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Effect of vitamin E on peroxidation and permeability of the peritoneum.

Because of the evidence that peritoneal macrophages are activated during peritoneal dialysis, we hypothesised that the injury of the peritoneum is, at least in part, dependent on the intraperitoneal generation of free radicals. The aim of the study was to evaluate the effect of vitamin E on the peroxidation and permeability of the peritoneum during chronic peritoneal dialysis in rats. Supplementation of the intraperitoneally infused saline with vitamin E decreased the peroxidation of peritoneum estimated as the malondialdehyde (MDA) level in rats' omentum. However the permeability of the peritoneum to glucose and protein in vitamin E treated rats was increased. In in vitro study we have found that vitamin E is cytotoxic to human mesothelial cells (HMC) as measured by inhibition of their proliferation and this effect was irreversible. We conclude that vitamin E, despite its antioxidant effect, causes the changes of the peritoneum permeability which could decrease the effectiveness of peritoneal dialysis.

Animals↗

Closure versus non-closure of peritoneum at cesarean section--evaluation of pain. A randomized study.

OBJECTIVE: To evaluate the effects of leaving the parietal peritoneum open at lower segment cesarean section (LSCS) measured by postoperative pain. DESIGN: A randomized, prospective and double-blind study. SETTING: Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark. POPULATION: Forty women referred for an elective cesarean section were assigned to one of two groups: peritoneum open (n=21) or peritoneum closed (n=19). METHODS: Pain was evaluated twice a day from the first to the fifth postoperative day by Visual Analog Scales. MAIN OUTCOME MEASURES: Postoperative pain. Other outcomes include usage of analgesics, bowel function, postoperative complications, and hospital stay. RESULTS: We found no overall difference in postoperative pain. A tendency to less pain was found in the non-closure group from the third postoperative day to the fifth postoperative day. No differences were found either in the incidence of postoperative complications, or the time to return of bowel function. Concerning opiate analgesics the non-closure group had a significantly higher use in the second postoperative 24-hour period, but in the remains of the registration period it was significantly lower. For oral analgesics no difference was found in the first 24-hour period, but in the remains of the period the non-closure group had a significantly lower use. CONCLUSIONS: The VAS-scales showed no difference in postoperative pain comparing closure to non-closure of the parietal peritoneum. However, the use of analgesics is lower in the non-closure group. We suggest leaving the parietal peritoneum open when performing LSCS.

Adult↗

Effects of continuous ambulatory peritoneal dialysis and kidney transplantation on advanced glycation endproducts in the skin and peritoneum.

Advanced glycation endproducts (AGE) form as a result of non-enzymatic reaction of reducing sugars with proteins. Patients with chronic renal failure (CRF) have elevated AGE in plasma, skin and peritoneum. We measured AGE in the skin and peritoneum of individuals with CRF, patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and in renal transplant recipients (TR). Pentosidine concentration and collagen-linked fluorescence (CLF) were measured. Pentosidine and CLF correlated in all patient groups (CRF r=0.688, p<0.01; CAPD r=0.674, p<0.05; TR r=0.811, p<0.01). Successful kidney transplant reduced AGE levels in the skin (CRF 11.7 +/- 4.51 U/mg; TR 5.02 +/- 3.13 U/mg, p<0.00001) and peritoneum (CRF 17.5 +/- 6.16 U/mg, TR 9.4 +/- 4.97 U/mg, p<0.0001). However in contrast to the TR group, CLF in peritoneum increased following CAPD (CRF 17.5 +/- 6.16 U/mg; CAPD 24.2 +/- 10.4 U/mg; p=0.06). Our results suggest that AGE might be formed in the peritoneum during CAPD treatment.

Adolescent↗

A novel ex vivo method for assaying adhesion of cancer cells to the peritoneum.

A novel ex vivo method to determine the cell adhesion of cancer cells to the peritoneum was described. The wells of a microtiter plate were filled with cell suspension and sealed using mouse peritoneum. The peritoneum was fixed using a plastic cover and the plate was turned upside down and incubated for cell adhesion. After incubation for 80 min, the plate was centrifuged and non-adherent cells were assayed by MTT assay. Human cancer cells (MKN28, MKN45, MKN74, KM12C and KM12SM) adhered to the mouse peritoneum as well as cells from mouse (Colon26) and the ratio of cells attached to the peritoneum was estimated to be between 12.8 and 66.4%. This simple method could be useful to investigate the adhesion molecule associated with peritoneal dissemination.

Animals↗

[Disorders of the peritoneum].

The peritoneum is an important actor in diseases of the abdomen: defects of the peritoneum or mesos may lead to internal hernias; developmental anomalies of the peritoneum may lead to volvulus and bowel obstruction; diffuse or localized primary or secondary tumors of the peritoneum may develop; infectious, inflammatory or ischemic primary diseases of the peritoneum may cause abdominal pain, sepsis or result in the formation of fluid collections. The purpose of this presentation is to illustrate the role of imaging in the diagnosis of these different diseases and to provide some guidelines allowing their detection and characterization.

Hernia↗

Primary papillary serous carcinoma of the peritoneum: four cases and review of computed tomography findings.

Primary papillary serous carcinoma of the peritoneum is an uncommon primary malignancy of the peritoneum and is histologically indistinguishable from papillary serous carcinoma of the ovary. The diagnosis of primary peritoneal papillary serous carcinoma should be considered in the presence of peritoneal and omental masses in the absence of an ovarian mass. Although it has been extensively documented in the pathological and gynaecological oncology literature, the CT appearance of primary papillary serous carcinoma of the peritoneum has been reported in only 51 cases in five reports. We present four patients with CT findings of pathologically proven primary papillary serous carcinoma of the peritoneum. There were a total of 23 patients with a histopathologically proven diagnosis of primary papillary serous carcinoma of the peritoneum between 1980 and 2002 with CT imaging. However, only four of the 23 patients' CT films were retrieved for retrospective evaluation. The rest of the films were not available as either patients had misplaced the films or patients were deceased.

Aged↗

[Screening and identification of phage-displayed polypeptides specifically binding to human gastric cancer with high metastatic potential to peritoneum].

OBJECTIVE: By means of phage-display technique, to screen polypeptides that specifically bind to human gastric cancer with high metastatic potential to peritoneum. METHODS: Two human gastric cancer cell lines were used: GC9811-P with high metastatic potential to peritoneum and its wild type parental GC9811, to carry out subtractive screening with a phage display-12 peptide library. RESULTS: After three rounds of screening, 40 phage clones bond to GC9811-P cells were randomly selected. When injected into the peritoneal cavity of nude mice, 6 of the 40 clones did not bind to mouse peritoneum as examined by immunohistochemical staining. They were considered to be capable of binding specifically to GC9811-P cells. Sequence analysis revealed two different exogenous peptides: TLNINRLILPRT and SMSI(X)SPYI(XXX). CONCLUSION: Two peptides have been obtained that specifically bind to a gastric cancer cell variant GC9811-P, which easily disseminates to the peritoneum. Whether or not they could block GC9811-P metastasis to peritoneum in vivo remains to be determined.

Animals↗

Activated macrophages migrate to the subcutaneous tumor site via the peritoneum: a novel route of cell trafficking.

Spontaneous regression of AK-5 tumor in syngeneic hosts reported earlier involves the interplay of Th1-type cytokines and cell-mediated immunity. Upon subcutaneous transplantation of AK-5 cells, there was accumulation of immune cells in the peritoneum, of which macrophages were the predominant type and were found to be in a hyperactive state. They released macrophage-derived tumoricidal mediators like NO, O2(-), and ONOO(-) which exhibited potent cytotoxic activity against AK-5 cells in vitro. Interestingly, there was a dramatic disappearance of these hyperactive cells from the peritoneal cavity which correlated well with the onset of tumor regression at the subcutaneous site. Direct labeling of these cells in the peritoneum by the tracking dye PKH26 showed their migration to the tumor site. Similarly, frozen tumor sections when scanned under confocal microscope clearly exhibited fluorescent macrophages embedded into the tumor. Immunohistochemical sections of these intratumoral macrophages showed nitrotyrosine residues, indicating their contribution in the free-radical-mediated AK-5 cell death, thereby leading to successful tumor remission. These observations suggest a directional migration of the hyperactivated peritoneal population to the tumor site. We have also confirmed the influx of macrophages and other immune cells into the peritoneum after sc transplantation of Meth A tumor cells in Balb/c mice. Our studies suggest a role for the peritoneal compartment in imparting appropriate stimulus to the immune cells prior to their participation in the antitumor immune response. These studies suggest a novel route of macrophage trafficking via the peritoneum.

Animals↗

Role of rectosigmoidectomy and stripping of pelvic peritoneum in outcomes of patients with advanced ovarian cancer.

BACKGROUND: The peritoneum of the cul-de-sac is frequently affected in advanced ovarian cancer patients. Stripping of the pelvic peritoneum (SoP) combined with rectosigmoidectomy (RS) in patients with confluent tumor are safe techniques that can eradicate macroscopic disease. We evaluated the therapeutic value of this maximal surgical effort in advanced ovarian cancer. STUDY DESIGN: Data from all consecutive patients with stages IIIC and IV epithelial ovarian cancer, primarily operated on from 1994 through 1998, were collected and analyzed using the chi-square test, Cox regression analysis, and Kaplan-Meier curves including log-rank test. RESULTS: Two hundred forty-four eligible patients were identified; 209 patients had tumor involving the peritoneum of the cul-de-sac. For this subgroup, those who were managed with stripping of the peritoneum (SoP, n=77) or rectosigmoidectomy (RS, N=57) had improved 5-year overall survivals relative to those who were not (n=75). (SoP=37% versus RS=39% versus neither=6%; p < 0.0001). In the subgroup of patients with cul-de-sac involvement optimally cytoreduced, we noted a survival benefit for those who were managed with a maximal pelvic surgical effort (5-year overall survival, 38% [SoP] versus 38% [RS] versus 15% [neither]; p=0.02). When evaluating patients with no macroscopic residual disease, a survival advantage for patients managed with RS compared with SoP was observed (5-year overall survival, 89% (RS) versus 50% (RS); p=0.04). CONCLUSIONS: Surgical resection of cul-de-sac disease by SoP and RS is associated with improved survival in ovarian cancer patients. Tumor resection with en bloc RS may be preferable to allowing microscopic or infiltrative residual tumor.

Adult↗

Adhesion of endometrial cells labeled with 111Indium-tropolonate to peritoneum: a novel in vitro model to study endometriosis.

OBJECTIVE: To evaluate, in a new original in vitro assay, putative factors that could modulate the adhesion of endometrial cells to peritoneum. DESIGN: Prospective, controlled in vitro study. SETTING: Academic research laboratory. PATIENT(S): Fourteen nonmenopausal women undergoing hysterectomy or laparoscopy for benign gynecologic indication. INTERVENTION(S): Endometrial cells obtained from women with regular cycles without endometriosis were labeled with 111Indium and confronted in vitro with mouse peritoneum in the presence of various cytokines and/or antiadhesive compounds. MAIN OUTCOME MEASURE(S): Radioactivity in 111Indium-labeled endometrial cells. RESULT(S): The adhesion of human endometrial cells to mouse peritoneum was increased by treatment with pro-inflammatory cytokines (interleukin IL-1beta, IL-6, TNF alpha, TGF-beta1). Whereas heparan sulfate had no effect on cell adhesion, a gel of ferric hyaluronate (Intergel) was able to counteract the pro-adhesive effect of cytokines. Interestingly, the pretreatment of peritoneum with cytokines, 24 hours before cell seeding in the presence of the ferric hyaluronate gel, restored the cytokine-promoting effect on cell adhesion. CONCLUSION(S): Proinflammatory cytokines promote the in vitro peritoneal adhesion of endometrial cells. An antiadhesive hyaluronate gel used in clinics decreases the adhesion in a dose-dependent manner and reduces cytokine bioavailability.

Adult↗

Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study.

OBJECTIVE: To compare closure and nonclosure of the peritoneum at radical abdominal hysterectomy and pelvic node dissection with respect to postoperative morbidity. METHODS: Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned randomly to have a standard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed. Adjuvant radiotherapy was given to patients with risk factors. The postoperative incidence of lymphocysts (within 8 weeks from the operation and after 1 year) and infection-related and non-infection-related complications were analyzed. RESULTS: One hundred twenty subjects were enrolled, of whom 59 had peritoneal closure and 61 did not. Both groups were similar with regard to age, weight, nodes removed, nodal metastases, operative time, type of surgery, need for transfusion, and incidence of postoperative radiotherapy. The median follow-up was 36 months (range 11-72). Eleven patients died, four because of treatment-related complications. The amount of drainage was significantly higher in the closed group than in the unclosed group (median 740 mL, range 50-5980 versus median 340 mL, range 40-4000; P < .005). The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks (17 of 59 versus 15 of 6, respectively), at 8 weeks (eight of 56 versus ten of 61, respectively), and after 1 year (one of 21 versus four of 22, respectively). No difference was found between closed and open groups in terms of symptomatic lymphocysts (one of 59 versus two of 61, respectively), wound and pelvic infection (seven of 59 versus 11 of 61, respectively), febrile morbidity (two of 59 versus 11 of 61, respectively), and obstruction (zero of 59 versus one of 61, respectively). CONCLUSION: Nonclosure of the peritoneum at radical abdominal hysterectomy and node dissection is not hazardous and is not associated with an increased incidence of infection- or adhesion-related complications.

Adult↗

[Acute rupture of hydatid cysts in the peritoneum: 17 cases].

OBJECTIVE: Specify the clinical and progressive characteristics of acute rupture of hydatid cysts in the peritoneum. METHOD: We retrospectively studied patients who had undergone surgery for a hydatid cyst (HC) of the abdomen between January 1990 and December 2000 and in whom the exploration had confirmed the diagnosis of acute rupture of a hydatid cyst in the peritoneum. RESULTS: Over this period of 11 Years, 970 patients had undergone surgery for hydatid cysts of the liver and the spleen, 17 of whom had presented an acute rupture of the hydatid cyst in the peritoneum, that is to say 1.75% of the cases. The mean age was 30 Years and sex ratio was 0.41. Rupture was secondary to a trauma in 6 cases and to an intense physical effort in one case. The clinical table was acute peritonitis in 14 cases, acute intestinal occlusion in one case, suggested anaphylactic shock in one case, and a non-complicated hydatid cyst in one case. Ultra-sonographic diagnosis was made in all the cases, but that of rupture in 12 cases only. No scans were performed. Intervention was decided on within a delay of less than 72 hours in 16 cases. Surgical treatment consisted in the treatment of the peritonitis, the ruptured hydatid cyst, the associated hydatid cysts in the liver and the spleen, and the hydatid cyst of the right lung in two cases. Post-operative follow-up was complicated in 4 cases with two deaths through septic shock. Distant follow-up was marked by a secondary peritoneal hydatidosis in a patient whom has not benefited from medical treatment. The latter, based on albendazole, was prescribed in 6 patients with satisfying results and a mean follow-up of 32 months. CONCLUSION: The therapeutic progress has improved the prognosis of ruptured hydatid cysts in the peritoneum. Secondary peritoneal hydatidosis is fundamentally enhanced by the delay in diagnosis and treatment and the absence of medical treatment. The optimal strategy is to treat the patients at the non-complicated stage of the hydatid cyst and, above all, prevent the hydatid infestation.

Acute Disease↗

The ultrastructure of vesicle-containing cells and ER-cells of human peritoneum.

In 16 human specimens the mesothelial cells of the diaphragmatic peritoneum and the pelvic parietal peritoneum were observed by transmission electron microscopy and freeze fracture replica. There were two types of cells i.e. the vesicle-containing cells and ER-cells. The former were found only in the diaphragmatic peritoneum and contained numerous cytoplasmic vesicles. These vesicles could be alone or in clusters. The clustered vesicles were often fused to form large vacuoles which opened on the free surface of the cell, into the intercellular space, or through the basement membrane, or sometimes became secretory particles on the free surface of the cells. Some vesicles were also observed in the microvilli. The latter were only found in the pelvic parietal peritoneum and contained abundant endoplasmic reticulum. The vesicle-containing cells seemed to absorb the material from the peritoneal cavity. The ER-cells contained abundant endoplasmic reticulum and Golgi apparatus, and showed high synthetic activity, possibly related to the production of peritoneal fluid.

Adult↗

Randomized study of non-closure of peritoneum in lower segment cesarean section.

BACKGROUND: The advantages of non-closure of the visceral and parietal peritoneum at lower segment cesarean section seems to be evident but in the reports published so far, the number of patients studied has been relatively small and the follow-up periods short. It is obviously of value to reconfirm such important observation in several institutions and therefore, in 1991, we decided to study non-closure of the peritoneum in lower segment cesarean section in a large series of patients with long-term follow-up of at least one year. METHODS: A prospective randomized study of 361 patients undergoing lower segment cesarean section in a University Affiliated Hospital, Al-Ain, United Arab Emirates. The operative technique was randomized to include either non-closure of both visceral and parietal peritoneum (study group, n = 179) or closure of both layers (control group, n = 182). Patients were followed up according to a study protocol. The nursing staff and the obstetricians responsible for data collection were unaware as to which of the two groups the patients belonged to. Student-t test and Chi-square test were used for statistical analysis of the results, where appropriate, with a p < 0.05 considered probability level to reflect significant differences. RESULTS: Postoperative febrile morbidity and wound infection were significantly lower in the study group as compared to the control group (p < 0.001 and p < 0.05 respectively). The incidence of wound dehiscence, urinary tract infection and the time to opening of the bowels postoperatively were similar in the two groups. In the non-closure group, the average operating time was significantly shorter by 7.9 minutes (p < 0.01) and the hospital stay was one day less (p < 0.01). There were no patients with late postoperative complications or readmissions during 2-5 years of follow-up that could be attributed to complications associated with lower segment cesarean section. CONCLUSION: Non-closure of the visceral and parietal peritoneum at lower segment cesarean section is associated with fewer postoperative complications, is more cost effective and is simpler than the traditional operative technique of closing both peritoneal layers.

Adult↗

Visceral peritoneum is not essential for solute transport during peritoneal dialysis.

The importance of visceral peritoneum in determining transperitoneal solute exchange was studied by determining the influence of evisceration on diffusive solute transport during peritoneal dialysis. Three series of experiments were performed in anesthetized New Zealand White rabbits. Series 1 studies compared solute transport rates from eviscerated rabbits (N = 5) with those from sham-operated controls (N = 5). Series 2 studies compared solute transport rates from eviscerated (N = 6) and sham-operated rabbits (N = 5) with application of circumferential abdominal compression to control intraperitoneal pressure and presumably maximize dialysate-peritoneum contact. Series 3 studies compared solute transport rates from sham-operated rabbits (N = 4) with and without applied circumferential abdominal compression. Transperitoneal solute exchange of creatinine and FITC-labeled neutral dextran (15 to 40 A) was equally assessed by both the dialysate to plasma concentration ratio at the end of the exchange and the diffusive permeability-area product of the peritoneum. Evisceration reduced creatinine (P less than 0.001) and dextran (15 to 30 A, P less than 0.05) transport to approximately one quarter that of controls in series 1 rabbits. When circumferential abdominal compression was applied in series 2 rabbits, however, evisceration had no effect on peritoneal solute transport rates. Moreover, circumferential abdominal compression per se had no effect on solute exchange in series 3 experiments. These findings demonstrate that the influence of evisceration on peritoneal solute transport depends on the experimental conditions. These observations further demonstrate that visceral peritoneum is not essential for solute transport during peritoneal dialysis.

Animals↗

Immunohistochemical detection of advanced glycosylation end-products in the peritoneum and its possible pathophysiological role in CAPD.

It has recently been suggested that advanced glycosylation end-products (AGEs) are formed in the peritoneum in patients on CAPD. However, the exact location of AGE accumulation, the relation with the duration of CAPD and its pathophysiological role in CAPD remain unclear. If the peritoneum is glycosylated, it could bring about altered peritoneal function. Therefore, the aim of this study is to clarify the localization of AGEs in the peritoneum in accordance with the duration of CAPD and to examine its relation to the peritoneal permeability. Fifteen non-diabetic patients were divided into three groups (each 5 patients) on the basis of the mean duration (D) of CAPD (Group 1, D = 0 month; Group II, D = 34 months; Group III, D = 84 months). The AGE staining by monoclonal anti-AGE antibody in the peritoneum and the four-hour peritoneal equilibration test (PET) were compared among these groups. AGE was absent or found only weakly in Group I. However, in groups II and III, AGE was moderately or strongly positive especially in the vascular walls and it was dominant in group III. PET revealed that peritoneal permeability for glucose, creatinine, beta2-microglobulin and albumin was increased in Group II as compared to Group I, and it was further increased in Group III. The results of this study indicate that AGEs become dominantly accumulated in the vascular wall in accordance with the prolongation of CAPD treatment, and this might play some roles for the increased permeability of the peritoneal membrane in CAPD.

Adult↗

Aristolochic acid nephropathy and the peritoneum: Functional, structural, and molecular studies.

BACKGROUND: Aristolochic acid nephropathy (AAN) is a rapidly progressive interstitial nephropathy linked to the exposure to aristolochic acid (AA) and characterized by extensive fibrosis and urothelial atypia. Although the fibrotic process has been documented in extrarenal tissues, the involvement of the peritoneum, as well as the efficacy of peritoneal dialysis in AAN patients, remain uncertain. METHODS: The structure of the peritoneal membrane and the expression of basic fibroblast growth factor (bFGF), collagen type III, endothelial nitric oxide synthase (eNOS), and aquaporin-1 (AQP1) were investigated in peritoneal biopsies from an index AAN patient, four other AAN patients, four regular peritoneal dialysis patients, and two controls. Similar methods were used to investigate a rabbit model of AAN after intraperitoneal exposure to high-dose AA. AA-DNA adducts were screened by 32P-postlabeling analysis. RESULTS: The AAN patients had renal failure, renal fibrosis, and urothelial atypia. The peritoneum of AAN patients had a normal structure, lacked cellular atypia, and, in comparison with regular peritoneal dialysis patients and controls, did not show abnormal regulation of fibrotic and endothelial markers. Furthermore, specific AA-DNA adducts were not identified in the peritoneum of AAN patients. In contrast, AA-DNA adducts were detected in peritoneal and kidney tissues of all exposed rabbits, and one of them developed a malignant mesothelioma. CONCLUSION: These data demonstrate the lack of fibrotic and vascular alterations and the absence of cellular atypia in the peritoneum from AAN patients. Thus, peritoneal dialysis should not be discouraged in these patients. Nevertheless, studies in a rabbit model of high-dose AA exposure may suggest a potential risk of peritoneal malignancy.

Aged↗

Histochemical distribution and expression of aquaporin 1 in the peritoneum of patients undergoing peritoneal dialysis: relation to peritoneal transport.

BACKGROUND: Aquaporin 1 (AQP-1) channels have been claimed to be responsible for osmotically driven free-water movement across the peritoneal membrane. Data about AQP-1 expression and its location in the human peritoneum related to clinical findings concerning ultrafiltration (UF) and free-water transport are still lacking. METHODS: Fifty-seven peritoneal biopsy specimens obtained from peritoneal dialysis (PD) patients were investigated. AQP-1 expression was detected by means of immunohistochemistry and a semiquantitative scoring system. Histological findings were related to peritoneal transport properties measured by means of an extended peritoneal equilibration test (PET) using dextran 70 as a volume marker. RESULTS: AQP-1 expression in the peritoneum was detected in both vascular endothelial cells (capillaries and small venules; score, 2.96 +/- 0.92) and the mesothelial cell layer (score, 2.31 +/- 1.54). There was significantly greater AQP-1 expression in vascular endothelial cells of patients showing increased thickness of the submesothelial fibrous layer of the peritoneum greater than 400 microm compared with less than 400 microm. Free-water transport through AQP-1 was 42% +/- 12% from total UF after 1 hour. There was a significant correlation between AQP-1 expression and free-water transport after 1 hour of equilibration with 3.86% glucose in the PET (r = 0.753; P < 0.001). CONCLUSION: Our data indicate that AQP-1 is located not only in the endothelial cell layer of capillaries and small vessels in the peritoneum of PD patients, but also in the mesothelial cell layer. AQP-1 expression correlated with free-water transport after 1 hour of equilibration, reaching a significant part from total UF at this time.

Adult↗