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PubMed2006

Inhibition by mercuric chloride of aquaporin-1 in the parietal sheep peritoneum: an electrophysiologic study.

The peritoneal mesothelium is a barrier to ion transport in peritoneal dialysis. In this study, we used Ussing-chamber experiments to investigate the effect of HgCl2, an aquaporin-1 inhibitor, on the transmesothelial electrical resistance (RTM) of isolated sheep parietal peritoneum. Peritoneal samples from the diaphragm of adult sheep were isolated immediately after the death of the animal and were transferred within 30 minutes to the laboratory in a cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O(2)/5% CO2. A planar sheet of the parietal peritoneum was mounted in an Ussing-type chamber and HgCl2 (10(-4) mol/L) was added apically or basolaterally. The RTM was measured before and serially after the addition of the HgCl2. The entire experimental apparatus was held at 37 degrees C, because active ion transport is temperature-dependent. The results presented are the mean +/- standard error of 12 experiments. The control RTM (that is, before the addition of HgCl) was 19.3 +/- 0.38 omega x cm2. Addition of HgCl2 apically induced a decrease in the RTM to 16.25 +/- 0.86 omega x cm2 within 1 minute. When added basolaterally, HgCl2 action was similar, with a rapid reduction in the RTM to 18.1 +/- 0.51 omega x cm2 (p < 0.05). A clear association between the RTM and the active transmesothelial ion transport was shown in previous studies. In the present study, rapid action of HgCl2 on the permeability ofthe parietal peritoneum was observed, resulting in a reduction in the RTM Taken together, these findings indicate that inhibition of aquaporin-1 alters the ionic permeability of the parietal peritoneal membrane.

Animals↗
PubMed1991

A randomized study of closure of the peritoneum at cesarean delivery.

This study was conducted to test the hypothesis that nonclosure of the visceral and parietal peritoneum during low transverse cervical cesarean delivery is not associated with increased intraoperative or immediate postoperative complications. One hundred thirteen patients scheduled for low transverse cervical cesarean were randomized to either closure of both the visceral and parietal peritoneum with absorbable suture (N = 59) or no peritoneal closure (N = 54). Patients were cared for in the usual postoperative manner without reference to treatment group. There were no demographic differences between the groups and no differences in method(s) of anesthesia, operative indication(s), or use of peripartum epidural narcotics. The incidence of fever, endometritis, or wound infection was similar between groups. There were no differences in the number of patients requiring parenteral narcotic analgesia or in the number of doses per patient. The number of oral analgesic doses was significantly greater with closure than without (P = .014). The frequency with which postoperative ileus was diagnosed in each group was similar, and there was no difference regarding the day on which patients were advanced to liquid or select diets. Bowel stimulants were administered more frequently to the closure than to non-closure patients (P = .03). The average operating time was shorter for the open group than for the closure group (P less than .005). We conclude that non-closure of the visceral and parietal peritoneum at low transverse cervical cesarean delivery appears to have no adverse effect on immediate postoperative recovery, may decrease postoperative narcotic requirements, allows less complicated return of bowel function, and provides a simplified and shorter surgical procedure.

Adult↗
PubMedDate not supplied

Prostaglandin F2 alpha and E2 release by peritoneum with and without endometriosis.

Peritoneal endometriotic implants and adjacent normal peritoneum from five patients were analyzed for prostaglandin (PG) release. Each tissue biopsy was incubated using medium 199 in triplicate at 37 degrees C for six hours, and PGF2 alpha and PGE2 concentrations were measured in the incubation medium every two hours. This study demonstrates that peritoneum involved with endometriosis releases significantly more PGF2 alpha and PGE2 (P less than .05) than adjacent normal peritoneum, and suggests that peritoneal endometriotic implants may be a source of the elevated peritoneal fluid PG levels previously reported in patients with endometriosis.

Analysis of Variance↗
PubMed1984

[Action of low-frequency ultrasound on the peritoneum, peritoneal exudate cells and the course of experimental peritonitis].

The authors studied the action of low-frequency ultrasound on rat and guinea-pig peritoneal exudate cells during aseptic peritonitis, on the intact peritoneum of these animals, and on experimental peritonitis in guinea-pigs. It was shown that ultrasound "hammers in" India ink solutions and antibacterial drugs into the peritoneum and in combination with antibiotics, it increases the guinea-pig survival rate in peritonitis. Ultrasound was not found to produce a direct bactericidal effect in vivo. Exposure of peritoneal exudate to ultrasound (1 s/cm2) demonstrated an increase in chemotaxis of neutrophil leukocytes to autologic serum and appreciable phagocytic activity. A longer exposure (up to 3-5 s/cm2 or 6-8 s/cm2) resulted in the partial damage to the peritoneum. Leukocytes, mesotheliocytes and subperitoneal striated muscles were found to be especially sensitive to ultrasound.

Animals↗
PubMed1981

[Kanamycin deposition in the peritoneum as affected by dimexide].

The effect of dimexid (dimethylsulfoxide) on kanamycin absorption from the peritoneum was studied on normal albino rats with aseptic peritonitis. Contrary to the present opinion that the rate of various drug absorption into the blood increases under the effect of dimexid, it was shown that intraperitoneal administration of dimexid and kanamycin resulted in deposition of kanamycin in the peritoneum followed by its slow liberation into the blood channel. The concentration of kanamycin in the peritoneum increased 3--8 times under the effect of dimexid, thus prolonging its retention time by 10--13 hours. The depositing effect was more pronounced in the animals with peritonitis.

Absorption↗
PubMed1981

Biopsy of the peritoneum in decompensated cirrhosis of the liver.

Fifteen patients with noninfectious chronic ascites due to liver cirrhosis were investigated by laparoscopy and/or peritoneal biopsy. Laparoscopic inspection revealed thickening of the peritoneum, diffuse patchy redness and diffusely increased small vascular injection. Biopsies of the parietal peritoneum showed cuboidal transformation and hyperplasia of the mesothelial cells, fibrinoid depositions, fibroblastic proliferation and mononuclear cell infiltration. Probable pathogenesis of the parietal chronic nonspecific peritonitis in ascites of liver cirrhosis is the presence of irritating substances in the ascitic fluid. Diffuse small vascular injection of the peritoneum reflects most likely the inflammatory nature of the peritoneal process and not a direct influence of portal hypertension.

Ascites↗
PubMed1993

Pedicle grafts of peritoneum and transversalis muscle for the repair of large defects in the duodenal wall.

OBJECTIVE: To find out if pedicle grafts of peritoneum and transversalis muscle could be used to repair large defects in the wall of the duodenum. DESIGN: Experimental study. MATERIAL: 18 healthy mongrel dogs. INTERVENTIONS: Defects were created in the second part of duodenum and repaired with pedicle grafts of peritoneum and transversalis muscle from the anterior wall of the right side of the abdomen. MAIN OUTCOME MEASURES: Postoperative complications, appearances on upper gastrointestinal radiography two and four months after operation, and histological examination of necropsy specimens. RESULTS: There were no postoperative deaths or complications. Radiographs of the duodenum showed no abnormalities and in particular no signs of obstruction. Animals were killed at intervals from one week to eight months after operation, and the only abnormality was 20-30% stenosis found in five dogs killed within two months of operation, which did not affect gastric emptying. Histological examination showed that by four months after operation the patch was completely covered by neomucosa that was similar to normal duodenal mucosa. By six months the site of the defect was well healed and the histological appearance was the same as at four months. CONCLUSION: Pedicle grafts of peritoneum and transversalis muscle may be useful in the treatment of patients with large defects in the wall of the duodenum.

Abdominal Muscles↗
PubMedDate not supplied

Vena cava replacement with a peritoneum-lined vascular graft.

The use of the peritoneum as a venous conduit was analyzed because of the inherent fibrinolytic properties of the mesothelium. A canine model in which the infrarenal inferior vena cava was replaced with interposition grafts (2 cm) of either a peritoneal tube, polytetrafluoroethylene (PTFE), or PTFE lined with peritoneum (lined graft) was studied. Venograms were performed 1 and 6 weeks after graft implantation for the percent area reduction of the lumen. Grafts were explanted at 6 weeks for light and scanning electron microscopy. The percent area reduction at 1 week for all grafts was found to be predictive of graft clotting by 6 weeks. At 6 weeks, one of three peritoneal tube grafts (33%), six of seven PTFE grafts (86%), and four of seven lined grafts (57%) were patent. Histologic studies demonstrated that stenosis of PTFE grafts was due to intraluminal thrombus formation, whereas lined grafts stenosed due to granulation tissue growth between the mesothelium and PTFE. A cellular circumferential intraluminal lining was found in four of four lined grafts, but in none of six PTFE grafts (p < 0.01). Furthermore, none of four lined grafts had intraluminal thrombus, but all of six PTFE grafts did (p < 0.01). Peritoneum-lined PTFE grafts maintain a continuous circumferential cellular lining, but have no improvement in short-term patency compared to PTFE alone.

Analysis of Variance↗
PubMedDate not supplied

Ultrastructure, distribution, and density of lamellar bodies in human peritoneum.

OBJECTIVE: To determine the ultrastructure, relative density, and location of lamellar bodies in the various regions, structures, cells, and intercellular matrix in normal human peritoneum; to carry out engineering analysis of the role of lamellar structures in serosal lubricancy and deduce what effect this system may have on the process of peritoneal dialysis. DESIGN: Five samples of normal human parietal peritoneum obtained at elective operation were fixed in a tannic acid-glutaraldehyde mixture and submitted to examination by transmission electron microscopy. Detailed analysis using reconstruction of serial electron micrographs and tracings of montages were employed in determining location, disposition, density, and geometric patterns of lamellar bodies in all levels of the peritoneal membrane. RESULTS: Lamellar profiles were found in greatest density enmeshed in surface microvilli and in mesothelial cytoplasm. Lamellar bodies were frequently observed capping the external portion of mesothelial junctional complexes, and within intercellular junctions. Lamellar bodies were also encountered in macrophages, both in the peritoneal cavity and submesothelial tissue, and also in fibroblasts. Lamellar bodies were present in low density in the matrix ground substance of submesothelial connective tissue, in blood vessel walls between smooth muscle, in endothelial cell cytoplasm, and in vascular lumina. CONCLUSION: Three-dimensional analysis of lamellae on mesothelial surfaces indicates that an arrangement of constantly changing microscopic spheres and cylinders would act as "ball and roller bearings" among the microvilli for the lubrication of opposing surfaces. The entrapment of fluid in lamellar bubbles, which in normal peritoneum fill the microvillous layer, would, if maintained in peritoneal dialysis, constitute a stagnant layer of considerable stability and inertia.

Biomechanical Phenomena↗
PubMed1996

[Peritoneum as a dialysis membrane. I. Physiology].

The interest in structure and function of peritoneum increased when it turned out that it may be used as biologic dialysis membrane. The structure of peritoneum is of significant value in the course of peritoneal dialysis. The role of the mesothelium, the interstitium, blood and lymphatic capillaries, major constituents of peritoneum, have been deeply studied. Moreover, it is well known that process of dialysis influence the structure and function of different peritoneal elements. Having more date about physiological structure of these elements, and making conditions of peritoneal dialysis more physiologic might be crucial factors to reduce the amount of complications, and increase the usefulness of this method of treatment. This article is the first of two parts and discusses the peritoneal structure in physiologic conditions and in conditions of peritoneal dialysis.

Epithelium↗
PubMedDate not supplied

Ultrastructure, distribution, and density of lamellar bodies in human peritoneum.

OBJECTIVE: To determine the ultrastructure, relative density, and location of lamellar bodies in the various regions, structures, cells, and intercellular matrix in normal human peritoneum; to carry out engineering analysis of the role of lamellar structures in serosal lubricancy and deduce what effect this system may have on the process of peritoneal dialysis. DESIGN: Five samples of normal human parietal peritoneum obtained at elective operation were fixed in a tannic acid-glutaraldehyde mixture and submitted to examination by transmission electron microscopy. Detailed analysis using reconstruction of serial electron micrographs and tracings of montages were employed in determining location, and disposition, density, and geometric patterns of lamellar bodies in all levels of the peritoneal membrane. RESULTS: Lamellar profiles were found in greatest density enmeshed in surface microvilli and in mesothelial cytoplasm. Lamellar bodies were frequently observed capping the external portion of mesothelial junctional complexes, and within intercellular junctions. Lamellar bodies were also encountered in macrophages, both in the peritoneal cavity and submesothelial tissue, and also in fibroblasts. Lamellar bodies were present in low density in the matrix ground substance of submesothelial connective tissue, in blood vessel walls between smooth muscle, in endothelial cell cytoplasm, and in vascular lumina. CONCLUSIONS: Three-dimensional analysis of lamellae on mesothelial surfaces indicates that an arrangement of constantly changing microscopic spheres and cylinders would act at "ball and roller bearings" among the microvilli for the lubrication of opposing surfaces. The entrapment of fluid in lamellar bubbles, which in normal peritoneum fill the microvillous layer, would, if maintained in peritoneal dialysis, constitute a stagnant layer of considerable stability and inertia.

Absorption↗
PubMedDate not supplied

Limitation of small-solute exchange across the visceral peritoneum: effects of vibration.

OBJECTIVE: To evaluate the importance of the peritoneal membrane diffusion resistances to small solutes prevailing outside the capillaries in the visceral versus the parietal peritoneum during acute peritoneal dialysis (PD). DESIGN: Experimental study in anesthetized Wistar rats undergoing PD in a single exchange (120 min) using 1.36% Dianeal as dialysis fluid. Vibration, using a standard laboratory shaker at 10 Hz, was used to induce dialysate mixing and reduce the impact of "unstirred layers" in intact and eviscerated rats. Nonvibrated rats served as controls. MEASUREMENTS: The mass transfer area coefficient (PS) for chromium 51-ethylenediamine tetraacetic acid (51 Cr-EDTA), continuously infused intravenously, the plasma-to-peritoneal clearance (Cl-->D) of radioiodinated (125I) serum albumin (human)(RISA), as well as the total clearance out of the peritoneal cavity (Cl) of Evans blue labeled albumin, given as an intraperitoneal volume marker, and the portion of this Cl reaching the plasma per unit time (Cl-->P) were assessed. RESULTS: In intact rats there was a marked increase in PS for 51 Cr-EDTA, from 0.297 +/- 0.036 mL/min to 0.642 +/- 0.122 mL/min (n = 7, p < 0.01), and a moderate increase in Cl and Cl-->D, from 37.6 +/- 1.3 microL/min to 63.3 +/- 9.0 microL/min and from 6.04 +/- 0.51 microL/min to 9.54 +/- 0.93 microL/min (n = 7, p < 0.05), respectively, upon vibration. However, the plasma absorption clearance of albumin (Cl-->P) was unchanged after vibration. Furthermore, in eviscerated rats, vibration caused no significant changes in either of the exchange parameters measured. CONCLUSION: In conclusion, the visceral peritoneal transport of small solutes is normally limited by the presence of diffusion resistance outside the capillaries, which may be markedly reduced by "stirring" of the dialysate by vibration. Normally, the parietal, rather than the visceral, peritoneum is the major site for small-solute mass transfer in stationary animals. However, the visceral peritoneum apparently becomes increasingly important after stirring. The moderate increases in transperitoneal clearances of macromolecules occurring upon vibration, which were quite unexpected, indicate that vibration may also increase the dialysate/peritoneal membrane contact and/or cause some recruitment of capillaries.

Animals↗
PubMed1996

[Functional aspects of topographic differentiation in the peritoneum].

Volumetric measurements have been performed in vitro to define permeability for water of different parts of peritoneum. The experiments were carried out on isolated fragments of rabbit mesentery, anterior abdominal wall, and diaphragm; mesothelial layer lining these membranes was retained in one group, whereas in another one it was intentionally desquamated. The membranes were mounted between two semichambers filled with Hanks solution; the volume on both sides of the membrane was strictly controlled by photo-gauges coupled with microdosi-meters. Transmembrane volume flow (Jv; nL/sec cm2) induced by hydrostatic pressure gradient (delta P; atm) was measured using an electronic device connected with the photo-gauges, and joined with a computer which monitored the values throughout the experiment. Hydraulic conductivity (Lp; in cm/sec atm) and index of impediment (Zp; in sec atm/cm) were calculated from the monitored values. Significant differences between the three types of peritoneal membrane were observed: the hydraulic conductivity of diaphragm was lowest, and the impediment highest (0.86 +/- 0.11 x 10(-2) and 116.3 +/- 12.2, respectively) contrasting with the corresponding values of mesentery which were highest, and lowest (38.9 +/- 3.7 x 10(-2), and 2.57 +/- 0.25, resp.); peritoneum taken from anterior abdominal wall showed intermediate values (6.3 +/- 0.56 x 10(-2), and 15.9 +/- 1.5, resp.). Removal of mesothelium induced significant increase of the permeability of diaphragm and anterior abdominal wall, however, no such effect was observed in mesentery. The obtained results seem to show that various parts of peritoneum may function qualitatively different during dialysis, however, any conclusion concerning clinical aspects of the dialysis should be drawn with all proper reserves.

Abdominal Muscles↗
PubMed1997

[Morphologic parameters for quantitative determination of inflammatory activity of the peritoneum].

The morphology of the inflammatory activity of the peritoneum has been measured qualitatively but quantitative assessments are not common. In a standardized rat model we induced chronic abscess-forming peritonitis after laparotomy and inoculation of 2 ml Bacteroides fragilis suspension at a concentration of 10(9)/ml colony-forming units. The morphological inflammatory activity was determined quantitatively by staining the specimen of the peritoneum with naphthol-AS-D-chloracetate-esterase (NASDCE); through this staining the cytoplasm of granulocytes and tissue mast cells were marked. The peritonitis group (n = 53) and controls (n = 15) were randomly divided into three subgroups (nPeritonitis = 17/18/18 vs. ncontrol = 5/5/5) and observed for 3/7/14 days, respectively. On days 3/7/14 we diagnosed intra-abdominal abscesses in 2 of 17, 13 of 18, and 12 of 18 animals in the peritonitis group. In controls there were no abscesses (P < 0.05). The total cellularity and NASDCE-positive rates on days 3/7/14 in the peritonitis group were 301/409/280 (vs. 155/240/273 in controls) and 1.8/2.9/3.6% (vs. 0.7/0.9/1.4%) in the non-abscess-forming regions and 392/661/625 and 14.4/12.9/11.5% in the abscess-surrounding regions in the infected animals, respectively (P < 0.05). We conclude that the qualitative histological evidence of the morphological inflammatory activity of the peritoneum in the form of an abscess can be supplemented by a quantitative method. Through NASDCE staining the granulocyte and tissue mast cell proportion of the total cellularity as main indicators of the local inflammatory activity can be estimated in peritonitis. This method can be helpful in deciding when to definitively close the abdomen in the course of a programmed lavage treatment in peritonitis.

Abdominal Abscess↗
PubMed1996

Concomitant malignant mesothelioma of the pleura, peritoneum, and tunica vaginalis testis.

We describe the cytohistological, immunohistochemical and ultrastructural findings in a 55-yr-old-man with history of asbestos exposure and diffuse malignant mesothelioma (DMM) of the pleura, peritoneum, and tunica vaginalis presenting with chest pain and scrotal swelling. Pleural fine-needle aspiration (FNA) revealed mesenchymal elements and spindle-shaped epithelial-like cells, while biopsy showed pure sarcomatous tumor invading lung parenchymal. In both samples tumor cells coexpressed cytokeratin and vimentin. Peritoneal and hydrocele effusions contained aggregates of malignant mesothelial cells. Electron microscopy showed intermediate filaments, rare desmosomes and sparse microvilli. Morphological findings were consistent with a DMM, with a biphasic pattern in the pleura and an epithelial one in the peritoneum and tunica vaginalis. Although the possibility of a multicentric origin cannot be ruled out, clinical chronologic sequence suggests that the pleura was the primary involved site, followed by spread to peritoneum and tunica vaginalis.

Asbestos↗
PubMed1982

Cystic mesothelioma of the peritoneum: a report of five cases and review of the literature.

Five cases of the recently characterized cystic mesothelioma of the peritoneum are presented. The patients, all women, ranged in age from 23-50, and were seen with large, solitary or multiple, multicystic masses involving the abdominal and pelvic peritoneum. Histologically, they consisted of interconnecting cystic cavities lined by a single layer of flattened to cuboidal cells with variable nuclear atypia. These cells in one case showed ultrastructural features consistent with mesothelial origin. In follow-up periods ranging from 1-13 years, two patients have had recurrence of disease, but all patients are still alive. When these cases are combined with the ten previously reported, the recurrence rate in patients followed for two years or more is 50% (four of eight). This lesion may represent a clinically "borderline" variant between the better known benign (adenomatoid tumor) and malignant mesotheliomas of the peritoneum.

Adult↗
PubMed1995

Papillary serous carcinoma of the peritoneum in women. A clinicopathologic and immunohistochemical study.

BACKGROUND: Papillary serous carcinoma of the peritoneum (PSCP) is a primary peritoneal tumor in women that histologically resembles papillary serous carcinoma of the ovary (PSCO). Recognition of PSCP as an entity is controversial, as is the histogenesis, histopathologic differential diagnosis, and treatment. METHODS: Ten cases of PSCP retrieved from the pathology files of 4 hospitals in Kyoto and Nara, Japan, were studied clinicopathologically and immunohistochemically. RESULTS: Patient ages at presentation ranged from 40 to 74 years (median, 56 years). All patients were Asian (Japanese). None of the patients had a history of asbestos exposure. Most of the patients had abdominal swelling, ascites with positive cytology, and elevated serum CA125. At surgery, omental tumors with dissemination to the abdominal and pelvic peritoneum were found in all patients. The histology was similar to that of Grade 2 to 3 PSCO. Immunohistochemical studies using a panel of monoclonal antibodies against carbohydrates showed that Lewis Y is a good marker, in addition to S-100, placental alkaline phosphatase, CA125, and CD15 for separating PSCP from malignant mesothelioma (MM). With cytoreductive surgery and cisplatin-based combination chemotherapy and in some cases adoptive immunotherapy and radiation, a median survival of 27 months and a 5-year survival rate of 27% were attained. One patient with Grade 3 tumor has survived for more than 6 years after surgery. CONCLUSIONS: (1) Papillary serous carcinoma of the peritoneum is a definite clinicopathologic entity; (2) immunohistochemistry is a useful tool for distinguishing PSCP from MM; (3) cytoreductive surgery and cisplatin-based combination chemotherapy with other adjunct therapies such as immunotherapy and radiation may improve patient survival in PSCP.

Adult↗
PubMed1990

Tissue reactivity and degradation patterns of absorbable vascular ligating clips implanted in peritoneum and rectus fascia.

Absorbable vascular ligating clips are finding increasing use in intraabdominal surgery. We report the results of a light and scanning electron microscope investigation of the tissue reactivity and clip degradation patterns of two such materials, Absolok (polydioxanone) and Lactomer (copolymer of glycolic and lactic acid), implanted in the fascia and peritoneum of rabbits for intervals of 2 to 70 days. Cellular response to the clips, defined as the number of inflammatory cells/10(4) microns 2, was maximum at day 4 postimplantation, then gradually declined as the duration of implantation increased. This pattern, seen with both types of clips, was similar to that seen with polydioxanone (PDS) suture, but significantly greater than that associated with polypropylene (Prolene) suture. Although cellular response to the clips was greater in peritoneum than in fascia, especially on two occasions associated with adhesion formation, this was not statistically significant. Based on our morphological observations, the signs of clip degradation which were indicated by the appearance of surface crazing and cracks occurred earlier in peritoneum than in fascia.

Abdomen↗