Identifying and sampling minimal amounts of liquid in the peritoneal cavity. Peritoneal paracentesis and the paracolico-iliac recess: a simple bedside method.
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Ascitic Fluid↗
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[Primary splenic abscess ruptured into the peritoneal cavity (peritonitis in 3 stages)].
The authors present a case with peritonitis following rupture of a splenic abscess in a female aged 18 years. Peritonitis developed in three stages. The diagnosis before surgery was of pelvic peritonitis. Bacteriologic examination revealed the presence of B. colli. Splenectomy was followed by complete recovery of the patient. The site of the primary infection could not be determined. The authors stress the usefulness of exploration of the splenic lodge in the so-called "primary" generalized peritonitis, in pelvic peritonitis or in all cases when the origin of the peritoneal infection is not known.
Abscess↗
Gamma interferon induces the appearance of a CD4-, major histocompatibility complex class II+ macrophage subpopulation in the rat peritoneal cavity.
Peritoneal cells from gamma interferon (IFN-gamma)-treated rats were phenotypically characterized by flow cytometry. Intraperitoneal inoculation of 3 x 10(4) units of IFN-gamma induced, within 24 h, the appearance of a CD4-, major histocompatibility complex (MHC) class II+ macrophage subpopulation not present in rats treated with phosphate-buffered saline. IFN-gamma induced an increased expression of MHC class II I-A molecules on both CD4- and CD4+ macrophages. Both cell types adhered to plastic and expressed high levels of the macrophage membrane molecules CD11b and OX41. Histological examination of sorted CD4- and CD4+ macrophages confirmed the macrophage morphology of both populations with less granula in the former. We conclude that the appearance of CD4- macrophages in the peritoneal cavity after inoculation with IFN-gamma most probably reflects a selective recruitment of these cells from blood or surrounding tissues. The function of these cells is still unknown, although strong expression of MHC class II I-A indicates competence as antigen-presenting cells.
Animals↗
Transfer of autologous haemoglobin from the peritoneal cavity during peritoneal dialysis.
Transfer of autologous haemoglobin from the peritoneal cavity was evaluated retrospectively in 14 patients who received this marker intraperitoneally (group 1) during routine continuous ambulatory peritoneal dialysis (CAPD). Five additional patients were studied during acute peritonitis (group 2). A model for balance of both dialysate volume and amount of haemoglobin is developed to assess movement of the compound into lymph or adjacent tissues. Under the conditions of the study the transfer was slow (8 +/- 10 ml/h) in patients without peritonitis (group 1), and significantly faster (25 +/- 22 ml/h) in those with peritonitis (group 2). These clearance values are the upper limits for lymph flow.
Adult↗
Connective tissue growth factor and its regulation in the peritoneal cavity of peritoneal dialysis patients.
BACKGROUND: Connective tissue growth factor (CTGF) is a fibrogenic cytokine that is highly expressed in wound healing and fibrotic lesions. The role of transforming growth factor-beta (TGF-beta) in fibrosis is well documented, and the emerging understanding that its fibrogenic actions are mediated through CTGF has provided an attractive target molecule for the modulation of matrix overproduction in fibrotic disease. The involvement of CTGF in the pathogenesis of peritoneal membrane fibrosis in peritoneal dialysis (PD) patients has not been investigated, and so the aim of this study was to ascertain whether CTGF is produced in the peritoneal cavity of PD patients and to investigate its regulation by cytokines. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR), Northern blotting, and Western blotting were used to study CTGF expression by cultured human peritoneal mesothelial cells (HPMC) from peritoneal dialysis patients. Western blotting was used to detect CTGF expression in spent peritoneal dialysate from patients with and without peritonitis. RESULTS: RT-PCR analysis demonstrated the expression of CTGF mRNA in cultured primay HPMCs isolated from spent peritoneal effluent. The production of the major 36 to 38 kD CTGF protein doublet by HPMC in addition to a 23 to 25 kD proteolytically processed form was confirmed by Western blotting. Several molecular weight forms of CTGF (18 to 38 kD) were also detected by Western blotting in peritoneal dialysate, with levels markedly elevated during episodes of peritonitis. Northern and Western blot analysis revealed that CTGF mRNA and protein production by HPMC was up-regulated by TGF-beta, with mRNA levels significantly increasing above the control (P < 0.01). In contrast, platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and tumor necrosis factor-alpha (TNF-alpha) had no measurable effects on CTGF mRNA expression. CONCLUSION: These results are the first to demonstrate the production of CTGF by HPMC and its presence in the peritoneal cavity of PD patients. The marked increase in CTGF levels by factors implicated in the development of peritoneal membrane fibrosis suggests its involvement in the underlying pathophysiologic mechanism(s).
Base Sequence↗
Reduced lymphatic drainage of dialysate from the peritoneal cavity during acute peritonitis in sheep.
OBJECTIVES: The purpose of this study was to investigate the effects of acute peritonitis on lymphatic drainage of the peritoneal cavity in conscious sheep. DESIGN: Peritonitis was induced with the addition of 1% casein or 1% albumin to the dialysis solution. Thirty sheep (5 groups of 6) were used in this study. One group received 50 mL/kg intraperitoneal infusions of Dianeal 4.25% (486 mOsm/L); a second group received 1% casein-Dianeal 4.25% (493 mOsm/L); a third group received 1% albumin-Dianeal 4.25% (487 mOsm/L). In the fourth and fifth groups (controls and casein-injected) lymph was collected from the caudal mediastinal lymph node and the thoracic duct, both of which are involved in the lymphatic drainage of the peritoneal cavity (peritonitis induced with casein). (125)I-human serum albumin (25 mu CI) was added to the dialysate as the lymph flow marker. Lymph drainage was estimated from (1) the appearance of the intraperitoneally administered tracer in the blood; (2) the disappearance of the tracer from the peritoneal cavity; and (3) the recovery of tracer in lymph. RESULTS: In noncannulated animals the cumulative volume removed by lymphatics over 6 hours (based on tracer recovery in blood) was 10.5 +/- 1.0 mL/kg in control animals versus 5.0 +/- 0.6 mL/kg and 8.6 +/- 1.2 mL/kg in casein and albumin-infused sheep, respectively. The suggestion of decreased lymph drainage in peritonitis was supported by the cannulation experiments. While the cumulative fluid removed from the peritoneal cavity over 6 hours in caudal lymph was unaffected by peritonitis (3.8 +/- 0.4 mL/kg in controls vs 3.6 +/- 0.5 mL/kg in casein-injected animals), peritonitis reduced flow into the thoracic duct from 3.0 +/- 0.3 to 1.1 +/- 0.3 mL/kg. The sum of the volume removed in lymph in the cannulated preparations was 6.8 +/- 0.4 mL/kg in controls versus 4.7 +/- 0.5 mL/kg in the peritonitis group. The total volume removed from the cavity (including an estimate of flow based on the residual recovery of tracer in blood) was reduced from 12.6 +/- 1.4 in controls to 7.8 +/- 0.6 mL/kg in the peritonitis sheep. In contrast, estimates of lymph drainage based on the disappearance of tracer from the peritoneal cavity suggested that lymph drainage increased (from 16.6 +/- 1.6 mL/kg in controls to 17.8 +/- 1.5 mL/kg and 25.5 +/- 1.7 mL/kg in the casein and albumin groups, respectively, in noncannulated animals and from 15.3 +/- 1.4 mL/kg in controls to 25.0 +/-1.7 mL/kg in the cannulated group). In both noncannulated and cannulated sheep the total recovery of tracer was less in the peritonitis groups. CONCLUSIONS: These studies demonstrated that lymph drainage of the peritoneal space was decreased in a casein peritonitis model. The decrease in lymph drainage is most obvious in the visceral pathway leading to the thoracic duct; however, diaphragmatic drainage into the right lymph duct may also be inhibited. The disappearance of tracer from the peritoneal cavity was elevated during peritonitis. Tracer disappearance has been used to estimate lymph drainage, but this approach suggested, incorrectly, that lymph flow had increased.
Acute Disease↗
Magnetic resonance imaging of the peritoneal cavity among peritoneal dialysis patients, using the dialysate as "contrast medium".
The objectives of this study were to evaluate whether adequate observation of abdominal pathologic features related to peritoneal dialysis (PD) was possible with magnetic resonance imaging (MRI) under routine conditions, i.e., against the background of the dialysate and without contrast medium. For 16 male and seven female patients (mean age, 51.8 +/- 15.0 yr; mean duration of PD, 324 +/- 542 d), 25 peritoneal MRI studies were performed with the intraperitoneal dialysate as usual. Indications were symptoms or combinations of symptoms, such as leakage or abdominal wall edema (n = 3), bloody dialysate (n = 4), suspected herniation (n = 1), suspected ultrafiltration failure (n = 2), and abdominal pain (n = 5), or routine assessment after initiation of PD (n = 12). The MRI protocol, which was performed with a 1.0-T scanner, consisted of breath-hold, coronal and transverse, T2-weighted, half-Fourier single-shot turbo spin-echo sequences, using a standard body-array coil. MRI studies were well tolerated and successfully completed for all except two patients. Results indicated a leak along the catheter (n = 1), a leak in an umbilical hernia (n = 1), suspected leakage (n = 1), hernias (n = 5, in three patients), intraperitoneal adhesions (n = 5, in four patients), a ruptured ovarian cyst (n = 1), and pleural effusions (n = 4). Pathologic findings unrelated to PD or located extra-abdominally were observed in 19 of the 25 studies. The catheter tip position was easily identified for all patients. In conclusion, this first report on peritoneal MRI using only dialysate as the "contrast medium" indicates that MRI permits detailed observation of all relevant, PD-related, abdominal pathologic features against the dialysate background, thus avoiding system contamination (and thus the risk of peritonitis).
Adult↗
The absorption of iron dextran from the bovine peritoneal cavity in peritonitis. A preliminary report.
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Absorption↗
First-line defense mechanisms in the peritoneal cavity during peritoneal dialysis.
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Animals↗
[Ultrasonography of the retroperitoneal space, pelvic cavity and peritoneal cavity].
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Ascitic Fluid↗
[Evaluation of loss of active heparin in the peritoneal cavity during intermittent peritoneal dialysis].
Our studies aimed at determining a loss of active heparin from the peritoneal cavity after its intraperitoneal administration (250 JU/l of dialysis fluid) in 16 patients treated because of the end-stage renal failure with intermittent peritoneal dialysis and at comparing heparin influx clearance with that of glucose. It has been shown that heparin used in this dose loses 60-70% of its activity after 20-minute equilibration of dialysis fluid in the peritoneal cavity. Heparin influx clearance is higher than that of glucose but it depends on utilization of heparin in peritoneal cavity rather than on its penetration to the blood circulation.
Adult↗
Expression of defensin antimicrobial peptides in the peritoneal cavity of patients on peritoneal dialysis.
OBJECTIVE: To investigate the expression and regulation of defensins in the peritoneal cavity of peritoneal dialysis (PD) patients. DESIGN: The presence of defensins in the peritoneal cavity was assessed using reverse transcription polymerase chain reaction (RT-PCR). In vivo defensin expression was analyzed in human peritoneal membrane biopsies and in peritoneal cavity leukocytes isolated from spent dialysate. Defensin expression in vitro was assessed in cultured human peritoneal mesothelial cells (HPMC) and confirmed with PCR Southern blot and DNA sequencing. The effect of tumor necrosis factor alpha (TNFalpha) and epidermal growth factor (EGF) on beta2 defensin expression in HPMC was analyzed by Northern blot analysis and RT-PCR respectively. RESULTS: Both alpha and beta classes of defensins are expressed in the peritoneal cavity of PD patients. Messenger RNA for the alpha-defensin human neutrophil peptide 3 and for beta-defensin-1 (hbetaD-1) were found in preparations containing predominantly peritoneal leukocytes, whereas beta-defensin-2 (hbetaD-2) is expressed by HPMC. HPMC isolated from different individuals displayed variability in both basal hbetaD-2 expression and in response to stimulation by TNFalpha. Conversely, EGF consistently downregulated the level of hbetaD-2 message in HPMC. CONCLUSION: Alpha- and beta-defensins are expressed in the peritoneal cavity, and hbetaD-2 is the main defensin present in the peritoneal membrane. Variable levels of expression of hbetaD-2 by mesothelial cells were seen, with evidence of regulation by cytokines and growth factors. This provides evidence for a previously unknown mechanism of innate immunity at that site.
Base Sequence↗
Comparison of the accessory activity of murine peritoneal cavity macrophage derived dendritic cells and peritoneal cavity macrophages in a mixed lymphocyte reaction.
A detailed comparison of the accessory cell activities was carried out among murine peritoneal cavity macrophages (PEC-Mphi), peritonea] cavity macrophages stimulated with granulocyte-macrophage colony stimulating factor (GM-CSF) plus interleukin 4 (IL-4), the most popular cytokine combination widely used to generate dendritic cells (DC) and peritoneal cavity macrophage-derived DC (PEC-DC) using a two-way mixed lymphocyte reaction (MLR). All the cell types used efficiently induced statistically significant naïve T cell proliferation at all culture time points and responder:stimulator ratios used. However, marked differences were noted in the magnitude of the proliferative responses. These variations may be attributed to the intensity of expression of MHC class II glycoproteins, as well as the actual numbers of MHC class II+ cells.
Animals↗
Pathways for fluid loss from the peritoneal cavity.
During peritoneal dialysis, fluid is transported out of the peritoneal cavity by lymphatic and nonlymphatic pathways, thereby decreasing net ultrafiltration by 40-50% and reducing small solute clearance by 15-20%. The direct lymphatic pathway consists of the diaphragmatic lymphatics, which directly connect the peritoneal cavity to the bloodstream. The interstitial lymphatic and direct blood entry pathways convey fluid that has been driven into the interstitial space of the tissue surrounding the peritoneal cavity by the increased intraperitoneal pressure, and return it to the bloodstream. Since flow through lymphatic pathways is only a portion of the flow through all pathways, total fluid loss is greater than lymph flow. The best technique for estimating lymph flow is direct measurement by cannulation of lymphatic vessels, a technique that is not clinically feasible. The tracer disappearance technique, which measures the rate at which macromolecules leave the peritoneal cavity, is an indirect measure of fluid loss. The tracer appearance technique, which measures the rate at which macromolecules reach the blood from the peritoneal cavity, slightly overestimates lymph flow because some tracer may enter the bloodstream directly from the tissues. Much of the previous controversy over the contribution of the lymphatic pathways to total fluid loss can be resolved by understanding the differences in what these techniques measure.
Ascitic Fluid↗
[Perforation in Crohn's ileitis and its consequences in the natural history of disease. 2. Consequences of perforation in the peritoneal cavity: diffuse septic peritonitis, abscesses, external and internal fistulas].
Perforation of Crohn's ileitis occurring in the peritoneal cavity is always free perforation, but it causes usually a localized peritonitis, i.e. an abscess, and only in rare cases a diffuse septic peritonitis for the reasons expounded in the Part 1. Diffuse septic peritonitis has the common features of all perforative peritonitis; its surgical treatment must be ileocolic resection, simple suture of perforation being a serious mistake. Abscesses develop: as regards the ileum, about 30-45 cm from the ileo-caecal valve; as regards the abdominal cavity, in the right iliac fossa or in the pelvis, at a site where the ileum, weighed down by its chronic inflammation, rests. These abscesses have a wall like that of all abscesses, with no specific crohnian features. On operation, if technical considerations so require, part of the abscess wall may be left in place with no fear of recurrences or fistulas. Nowadays, most abscesses of the right iliac fossa are opened surgically; an enterocutaneous fistula follows. Most abscesses of the pelvis still open spontaneously into a hollow organ (sigma-rectum, urinary bladder), and rarely into the vagina or onto the perineum after penetrating through the levator any muscle and causing suppuration of the ischiorectal fossa.
Abdominal Abscess↗
Environmental conditions favorable for tumor progression in peritoneal cavity induced by peritoneal cells without tumor selectivity.
The incidence of the lethal growth of 10(1) L1210 murine leukemia cells in mice was higher in intraperitoneal (i.p.) (97%) than in intradermal (i.d.) (17%) inoculation, and survival time of mice was shorter in i.p. than i.d. inoculation. It was supposed that resident peritoneal cells (PC) enhanced tumor progression. I.d. inoculation of 10(1) L1210 cells mixed with 10(6) PC induced a lethal tumor growth at higher incidence than that of 10(1) L1210 cells alone or the mixture of 10(1) L1210 cells and 10(4) peripheral blood mononuclear cells (PBM) did. Furthermore, co-inoculation of a tumorigenic number of L1210 cells (10(3] with 10(6) PC resulted in marked shortening of median survival time of mice. Similar growth enhancing effect of PC was observed in Meth 1 fibrosarcoma. Meth A fibrosarcoma and colon carcinoma 26 (C26). Further study showed that PC, intact or X-rayed, helped the in vitro tumor growth under the conditions in which L1210 alone did not grow at all, whereas PBM had no enhancing effect to L1210 growth. We characterized the cells involved in tumor growth enhancement by the in vivo and in vitro tests. Plastic dish adherent cells of PC which were Mac-1 positive, large in size and resistant to X-ray, enhanced L1210 growth, whereas non-adherent cells which were Mac-1 negative and small in size, did not. These data suggest that the cells responsible for enhancing activity of tumor progression in the peritoneal cavity were macrophages (M phi).
Animals↗
Bad and good growth factors in the peritoneal cavity.
Progressive peritoneal membrane fibrosis, and associated loss of ultrafiltration and dialysis capacity, is an increasingly limiting problem with time on peritoneal dialysis. The primary culprit is the composition of the peritoneal dialysate, although episodes of peritonitis can hasten the process. At a molecular level, there is increasing evidence that several growth factors play key roles in the development of peritoneal membrane fibrosis. Transforming growth factor (TGF)-beta is widely implicated in pathological fibrosis, and a considerable body of evidence favours a similar role in the peritoneal membrane. Connective tissue growth factor (CTGF), a downstream mediator of TGF-beta-induced fibrosis, has more recently been implicated in peritoneal membrane scarring. In contrast to the pleiotropic effects of TGF-beta, CTGF more specifically targets the fibrosis pathway, and so is an attractive candidate for inhibiting the damage to the membrane. Heparin-binding epidermal growth factor-like growth factor (HB-EGF) has also been found in the peritoneal cavity, but its effect on peritoneal mesothelial cells suggests that it has a positive role in guiding membrane repair and avoiding pathological fibrosis. In the future, it is hoped that changes in peritoneal dialysis technology will create a better balance between the bad and good effects of these growth factors, which in turn will lead to more successful long-term outcomes for this major renal replacement therapy.
Growth Substances↗
Defense mechanisms of the peritoneal cavity.
The peritoneal cavity contains resident and migratory cell populations, which play crucial roles in the local defensive response against bacterial invasion. Although mononuclear phagocytes predominate in the peritoneal cavity of healthy subjects, recent attention has been focused on mesothelial and dendritic cells. Kinetic analysis of inflammatory mediators has derived from experimental models of peritonitis, but advances in the understanding of the roles of molecules such as lipocortins, PAF, leukotriene B4, PPAR gamma agonists, and chemokines has also been made. Little is known about the peritoneal response to physical trauma in the context of the abdominal compartment syndrome. Studies on the cellular and molecular pathology of intra-abdominal abscesses, peritoneal sclerosis, and other less frequent clinical entities (e.g., tertiary peritonitis) are needed. Biological therapy may contribute to improved clinical management of such diseases.
Animals↗