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At least 163 records · Page 9Linked to original sources
PubMed1998

The T pouch: an orthotopic ileal neobladder incorporating a serosal lined ileal antireflux technique.

PURPOSE: At our institution the Kock ileal neobladder has been the primary form of urinary diversion after cystectomy. The few associated complications are primarily related to the intussuscepted antireflux afferent limb, including stones, stenosis and extussusception of the afferent nipple. We present a novel orthotopic ileal neobladder, the T pouch, with an innovative antireflux technique designed to prevent complications of the intussuscepted afferent nipple. MATERIAL AND METHODS: From November 1996 through August 1997, 40 patients an average of 67 years old underwent construction of an orthotopic ileal neobladder (T pouch). Mean followup is 10.5 months (range 8 to 14). The T pouch incorporates an antireflux mechanism using a serosal lined ileal tunnel technique. Urinary reflux is prevented without ileal intussusception and with complete preservation of the blood supply to the afferent ileal segment. Followup in all cases includes clinical and functional results, and radiographic evaluation of the urinary reservoir and upper urinary tracts. RESULTS: One perioperative death (2.5%) and 5 early complications (12.5%) were unrelated to urinary diversion. There have been no late complications. All T pouch reservoirs had excellent capacity without evidence of urinary reflux. The upper urinary tracts remain unchanged or improved in all patients. CONCLUSIONS: The T pouch is an orthotopic ileal neobladder that incorporates an effective, innovative antireflux mechanism created by a serosal lined ileal tunnel. Early clinical and functional results of this type of urinary diversion have been excellent. Furthermore, we suspect that this antireflux technique may eliminate the complications associated with an intussuscepted afferent nipple and maintain an effective antireflux mechanism.

Adult↗
PubMed1994

Intraperitoneal adjuvant immunochemotherapy in operable gastric cancer with serosal involvement.

Since the peritoneal cavity is the most common site of initial recurrence in patients after surgery for gastric cancer, an intraperitoneal (IP) adjuvant treatment was tested in patients with resected gastric cancer with serosal involvement. Between March 1986 and September 1991, 44 consecutive patients with resected T3/T4-N0/N+ gastric cancer were given an IP combination, including cisplatin or carboplatin, etoposide, and alpha interferon-2b. The overall survival of these patients was compared with that observed in 47 historical controls (admitted to the same institutions from 1983 to 1986) with similar prognostic characteristics, who had not received adjuvant treatment after surgery. No major complication relating to the IP route was observed. Mild to moderate abdominal pain occurred in nine patients. Grade 3-4 myelotoxicity occurred in 14 patients. Interferon had to be reduced in five patients and suspended in one because of severe fatigue. Emesis occurred in 23/28 patients given cisplatin and 9/16 given carboplatin. At the time of this analysis (September 1992) median follow-up was 42 months (range 12-78) in the group receiving IP treatment, and 97 months (range 74-128) in the historical controls. There had been 20 deaths among treated patients compared with 36 in the control group. The 5-year estimated survival rate was significantly better in the patients who received IP adjuvant treatment (44% +/- 9 versus 23% +/- 6; P = 0.016). Using the Cox proportional hazard model with a backward procedure to correct for the influence of prognostic pretreatment variables, IP treatment again afforded a significant advantage in terms of survival (P = 0.04). Adjuvant IP immunochemotherapy appears to improve prognosis compared with historical controls in patients having operable gastric cancer with serosal infiltration.

Adult↗
PubMed1994

Mouse bone marrow-derived mast cells (mBMMC) obtained in vitro from mice that are mast cell-deficient in vivo express the same panel of granule proteases as mBMMC and serosal mast cells from their normal littermates.

The ear, skin, and purified serosal mast cells of WBB6F1/J-(+/+) (WB-(+/+)) and WCB6F1/J-(+/+) (WC-(+/+)) mice contain high steady-state levels of the transcripts that encode mouse mast cell protease (mMCP) 2, mMCP-4, mMCP-5, mMCP-6, and mouse mast cell carboxypeptidase A (mMC-CPA). In contrast, no mast cell protease transcripts are present in abundance in the ear and skin of WBB6F1/J-W/Wv (W/Wv) and WCB6F1/J-Sl/Sld (Sl/Sld) mice which are mast cell-deficient in vivo due to defects in their c-kit and c-kit ligand genes, respectively. We now report that the immature bone marrow-derived mast cells (mBMMC) obtained in vitro with recombinant interleukin 3 (rIL-3) or WEHI-3 cell conditioned medium from WB-(+/+), WC-(+/+), W/Wv, and Sl/Sld mice all contain high steady-state levels of the mMCP-2, mMCP-4, mMCP-5, mMCP-6, and mMC-CPA transcripts. As assessed immunohistochemically, mMCP-2 protein and mMCP-5 protein are also present in the granules of mBMMC from WB-(+/+), WC-(+/+), and W/Wv mice. That Sl/Sld and W/Wv mBMMC contain high steady-state levels of five granule protease transcripts expressed by the mature serosal, ear, and skin mast cells of their normal +/+ littermates suggests that c-kit-mediated signal transduction is not essential for inducing transcription of these protease genes. Because rIL-4 inhibits the rIL-10-induced expression of mMCP-1 and mMCP-2 in BALB/cJ mBMMC, the ability of rIL-4 to influence protease mRNA levels in WC-(+/+) mBMMC and W/Wv mBMMC was investigated. Although rIL-10 induced expression of the mMCP-1 transcript in WC-(+/+) and W/Wv mBMMC, rIL-4 was not able to suppress the steady-state levels of the mMCP-1 transcript or any other protease transcript in these cultured mast cells. Thus, not only do BALB/cJ mBMMC express fewer granule proteases than mBMMC from mast cell-deficient strains and their normal littermates but the subsequent induction of late-expressed proteases in BALB/cJ mBMMC is more tightly regulated by IL-3 and IL-4.

Animals↗
PubMed1965

THE EFFECT OF MUCOSAL AND SEROSAL SOLUTION CATIONS ON BIOELECTRIC PROPERTIES OF THE ISOLATED TOAD BLADDER.

The spontaneous transtissue potential and the DC conductance of the isolated toad bladder were measured when the tissue was exposed to sulfate Ringer's solutions of modified ionic composition. Na(+) was replaced to varying extents by (C(2)H(5))(3)NH(+), (C(2)H(5))(4)N(+), Li(+), Cs(+), K(+), or Rb(+). Reversible and irreversible changes were observed. The reversible changes were consistent with equations derived from the Nernst-Planck diffusion equation, and gave the following functional description of the bladder: (a) the potential measurements were compatible with two membranes in series; (b) the mucosal surface was more permeable to Na(+) than to other monovalent cations; (c) the serosal surface was permeable to both K(+) and Na(+) but preferentially to K(+); (d) the rate of Na(+) diffusion across the mucosal membrane appeared to approach a maximum but two alternative interpretations are discussed; (e) the conductance data were consistent with the assumption of a constant concentration gradient for the penetrating ions within the membrane (Henderson's assumption) provided suitable hypotheses are made concerning the Na(+) distribution between the membrane surfaces and the bulk phases of the adjacent solutions; (f) the conductance and spontaneous potential data suggested that the mucosal membranes of a small fraction of the epithelial cells were more permeable than the mucosal membranes of the majority of these cells. The irreversible changes were almost entirely associated with cation substitution in the serosal solution. However, Li(+) produced an irreversible fall in voltage when added to either side of the tissue.

Ammonium Compounds↗
PubMed1990

Expression of "myelomonocytic" antigens in mesotheliomas and adenocarcinomas involving the serosal surfaces.

Because of the demonstrated efficacy of Leu-M1 as a discriminant between malignant epithelioid mesothelioma (MEM) and adenocarcinomas involving the serosal surfaces (ACSs), the authors assessed the reactivities of related "myelomonocytic" antigens in this context. Paraffin sections from 41 MEMs and 43 ACSs (pulmonary, "serous surface papillary," and metastatic mammary adenocarcinomas) were evaluated for their expression of Leu-M1, LN1, LN2, and the Mac 387 antigen. Diagnoses were based in each case on the results of conventional histologic and electron microscopic examinations. Leu-M1 was detected only in minute foci of three peritoneal MEMs and was absent entirely in pleural mesotheliomas. Conversely, 38 of 43 ACSs expressed this marker. Three cases of peritoneal MEM and one pleural mesothelioma were multifocally LN2 positive, as were 39 of 43 ACSs. LN1 was the most frequently expressed antigen in MEM, being observed in 18 such tumors (10 pleural; 8 peritoneal); it was also detected in 37 of 43 ACSs. Mac 387 failed to label any of the neoplasms assessed in this series. These results demonstrate similar patterns of "myelomonocytic" antigen expression by diverse ACS and a general absence of Leu-M1 and LN2 in MEM. LN1 and the Mac 387 antigen appear to have no additional value when compared with Leu-M1 and LN2 in the immunohistochemical evaluation of serosal neoplasms.

Antigens, Neoplasm↗
PubMed1986

Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study.

Normal and reactive non-neoplastic serosal tissues and a spectrum of serosal neoplasms were studied using light-microscopic, ultrastructural, immunocytochemical, gel electrophoretic, and immunoblot techniques. Normal surface mesothelium expressed both low- and high-molecular-weight cytokeratins, whereas the scattered submesothelial cells were decorated only with antibodies to vimentin. Reactive non-neoplastic subserosal cells, however, coexpressed both low-molecular-weight cytokeratin and vimentin and demonstrated the ability for surface differentiation during which higher-molecular-weight cytokeratins were acquired and vimentin was lost. The authors suggest the term "multipotential subserosal cells," recognizing the unique intermediate filament expression of reactive subserosal cells and the ability for surface differentiation. The intermediate filament expression of the sarcomatoid/desmoplastic mesotheliomas resembled the MSC, whereas epithelial mesotheliomas resembled surface mesothelium. These findings have potential usefulness for diagnostic pathology.

Carcinoma↗
PubMed1998

Expression of bcl-2 oncoprotein in benign and malignant spindle cell tumors of soft tissue, skin, serosal surfaces, and gastrointestinal tract.

An immunohistochemical study to determine the pattern of immunoreactivity for bcl-2 oncoprotein was performed in 380 spindle cell tumors of soft tissue, skin, serosal surfaces, and gastrointestinal tract. The cases studied included examples of benign, reactive spindle cell proliferations to benign and malignant spindle cell neoplasms, including nodular fasciitis (10), fibromatosis (5), dermatofibroma (10), dermatofibrosarcoma protuberans (18), Kaposi's sarcoma (15), spindle cell lipomatous tumors (24), benign and malignant smooth muscle tumors (35), neural/peripheral nerve sheath neoplasms (53), synovial sarcomas (70) solitary fibrous tumors of serosal surfaces and other sites (56), gastrointestinal stromal tumors (GIST) (47), and malignant undifferentiated fibroblastic spindle cell proliferations of soft tissue (37 cases). The results of bcl-2 staining was additionally correlated with CD34 immunoreactivity. Bcl-2 was uniformly negative in all cases of nodular fasciitis, fibromatosis, and dermatofibroma, as well as in benign and malignant smooth muscle proliferations. Strong positivity for bcl-2 was observed in all cases of spindle cell lipoma, dendritic fibromyxolipoma, Kaposi's sarcoma, solitary fibrous tumors, gastrointestinal stromal tumors, and in the spindle cell component of synovial sarcoma. With the exception of the last, there appeared to be a close correlation between the expression of bcl-2 and CD34 in these tumors. Strong bcl-2 positivity also was found, at least focally, in approximately one third of benign and malignant peripheral nerve sheath tumors, particularly in the better-differentiated (Antoni type A) areas. Sarcomas of fibroblastic type, including low-grade myxofibrosarcoma, malignant fibrous histiocytoma, and fibrosarcoma, showed variable expression of bcl-2 in the tumor cells. Our results appear to indicate that bcl-2 may have a wide distribution among benign and malignant spindle cell neoplasms. Strong expression of this marker in some of these conditions, particularly solitary fibrous tumor, gastrointestinal stromal tumors, and synovial sarcoma, may be of aid for differential diagnosis.

Antigens, CD34↗
PubMed2002

Differential expression of matrix metalloproteinase and tissue inhibitor of MMP in serosal tissue of intraperitoneal organs and adhesions.

OBJECTIVE: To comparatively analyse the expression of matrix metalloproteinase (MMP-3) and tissue inhibitor of MMP (TIMP-2) in serosal tissue of intraperitoneal organs and adhesions, as well as peritoneal fluid and serum of subjects with and without adhesions. DESIGN: Cross sectional study. SETTING: Academic research centres. SAMPLE: Patients undergoing abdominal/pelvic surgery. METHODS: Messenger ribonucleic acid (mRNA) and protein expression using quantitative reverse transcription polymerase chain reaction (Q-RT-PCR), ELISA and immunohistochemistry. RESULTS: All the tissues examined express MMP-3 and TIMP-2 mRNA and protein at consistently varying levels ranging from 100- to 1000-fold and 2- to 10-fold mRNA and protein, respectively. Serosa of uterine, fallopian tube, ovary and partial peritoneum express a higher MMP-3 mRNA compared with small and large bowels and omentum, while TIMP-2 expression was less variable with the highest level found in uterine serosa (P < 0.05). The expression of MMP-3 and TIMP-2 mRNA in adhesions was not significantly different compared with parietal peritoneum. MMP-3 and TIMP-2 protein content in tissue extracts, peritoneal fluids and serum also varied with higher TIMP-2 than MMP-3 (P < 0.05). TIMP-2 levels were lower in serum of subjects with moderate/extensive adhesions compared with subjects without adhesions. Immunoreactive MMP-3 and TIMP-2 proteins were detected in various cell types in these tissues. There was no correlation between MMP-3 and TIMP-2 expression, and age, gender or menstrual status of subjects with or without adhesions. CONCLUSION: MMP-3 and TIMP-2 are expressed at varying levels in serosal tissues of peritoneal organs and adhesions, with higher TIMP-2 than MMP-3. Based on the knowledge that tissue injury alters the expression of MMPs and TIMPs, such variations may predispose an organ to develop more adhesions than others. In addition, the results suggest that serum level of TIMP-2 may represent a marker for subjects who will form adhesions with greater severity.

Adult↗
PubMed1984

Intraluminal distension pressure on intestinal lymph flow, serosal transudation and fluid transport in the rat.

Effect of distension pressure (d.p.) on the rate of lymph flow, serosal transudation and fluid transport was studied on an in vivo upper jejunal preparation. In the non-absorptive state with isotonic Na2SO4 solution as the luminal fluid, neither lymph flow nor transudation was increased with increasing d.p. from 0 to 3, 10, 20, 40 or 70 mmHg. Fluid absorption rate (Jv) increased by more than 100% when d.p. was increased from 0 to 3 mmHg whether glucose was present or absent in the luminal fluid (Krebs-Ringer solution). In the presence of glucose, there was no difference in Jv in the range of d.p. between 3 and 70 mmHg. In the absence of glucose Jv decreased when d.p. was above 10 mmHg. Whether with or without glucose, lymph flow did not change between d.p. of 0 and 10 mmHg but decreased at higher pressures. Whether with or without glucose, transudation began to appear at d.p. of 10 mmHg, increased with increasing d.p. up to 70 mmHg, but was much less in the absence of glucose. Protein concentration in the lymph (1.5-2.4% (w/v] and transudation (1.5-2.1% (w/v] was practically the same, suggesting that the latter could have originated from the lymph which leaked out of the serosal membrane. Blood flow in the subserosal capillaries and venules was remarkably reduced when d.p. was above 10 mmHg. In both jejunum and ileum, d.p. never caused fluid secretion during distension but resulted in transient fluid secretion as well as transudation following distension, apparently due to increased capillary filtration as a result of increased capillary permeability by ischaemia (during distension). From the effect of d.p. on the increase of transudation, presumably lymph, it is concluded that luminal hydrostatic pressure may play a role in fluid transport via the lymphatic system.

Animals↗
PubMed1977

Ileal mucosal cyclic AMP and Cl secretion: serosal vs. mucosal addition of cholera toxin.

Changes in ion transport and cyclic AMP (cAMP) concentration produced by addition of cholera toxin to the serosal side of isolated rabbit ileal mucosa (CTs) were compared to the changes produced by addition to the mucosal side (CTm). CTs increased short-circuit current (SCC) as did CTm but it did so more slowly. CTs, unlike CTm, did not significantly decrease electrical conductance. Inhibition of the SCC response to theophylline, a measure of preexisting secretion, was almost complete 180 min after CTm but was not yet significant 180 min after CTs. Longer (280 min) after CTs, the SCC response to theophylline was reduced by 59%, a significant reduction but less than that caused by CTm. A statistically significant change in net Cl flux could not be demonstrated after CTs, although at 280 min the measured flux was halfway between the fluxes for control and CTm tissues. Cyclic AMP concentrations were determined at 190 min, 10 min after addition of theophylline. CTs, despite little or no effect on ion transport, increased cAMP to the same level as did CTm, and the effect on cAMP of adding toxin to both sides was additive. We conclude that 1) active secretion is probably stimulated by cholera toxin added on the serosal side, although more slowly than after addition to the mucosal side and 2) much of the toxin-stimulated cAMP content of the mucosa is not coupled to secretion.

Animals↗
PubMed1992

Microvascular pressure profile of serosal vessels of rat trachea.

The distribution of intravascular pressures within the pulmonary airway microcirculation is an important determinant of transvascular liquid balance. Intravascular pressures were measured in the serosal vessels of the trachea in anesthetized, ventilated rats. The ventral portion of the trachea was surgically exposed and suffused with warm (37 degrees C) Krebs-Ringer bicarbonate. The serosal microvasculature was observed with a video microscope, and microvessel pressures and diameters were measured using the servo-null technique and video calipers, respectively. Mean arterial pressure (MAP) was monitored from the left femoral artery and averaged 106.1 +/- 5.2 mmHg (n = 14). The highest pressure (77% of MAP) was measured in a large (95-microns diam) transverse arteriole. As arteriolar diameter decreased from 39 to 11 microns, pressures fell from 62 to 18% of MAP. Capillaries drained into venular networks that formed extensive arcades. Pressures in these postcapillary venules (20-75 microns diam) were 7.7 +/- 5.5% of MAP (n = 9). These vessels in turn drained into large venous sinuses (120-425 microns diam) where pressures averaged 5.7 +/- 2.3% of MAP (n = 7). A four-parameter logistical model of these data predicts that capillary pressures range from 27 to 15% of MAP. We conclude that 1) a substantial resistance exists across precapillary arterioles less than 40 microns diam and 2) a small pressure drop occurs between systemic arteries and primary feed arterioles in this tissue.

Animals↗
PubMed1989

Effects of serosal anion composition on the permeability properties of rabbit urinary bladder.

This study describes the effects of serosal Cl- and HCO3- substitution on transepithelial Na+ transport and basolateral membrane properties of the rabbit urinary bladder. Replacement of Cl- with NO3-, SCN-, and Br- had no effect on transepithelial Na+ transport or the basolateral membrane potential (Vbl). However, gluconate, isethionate, and cyclamate (anions that were shown previously to be not as permeable as Cl- through the basolateral membrane anion channel), decreased transepithelial Na+ transport and depolarized Vbl. Replacement of HCO3- also produced a decrease in transepithelial Na+ transport and a depolarization of Vbl. Utilizing conventional and K+-specific microelectrodes, we found the depolarization to be due to a reduction in basolateral K+ conductance. This depolarization was reversible only when Cl- was returned to the serosal solution, the normally permeant anion NO3- being unable to affect repolarization, suggesting that both the K+ and Cl- conductance are reduced during depolarization. A lag period of some 4 min preceded the repolarization of Vbl. The Na+-H+ exchange blocker amiloride prolonged the lag phase associated with repolarization, whereas niflumic acid, a Cl-(-)HCO3- exchange blocker (in red blood cells) reduced the magnitude of Vbl repolarization. Because of the possible involvement of the exchangers it is believed that the lag phase represents a volume-dependent and/or pH-dependent reactivation of the basolateral membrane conductances.

Amiloride↗
PubMed2006

Efficacy and safety of intraoperative peritoneal hyperthermic chemotherapy for advanced gastric cancer patients with serosal invasion. A long-term follow-up study.

AIMS: This study was undertaken to investigate the clinical effects and safety of intraoperative peritoneal hyperthermic chemotherapy (IPHC) for advanced gastric cancer (AGC) patients. METHODS: A total of 118 AGC patients with serosal invasion were enrolled in this study from 1998 to 2001, 52 underwent IPHC after gastrectomy and 66 were treated with gastrectomy only. Among these cases, 96 patients without macroscopic peritoneal metastases were selected for the prophylactic study, 22 with peritoneal metastases were selected for the therapeutic study. Postoperative survival, recurrence pattern and incidences of postoperative complications between patients with and without IPHC were analyzed and compared. RESULTS: For the prophylactic study, the IPHC procedure improves postoperative survival rate and decrease the incidence of peritoneal recurrence, and is an independent prognostic factor for these patients. For the therapeutic study, postoperative survival times were longer if IPHC was undertaken. No surgery-related death occurred. The incidence of renal dysfunction was higher in the IPHC group, but all patients recovered without hemodialysis. CONCLUSION: IPHC is a safe procedure that improves the survival prognosis for AGC patients with serosal invasion. It is especially beneficial for patients without peritoneal metastasis due to the reduction of postoperative peritoneal recurrence.

Chemotherapy, Cancer, Regional Perfusion↗
PubMedDate not supplied

Stromal distribution of CA 19-9 as a predictor of lymph node metastases in gallbladder cancer without serosal invasion.

Gallbladder cancer without serosal invasion is often diagnosed during the pathologic examination of a gallbladder removed for presumed benign disease. The role of reoperative procedures in these patients is not well established, making it important to define prognostic factors that predict cancer spread. To determine if the pattern of immunohistochemical staining with a monoclonal antibody against CA 19-9 could predict lymph node spread of cancer, 23 patients with gallbladder cancer without serosal invasion were reviewed. CA 19-9 reaction was present in pathology specimens from all 23 patients. Twelve samples (52.2%) showed CA 19-9 in the stroma adjacent to cancer cells, while the remaining 11 did not show any stromal staining against CA 19-9. Lymph node development was found in only 2 (18.2%) of these 11 patients in the nonstromal staining group and 9 (75%) of the 12 patients in the stromal staining group. As these differences were statistically significant, we conclude that immunohistochemical localization of CA 19-9 in gallbladder cancer may be useful in predicting the presence or absence of lymph node involvement, and in developing a rational approach for a reoperative procedure.

Aged↗
PubMedDate not supplied

Early postoperative nutritional support using the serosal tunnel jejunostomy.

A silicone rubber serosal tunnel jejunostomy for postoperative nutritional therapy was placed in 38 patients who had major operations. A dilute, chemically defined diet was begun within 48 hours of surgery and an attempt made to advance it slowly to full strength by the fifth day. No catheter-related complications occurred. Intravenous fluid therapy was shortened to less than three days in 11 (29%) patients. Only 17 (45%) patients tolerated full-strength feedings within the protocol time. Three (8%) patients depended on their tube feedings for over 30 days and the need for parenteral nutrition was avoided. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the pded. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the patients with albumin greater than 4 g/dl had no problems. Postoperative feeding utilizing the serosal tunnel jejunostomy is technically safe, but feeding difficulties can be anticipated in those patients who are septic or severely malnourished; these are the patients whose nutritional needs are the greatest. The greatest benefits accrue to those patients who are in need of long-term nutritional support. We recommend routine placement of these catheters in major operations.

Enteral Nutrition↗
PubMed2001

Insights from animal models for growing intestinal neomucosa with serosal patching--a still untapped technique for the treatment of short bowel syndrome.

The aim of surgical treatment of short bowel syndrome is to increase the intestinal absorptive capacity by increasing the area of absorption or by slowing intestinal transit. The use of serosal patching to grow new intestinal mucosa is a technique for enlarging the intestinal surface. The regenerated intestine develops by lateral ingrowth from the neighbouring mucosa and is functionally similar to normal intestinal mucosa. The present review summarizes the main contributions of the rabbit, the rat and the canine models used to date for growing neomucosa using the serosal patch technique, as well as examining the influence of some growth factors on the development of neomucosa.

Animals↗
PubMedDate not supplied

Prevention of scald injury on the peritoneo-serosal surface in advanced gastric cancer patients treated with intraperitoneal hyperthermic perfusion.

In attempts to avoid the side-effects derived from a scald on the peritoneo-serosal surface during intraperitoneal hyperthermic perfusion (IPHP) for advanced gastric cancer, a randomized study using cimetidine, a histamine H2-receptor antagonist, was carried out on 18 patients with advanced gastric cancer. Cimetidine, 50 mg/kg, was administered intravenously and immediately before IPHP. The background characteristics of the patients and the types of surgical treatment used were almost the same between each group of patients, whether or not cimetidine was given. The perfusion time in the cimetidine and control groups was 123 +/- 9 and 117 +/- 9 min, respectively. The inflow and outflow temperatures of the perfusate were 46.3 +/- 0.4 and 44.2 +/- 0.1 degrees C in the cimetidine group, respectively, whereas in the control group the temperatures were 46.0 +/- 0.3 and 44.1 +/- 0.2 degrees C, respectively. In the nine patients who were given cimetidine, the histamine concentrations in the peripheral blood increased significantly, compared to those in the nine controls; this resulted from the release of histamine into the circulating blood. Higher concentrations of protein were observed in the post-hyperthermic intraperitoneal exudate of the control group for 3-24 h after IPHP and, consequently, post-hyperthermic hypoproteinaemia was remarkable in the control group. These data suggest that when pre-IPHP cimetidine was prescribed for patients with gastric cancer treated with IPHP, the peritoneo-serosal surface was protected from scald injury and the side-effects of IPHP were reduced.

Blood Proteins↗
PubMed1991

Motor and absorptive function of the canine intestine following serosal patching: the effects of a lateral enterotomy on small intestinal myoelectrical activity.

We studied the effects of serosal patching of a 4 x 15-cm, full-thickness, jejunal defect on absorptive function and fasting and postprandial myoelectrical activity in 5 patched and 5 control animals over a 3-month period. While fat and D-xylose absorption were similar in both groups, serum albumin was significantly depressed (2.96 +/- 0.24 g/dL preop vs 2.29 +/- 0.23 g/dL postop, p less than .05) and stool moisture content was elevated following patching (54 +/- 4% vs 67 +/- 9%, p less than .05). Neither the generation of the various phases of the interdigestive myoelectrical complex (IDMEC), the development of postprandial myoelectrical activity, or colonic myoelectrical patterns were impaired in the patched animals. The normal gradients of slow wave frequency, phase III propagation velocity, and onset of the fed pattern were similar in control and patched animals. However, jejunal slow wave frequency (cpm, control vs patch: 18.6 +/- 0.6 vs 19.5 +/- 0.6, p less than .05) and IDMEC frequency (0.36 +/- 0.25 vs 0.56 +/- 0.32, p less than .05) were greater and the IDMEC period shorter (109.6 +/- 27.8 vs 88 +/- 35.7, p less than .05) in the patch animals. In vitro studies demonstrated similar absorptive function in intact mucosa and neomucosa. We conclude that the technique of serosal patching is associated with impaired absorption in vivo. While this may be related, in part, to the minor motility changes observed, other factors such as hormonal changes may also be important.

Animals↗