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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

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

[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

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

Lymphatic versus nonlymphatic fluid absorption from the peritoneal cavity as related to the peritoneal ultrafiltration capacity and sieving properties.

In this article we discuss the role of capillary fluid absorption via Starling mechanisms (the transcapillary hydrostatic pressure gradient opposed by the colloid osmotic pressure gradient as multiplied by the capillary UF coefficient) vs. lymphatic fluid absorption as determinants of the total fluid loss from the peritoneal cavity during continuous ambulatory peritoneal dialysis (CAPD). We also mention that, under nonsteady state conditions, there is in addition some net absorption of fluid into the interstitium of tissues surrounding the peritoneal cavity. Support for the contention that nonlymphatic fluid absorption directly into the capillaries is the major mode of fluid transport from the peritoneal cavity to the blood is given by measurements of the peritoneal-to-blood clearance of tracer albumin (or other proteins). Such measurements yield clearance values of the order of 0.2-0.3 ml/min in CAPD. This represents only about 20% of the total peritoneal fluid loss rate (1.2-1.3 ml/min) in ordinary CAPD dwells. Indirect support for a relatively low lymph flow is also derived from capillary physiology. Like continuous capillary walls, the peritoneal membrane shows a bimodal selectivity towards molecules of graded molecular size. Thus, small solute transport can be described as occurring by diffusion through numerous 'small' (approximately 50 A radius) pores, whereas large solute transport is consistent with blood-peritoneal convection through smaller numbers of 'large' (radius approximately 250 A) pores. Furthermore, peritoneal sieving data are compatible with the notion that large crystalloid osmotic pressure gradients cause fluid flow through a water-exclusive ('ultra-small' pore) pathway. A three-pore model of peritoneal selectivity can explain why small solute sieving coefficients are only 0.5-0.6, even though small solute reflection coefficients are close to zero. Another important implication of the three-pore concept is that the peritoneal UF-coefficient is much higher than previously thought, emphasizing the role of capillary absorption in the fluid loss from the peritoneal cavity in CAPD. It is concluded that fluid loss from the peritoneal cavity is dominated by capillary fluid absorption. Hence, lymphatic absorption accounts for just a small fraction of the peritoneal-to-blood absorption of fluid in peritoneal dialysis.

Absorption

Absorption from the peritoneal cavity: SEM study of the mesothelium covering the peritoneal surface of the muscular portion of the diaphragm.

Colored tracers, injected intraperitoneally in mice, are taken up by diaphragmatic lymphatics, outlining their large, terminal cisterns, the so-called lacunae. The lacunae occur exclusively on the muscular portion of the diaphragm. The mesothelium covering non-lacunar and lacunar areas of the muscular portion was examined with the SEM. Mesothelial cells overlying non-lacunar areas are extremely flat, and their boundaries are indistinct. Mesothelial cells overlying lacunae protrude towards the lumen of the peritoneal cavity and have distinct outlines. There are openings or stomata, 4-12 micron in diameter, between them. Some of the stomata overlie a deep pit; others overlie a shallower pit in which the surface of another cell can be seen beneath the opening. It seems likely that the bulk of the fluid draining from the peritoneal cavity passes through these stomata into underlying lymphatic lacunae.

Absorption

Transport of paraquat and mexiletine from the blood into the rat intestinal lumen and peritoneal cavity.

Transport of paraquat and mexiletine from the blood into the intestinal lumen and the peritoneal cavity was examined after their intravenous administration (paraquat: 20 mg kg-1, mexiletine: 10 mg kg-1) to rats. The average amounts of paraquat transferred into the intestinal lumen and the peritoneal cavity were 1.39 and 22.8% of the dose in 120 min, respectively. The average amounts of mexiletine transferred into the intestinal lumen and the peritoneal cavity were 6.1 and 2.5% of the dose in 120 min, respectively. The transfer rate of 3H2O into the peritoneal cavity after intravenous administration (1.85 MBq) was greater than that into the intestinal lumen. In view of the hydrophilic nature of paraquat cation, a solvent drag effect due to movement of water might contribute to transport of paraquat from the blood to the peritoneal cavity. Differences in transport behaviour across the two membranes could be due to differences in the geometrical factors such as the surface area and the distribution of blood vessels. Differences might also be due to differences in physicochemistry and pharmacological effects of both substances.

Animals

Absorption of Intralipid and interferences from nutrients infused into the peritoneal cavity of the rat.

We studied the peritoneal absorption and elimination of Intralipid after its intraperitoneal and intravenous infusion into rats, by means of a two-compartment model. Follow-up measurements of the plasma triglyceride rate were made. The peritoneal absorption of Intralipid gives the following absorption and elimination constants: Ka (absorption constant from the peritoneal cavity) is 0.106 +/- 0.08 h-1; Ke (elimination constant from the blood stream) is 0.0440 +/- 08 h-1; and BAa (absolute bioavailability) is 84.5 +/- 0.08% 8 hours after infusion. These results show that the intraperitoneal absorption of Intralipid is high and progressive during the first 8 hours, thus supplying the daily caloric needs of the animal through the administration of a single bolus administration, and the plasma triglyceride clearance is faster than the intraperitoneal absorption after the first 6 hours, thus avoiding dangerous overloads. We also studied the behavior of different combinations of glucose, amino acids, and fats infused into the peritoneal cavity of rats in order to observe possible interferences with the absorption of these nutrients. Two microcuries of radioactive L-glucose-1-C14 with 5 mL of 5% D-glucose, with 5 mL of 3.5% amino-acid solution, or with 5 mL of 20% fat emulsion were infused intraperitoneally into three different groups of animals. Slight differences of plasma radioactivity were registered among these three groups 1 hour after infusion. Likewise, small differences of plasma radioactivity were observed between the animals receiving an infusion of 1 microCi of five L-amino-acids-U-C14 diluted with 5 mL of 3.5% amino-acid solution, with 5 mL of 5% glucose solution, or with 5 mL of 20% fat emulsion 4 and 6 hours after infusion. No differences in the plasma triglyceride rates were observed between those groups of animals infused with 5 mL of 20% Intralipid plus 5 mL of glucose solution or with 20% Intralipid plus 3.5% amino-acid solution compared with the group receiving only 5 mL of 20% Intralipid. The infusion of fats does not seem to interfere with that of other substrates, possibly because of the different absorption route (lymphatic for fats and capillary vessels for amino acids and glucose solutions), but further research is needed to reach conclusive results. Perhaps the prolonged administration of fat, together with other substrates, produces precipitates and other galenic problems that hinder absorptive mechanisms of the preparations.

Absorption

Studies on lymphatic drainage of the peritoneal cavity in sheep.

In the sheep, it is possible to cannulate several of the lymphatics that drain the peritoneal cavity and assess lymphatic drainage of this serous space directly. Indwelling catheters were placed in the caudal mediastinal and thoracic ducts. The right lymph duct could not be cannulated. Lymphatic drainage of the peritoneal cavity based on the movement of 125I-albumin from the cavity into the lymph compartments was not affected by the osmolality of the dialysate but was markedly altered by anesthesia. In addition, lymphatic drainage was assessed from the disappearance of instilled 125I-albumin from the peritoneal cavity and from the appearance of intraperitoneally administered 125I-albumin in the bloodstream and compared with data from the cannulated preparations. Lymph flows derived from tracer movement into the cannulated lymph compartments and from the appearance of tracer in the bloodstream were very similar. However, calculations of lymph flows based on the disappearance of tracer from the peritoneal cavity appeared to overestimate lymphatic drainage.

Anesthetics

The mast cell: distribution and maturation in the peritoneal cavity of the adult rat.

In the peritoneal cavity of the adult rat mast cells at the four stages of progressive maturation (and corresponding increase of sulphation of granules) are best demonstrated in free peritoneal fluid. Of the 0.1-0.2x10(6) cells in the free fluid, 26% are at stage 1 of maturation (all granules are stained by Alcian blue). 24% at stage 2 (majority of granules are stained by Alcian blue, minority by safranin), 20% at stage 3 (majority of granules are safranin-positive), and 30% at stage 4 (all granules are safranin-positive). Peritoneal washings yield a mean of about 1.3-1.8x10(6) mast cells of which 16% are at stage 1, 24% at stage 2, 34% at stage 3 and 26% at stage 4. The greater number recovered by washing, compared with the number in free peritoneal fluid, suggests that a substantial number of mast cells lie on the surface of the peritoneal membranes.

Adipose Tissue

Effect of glucose concentration and dwell time of dialysis fluid on the antibacterial defense in the peritoneal cavity of rats.

To study the influence of dialysis fluid on the antibacterial defense in the peritoneal cavity of rats, especially glucose concentration and dwell time, an experimental infection was developed. Rats were injected intraperitoneally with dialysis fluid with a glucose concentration of 1.36%, 2.27%, or 3.86% or physiological saline. Subsequently 1, 4 or 18 hr thereafter an inoculum of approximately 3 x 10(8) colony forming units of Staphylococcus aureus was administered intraperitoneally (i.p.) Next, 24 hr after the inoculation the number of viable bacteria was determined. Peritoneal cells (PC) isolated 1, 4 and 18 hr after the administration of dialysis fluid were tested for their capacity to kill S. aureus in vitro. A positive relation was observed between the glucose concentration and the number of bacteria isolated; the longer the dwell time the lower this number. In vitro PC isolated at the various intervals did not differ in their capacity to kill S. aureus. It is concluded that the glucose concentration in dialysis fluid impairs the antistaphylococcal defense in the peritoneal cavity of rats. A relatively long dwell time enhances this defense. These results cannot be explained by a lower capacity of the PC to kill S. aureus in vitro.

Animals

Relative rates of absorption of fluid and protein from the peritoneal cavity in cats.

The relative rates of fluid and protein absorption from the peritoneal cavity of anesthetized cats were measured over 6 hours at an intraperitoneal pressure of 15 mm Hg and with intraperitoneal protein concentrations from 1-8 g%. The fractional absorption rates of fluid and protein did not change significantly over the 6 hours and were not significantly different from each other within each one hour period. In addition both fractional absorption rates were unaffected by the protein concentration of the fluid within the peritoneal cavity. Although the absolute rate of absorption is greatly increased by elevation of the intraperitoneal pressure, these data indicate that the process remains iso-oncotic as would be expected for lymphatic rather than transcapillary absorption.

Absorption

Possible association of granulocyte mobilization to the peritoneal cavity with ZnCl2-induced protection against endotoxin.

We have attempted to determine which components of the inflammatory response are responsible for ZnCl2-induced retention of endotoxin in the peritoneal cavity and enhancement of survival following challange with the toxin. ZnCl2 injected intraperitoneally into mice caused accumulation of granulocytes in the peritoneal cavity, but these cells were apparently not responsible for the trapping process. This contention in supported by our observation that reduction of hepatosplenic uptake of 51CR-labeled endotonxin was similar in unirradiated mice and in mice made by irradiation (1000 rad 60 Co) 1 rad = 10 (-2) J/kg). Hepatosplenic uptake was also depressed when untreated mice were injected with endotoxin suspended in cell-free plasma. Furthermore, zinc did not protect irradiated mice challanged with endotoxin, although it enhanced survival in urirradiated animals. Lack of protection in irradiated mice may be due to a deficiency in the cellular response in the peritoneal cavity.

Animals

Cytotoxic T cells in the peritoneal cavity of mice infected with ectromelia virus.

Peritoneal exudate cells from mice infected with ectromelia virus were cytotoxic for virus-infected target cells as measured in a 51Cr release assay. Cytotoxic activity seemed to be T cell-dependent as it was largely abolished by treatment with anti-theta serum and complement but was not impaired by macrophage depletion. The kinetics of development of cytotoxicity in the peritoneal cavity lagged behind spleen cytotoxicity by 1-2 days. Peak activity in peritoneal cells was present about 6 days after intravenous infection with virus. These studies suggest that macrophages present in the free peritoneal cell populations of ectromelia-infected mice are not cytotoxic for virus-infected target cells. The effect of macrophages in virus clearance is therefore likely to be due to phagocytic rather than cytotoxic effects.

Animals