the effects of horse serum plus 10 micrometers hemoglobin to those of fetal bovine serum on subcultures of chick embryo cells serially propagated at high cell densities. The cells became elongated in the presence of fetal bovine serum and their rate of proliferation progressively decreased, whereas they became polygonal in the presence of horse serum plus hemoglobin and proliferated well in successive cell passages. The polygonal cells obtained in the presence of horse serum plus hemoglobin rapidly elongated if cultured at low cell densities in the presence of fetal bovine serum, but, in contrast, elongated cells did not yield polygonal cells if cultured at low densities in the presence of horse serum plus hemoglobin. It is possible that the polygonal and elongated cells are undifferentiated cells and differentiating myogenic cells, respectively.
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