Effect of peritoneal fluid supplemented with exogenous progesterone on sperm motility in vitro

Since progesterone has been claimed to induce acrosomal reaction and hyperactivated motility of human spermatozoa, the present study was undertaken to determine if its presence at concentrations similar to those of peri-ovulatory follicular fluid could influence the effect of peritoneal fluid on sperm motility in vitro. To this end, 11 sperm samples were incubated at 37 degrees C with five peritoneal fluids with/without exogenous progesterone, and sperm motility was assessed using a computer-assisted analyser at time (t) = 0, 2.5, 5 and 24 h. Overall there was no observable constant trend for enhancement or inhibition of sperm motility. Progesterone generally induced a negative effect on those sperm samples with high velocities in the native peritoneal fluids and a positive effect on those sperm samples demonstrating low motility in the native peritoneal fluids. The incorporation of progesterone into the incubation medium seemed to result in a 'tuning' of sperm velocity to around 30-50 micron/s. However, a given sperm sample reacted differently when incubated with various peritoneal fluids and, reciprocally, different semen samples incubated with the same peritoneal fluid showed very variable motility patterns. The greater variability of the effects exerted by progesterone on sperm motility could arise from the fact that each sperm sample may contain subpopulations of gametes with different sensitivity to progesterone.

Analysis of pH and pO2 in abscesses, peritoneal fluid, and drainage fluid in the presence or absence of bacterial infection during and after abdominal surgery

The diagnostic significance of pH, pO2 (partial pressure of oxygen), and pCO2 (partial pressure of carbon dioxide) was studied in pus, peritoneal fluid, and drainage fluid obtained during or after abdominal surgery. Measurements of these fluids in 59 patients with clinically and bacteriologically documented abdominal or anorectal infection (median pH: 6.75, median pO2: 28 mm Hg, median pCO2: 89 mm Hg) differed significantly (p < 0.001) from data of 105 patients undergoing elective laparotomy for a reason other than infection (median pH: 7.49, median pO2: 144 mm Hg, median pCO2: 92 mm Hg). The combined use of a threshold criterion for pH and pO2 allowed for excellent discrimination between infected (pH less than 7.1, pO2 less than 49 mm Hg) and noninfected patients, with positive and negative predictive values of 98% and 99%, respectively. In conclusion, conditions prevailing during standard in vitro susceptibility tests more closely reflect physiologic conditions as opposed to the conditions prevailing at the site of abdominal infections. Measurements of pH and pO2 allow for an easy, quick, sensitive, and specific diagnosis of bacterial abdominal infection.

Effect of peritoneal fluid pH on outcome of aminoglycoside treatment of intraabdominal infections

Netilmicin and clindamycin were administered to 47 patients with an intraabdominal infection who underwent emergency laparotomy. Thirty-one patients were cured, seven were improved, and therapy failed in nine patients despite the fact that all aerobic bacteria isolated from these patients were sensitive to netilmicin as determined by standard in vitro susceptibility tests. The pH of peritoneal and drainage fluid collected intraoperatively and during follow-up correlated with clinical outcome. Acidic pH was found in 21 of 33 (64%) specimens sampled from patients with therapeutic failure compared to 17 of 80 (21%) obtained from the categories "cured" and "improved" (p < 0.001). Netilmicin concentrations in serum or peritoneal/drainage fluid did not correlate with clinical outcome. Netilmicin levels were above the minimal inhibitory concentration of the pathogens in 59 of 64 (92%) drainage fluid specimens in which aerobic bacteria were isolated. Aerobic bacteria were isolated in 91% of drainage fluid specimens if the pH was less than 7.0, compared to 37% if pH was more than 7.0 (p < 0.001). Reduction of pH antagonized aminoglycoside activity in vitro against clinical isolates of Escherichia coli. Surgical reexploration should be considered in cases of deterioration following a laparotomy associated with detection of acidic drainage fluid.

Increased chemotactic activity of peritoneal fluid in patients with endometriosis

OBJECTIVE

Our purpose was to investigate the ability of the peritoneal fluid of patients with endometriosis to induce chemotaxis of neutrophils and macrophages.

STUDY DESIGN

Peritoneal fluid samples of patients with endometriosis (n = 20), normal fertile controls (n = 12), or patients with medical suppression (n = 8) were evaluated for chemotactic activity. Results of chemotactic activity were analyzed by analysis of variance.

RESULTS

Peritoneal fluid of patients with endometriosis demonstrated a significantly higher chemotactic activity than that of patients without endometriosis or with medical suppression. Patients who had received medical treatment had the lowest chemotactic activity. (p < 0.001 for endometriosis vs control or treatment patients, p = 0.005 for control group vs treatment group).

CONCLUSIONS

Patients with endometriosis have a higher chemotactic activity in their peritoneal fluid; prior medical treatment significantly reduces this activity. This chemotactic factor has an estimated weight of 20 kd. The nature and source of this chemotactic factor remains to be determined.

Errors in estimating peritoneal fluid by bioelectrical impedance analysis and total body electrical conductivity

Whole-body bioelectrical impedance analysis (BIA) and total body electrical conductivity (TOBEC) have been used to estimate body composition and generalized changes in total body water (TBW). The sensitivity of these methods to measure small, rapid, localized changes in body water has not been fully evaluated. We compared the prediction of TBW by whole-body and segmental BIA and TOBEC with deuterium oxide dilution (D2O) in 10 control subjects and 7 renal failure patients receiving continuous ambulatory peritoneal dialysis (CAPD) prior to and after dialysate infusion. Using D2O as the reference method, there was no significant mean residual error between TBW predicted by BIA and TOBEC in controls (-1.2 +/- 1.5 and -0.9 +/- 1.0 kg) and CAPD patients pre-infusion (-1.0 +/- 2.0 and 0.29 +/- 2.01 kg). After infusing 1.9 +/- 0.18 kg dialysate, the mean residual error between change in body weight and the three methods was -0.44 +/- 0.53 kg for D2O (p < 0.1), -1.7 +/- 0.25 kg for BIA (p < 0.0001), and 1.2 +/- 0.4 kg for TOBEC (p < 0.001). Segmental BIA detected a 7.6% reduction in trunkal resistance with no significant change across the limbs, consistent with abdominal fluid accumulation. It is concluded that whole-body BIA underpredicts and TOBEC overpredicts small changes in peritoneal fluids.

Adverse effects on sperm movement characteristics in women with minimal and mild endometriosis

OBJECTIVE

To test the effect of peritoneal fluid from infertile women with minimal or mild endometriosis on sperm movement characteristics in comparison with fertile and infertile women with no endometriosis.

DESIGN

A prospective observer-blind trial.

SETTING

Academic infertility department.

SUBJECTS

57 women undergoing diagnostic laparoscopy or laparoscopic sterilisation.

MAIN OUTCOME MEASURES

Changes in sperm movement characteristics in semen samples provided during routine infertility investigation or from sperm donors. Computer assisted semen analysis (CASA) performed using a Celltrack-S system.

RESULTS

Significant reductions in linearity (P < 0.05), amplitude of lateral head displacement (P < 0.01), straight line velocity (P < 0.01), and curvilinear velocity (P < 0.01) (but not percentage motility) were observed.

CONCLUSIONS

Peritoneal fluid from women with minimal or mild endometriosis adversely effects sperm movement characteristics in comparison to fertile women.

Hemodynamic effects following intraperitoneal infusion of pancreatic ascites fluid

Severe necrotizing pancreatitis is accompanied by release of hemorrhagic ascites fluid (HAF), which is thought to be related to the occurrence and frequency of cardiocirculatory and pulmonary failure as a consequence of acute pancreatitis. The purpose of this study was to evaluate the role of HAF due to these systemic complications. Experiments were performed in 25 pigs (mean b.wt. 22 +/- 1 kg) under general anesthesia and mechanical ventilation. The animals received 50 ml/kg b.wt. i.p. of either physiologic saline solution (control CO, n = 9) or hemorrhagic ascites fluid (HAF, n = 16). HAF was obtained from 16 pigs with pancreatitis induced by intraductal infusion of bile salt. Eight animals in the HAF group were pretreated with indomethacin (10 mg/kg i.v. INDO/HAF). All animals were followed up for 6 h. Mean arterial pressure, cardiac output, and stroke volume fell significantly in the HAF (-25%, -27%, -27%) and in the INDO/HAF groups (-24%, -20%, -17%) as compared with controls (-6%, -6%, -6%). Also, left ventricular end-diastolic pressure (LVEDP) decreased by 52% and 48% in both HAF recipient groups, whereas LVEDP was unchanged in the control group. Myocardial contractility (Vmax) remained unaltered in all experimental groups. No significant differences in gas exchange and lung dry/wet weight ratio were observed. Lipase and PGI2 of the unpretreated HAF group rised to 203% and 198% in arterial blood at 6 h compared with unaltered levels in the control group. No increase of prostanoid concentrations was detected in the indomethacin-pretreated group, whereas lipase increase by a comparable extent as in the HAF group. We conclude that the early consequences of HAF are mainly characterized by systemic hypotension due to hypovolemia.

[The effect of ascitic fluid globulins on the growth of leukemia P388/DOX and Ehrlich's carcinoma in mice]

The study was performed to investigate the effect of ascitic fluid globulins of tumor on tumor growth and life span of mice. The globulins are shown to shorten the life span of Ehrlich tumor mice from 86.8 to 61.8 days, to increase 3-5-fold the growth rate of Ehrlich carcinoma and P388/DOX tumor. It was found that globulins of ascitic fluids and serum globulins of tumor have equal effects of tumor growth. It is proposed to use globulins of ascitic fluid to study the globulin role in tumor growth.

Impaired functions of normal peripheral polymorphonuclear leukocytes in cirrhotic ascitic fluid

The function of normal polymorphonuclear cells in the ascitic fluid of 32 patients with cirrhotic ascites and 17 patients with malignant ascites was studied independently of ascitic fluid heat-labile factors. Polymorphonuclear (PMN) function was assessed by a chemiluminescence method using preopsonized zymosan as stimuli. The chemiluminescence response was higher in malignant ascitic fluid than in cirrhotic ascitic fluid (0.84 and 0.15, respectively, p < 0.001). These results were confirmed by a microbiological assessment of phagocytosis. Suppressive factors were evidenced by making ascitic fluid dilutions and using cell-free chemiluminescence measurements. Addition of malignant ascitic fluid to cirrhotic ascitic fluid showed that there is also a deficiency in supportive factors other than C3. The impaired PMN production of oxidative metabolites we observed in cirrhotic ascitic fluid can partly explain the high susceptibility of cirrhotic patients to spontaneous bacterial peritonitis independently of C3 levels.

Peritoneal fluid from patients with endometriosis decreases sperm binding to the zona pellucida in the hemizona assay: a preliminary report

OBJECTIVE

To evaluate the effect of peritoneal fluid (PF) from patients with endometriosis on gamete interaction under hemizona assay (HZA) conditions.

DESIGN

The HZA was used to study the effect of PF from patients with endometriosis on sperm binding to the zona pellucida using media and normal PF as controls.

SETTING

The patients were collected from a university hospital infertility clinic.

PATIENTS

Peritoneal fluid from 16 women being evaluated for infertility or sterilization who were found to have endometriosis at surgery was used. Three normal patients, who were being sterilized, had PF that was used as a control.

RESULTS

Results suggest that there is a significant reduction in the number of tightly bound sperm to the zona surface in endometriosis specimens as reflected in the hemizona index and that this effect is directly related to the stage of the disease.

CONCLUSIONS

Although the sample is small, this methodology may help to elucidate one of the mechanisms responsible for endometriosis-associated infertility.

Effect of volumetric mixtures of peritoneal and follicular fluid from the same woman on sperm motility and acrosomal reactivity in vitro

OBJECTIVE

To study the effect of peritoneal (PF) and follicular fluids (FF from the same woman) as well as of given volumetric combinations thereof on sperm motility and acrosomal reactivity.

DESIGN

Prospective. Peritoneal fluid and FF were incubated separately or in given volumetric combinations (PF/FF = 100/0, 75/25, 50/50, 25/75, 0/100; vol/vol) with swim-up sperm suspensions.

SETTING

In vitro fertilization and general infertility clinic and laboratories.

PATIENTS, PARTICIPANTS

Women participants of the gamete intrafallopian transfer program (motility study, n = 20; acrosomal reaction study, n = 14). Sperm donors of the artificial insemination program and men with given sperm parameters.

INTERVENTIONS

Hormonal stimulation. Laparoscopy.

MAIN OUTCOME MEASURES

Progressive velocity and percentage of motile gametes measured with multiple-exposure photography. Acrosomal reactivity measured by an immunofluorescent technique.

RESULTS

Follicular fluid always influenced progressive motility and also sustained the number of motile gametes, as function of time, better than PF or the PF/FF mixtures (P less than 0.05). The acrosomal reactivity of sperm incubated in the various PF/FF combinations was low; after 5 hours only the FF-sperm suspensions showed a significant enhancement of acrosomally reacted gametes.

CONCLUSION

At ovulation, FF transmit positive (motility- and acrosomal reactivity-enhancing) signals to sperm, whereas PF may transmit positive, neutral, or negative signals (noise signals). The volumetric combination of FF and PF in the tubal environment, which may differ from cycle to cycle and from woman to woman, could therefore result in synergic (or antagonistic) effects on the sperm fertility potential.

Pathophysiology of ascites formation

Ascites formation in patients with cirrhosis of the liver is dependent on local factors that preferentially localize any fluid retention to the peritoneal space and systemic factors that favor renal retention of salt and water. The local factors are largely related to adaptive changes in the hepatic sinusoids and mesenteric capillaries in response to an increase in hydrostatic pressure. The systemic factors reflect the disturbance in volume homeostasis evident in patients with cirrhosis and are largely explained by the neurohumoral consequences of a decreased peripheral vascular resistance.

The effect of preovulatory peritoneal fluid from cases of endometriosis on murine in vitro fertilization, embryo development, oviduct transport, and implantation

OBJECTIVE

The null hypothesis of our study is that the success of in vitro and in vivo murine fertilization and embryo development is not decreased by gamete exposure to peritoneal fluid from superovulated patients with endometriosis.

STUDY DESIGN

A murine in vitro fertilization model was used to test the effects of endometriosis versus nonendometriosis peritoneal fluid at concentrations of 1%, 5%, and 10% versus an unsupplemented control. Fertilization and blastocyst formation were compared by analysis of variance. In a second experiment superovulated mice were given intraperitoneal injections of endometriosis or nonendometriosis fluid or saline solution 8 hours after human chorionic gonadotropin and then mated. Some mice were killed 3 days after coitus to assess embryo number, cleavage stage, and uterine versus tubal position by means of analysis of variance and covariance with repeated measures. Others were killed 12 days after coitus with the mean number of implantations per animal between groups compared by Student's t test.

RESULTS

In vitro fertilization rates decreased as peritoneal fluid concentration increased in both the endometriosis (65%, 43%, 33%) and nonendometriosis (65%, 52%, 35%) groups at 1%, 5%, and 10% peritoneal fluid concentration, respectively. Mice receiving intraperitoneal endometriosis or nonendometriosis fluid or saline solution injections showed no differences in embryo number, cleavage, uterine versus tubal position, or mean implantation number.

CONCLUSION

Peritoneal fluid from superovulated patients had no differentially negative effect when compared with the effect of nonendometriosis peritoneal fluid on murine in vitro or in vivo fertilization and embryo development, tubal embryo transport, or implantation.

[Mast cells in the focus of an acute infectious inflammation]

On the model of E. coli-induced acute infectious peritonitis in rats it is established that the mast cell reaction and histamine level increase in exudate and inflamed mesentery tissue are biphase and are observed predominantly following the inflammatory agent action, in the period corresponding to the immediate phase of peritoneal cavity vessel permeability increases. The preliminary elimination of mast cells significantly inhibits a rise in the vascular permeability in the immediate phase and slightly affects the delayed phase, thus prolonging exudation. At the same time the dynamics of free histamine indicates its direct involvement in mediation and/or modulation as well as in subsequent inflammatory events. The common rules of mast cell involvement and vascular permeability increase in infectious and aseptic inflammation have been shown.

Computer simulations of peritoneal fluid transport in CAPD

To model the changes in intraperitoneal dialysate volume (IPV) occurring over dwell time under various conditions in continuous ambulatory peritoneal dialysis (CAPD), we have, using a personal computer (PC), numerically integrated the phenomenological equations that describe the net ultrafiltration (UF) flow existing across the peritoneal membrane in every moment of a dwell. Computer modelling was performed according to a three-pore model of membrane selectivity as based on current concepts in capillary physiology. This model comprises small "paracellular" pores (radius approximately 47 A) and "large" pores (radius approximately 250 A), together accounting for approximately 98% of the total UF-coefficient (LpS), and also "transcellular" pores (pore radius approximately 4 to 5 A) accounting for 1.5% of LpS. Simulated curves made a good fit to IPV versus time data obtained experimentally in adult patients, using either 1.36 or 3.86% glucose dialysis solutions, under control conditions; when the peritoneal UF-coefficient was set to 0.082 ml/min/mm Hg, the glucose reflection coefficient was 0.043 and the peritoneal lymph flow was set to 0.3 ml/min. Also, theoretical predictions regarding the IPV versus time curves agreed well with the computer simulated results for perturbed values of effective peritoneal surface area, LpS, glucose permeability-surface area product (PS or "MTAC"), intraperitoneal dialysate volume and dialysate glucose concentration. Thus, increasing the peritoneal surface area caused the IPV versus time curves to peak earlier than during control, while the maximal volume ultrafiltered was not markedly affected. However, increasing the glucose PS caused both a reduction in the IPV versus time curve "peak time" and in the "peak height" of the curves. The latter pattern was also seen when the dialysate volume was reduced. It is suggested that computer modelling based on a three-pore model of membrane selectivity may be a useful tool for describing the IPV versus time relationships under various conditions in CAPD.

Lymphatic removal of dialysate from the peritoneal cavity of anesthetized sheep

Several investigators have suggested that the lymphatic circulation reduces ultrafiltration in continuous ambulatory peritoneal dialysis (CAPD). The purpose of this study was to assess lymphatic drainage of the peritoneal cavity directly in anesthetized sheep under dialysis conditions. Lymph was collected from the caudal mediastinal lymph node and the thoracic duct, both of which are involved in the lymphatic drainage of the ovine peritoneal cavity, and from the prescapular lymph node, which is not involved in peritoneal lymphatic drainage. Fifty ml/kg volumes of a mildly hypertonic dialysis solution (Dianeal 1.5%) containing 25 microCi 125I-human serum albumin were instilled into the peritoneal cavity, and lymph flows and the appearance of labeled protein in the lymphatic and vascular compartments were monitored for six hours. Following the instillation of dialysis fluid there was a tendency for lymph flow rates from the thoracic duct to increase but these changes were not significant. However, flow rates from the caudal lymphatic demonstrated significant increases, especially in the final three hours of the monitoring period. Only about 8% of the radiolabeled albumin was removed from the peritoneal cavity over six hours (that is, 92% was left in the peritoneal space). Of the albumin removed, approximately 17% of this was drained by abdominal visceral lymphatics into the thoracic duct. About 25% passed through the diaphragm into the caudal mediastinal lymph node and into efferent lymph. Since the efferent lymphatic duct of the caudal mediastinal node empties directly into the thoracic duct, about 42% of all protein removed from the peritoneal cavity of the sheep was ultimately transported to the thoracic duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma water filtration and lymphatic uptake during peritoneal dialysis

To clarify further the extent, pathways, and significance of convective transport during peritoneal dialysis, acute transport studies were conducted in which five continuous ambulatory peritoneal dialysis (CAPD) patients underwent 6 hr dialyses (2 L infusate with 2.25% dextrose) on 2 successive days, with multiple sampling of both blood and peritoneal dialysate. Concentrations of permeants (urea, creatinine, uric acid, beta 2 microglobulin, and apolipoprotein A) and a radiolabeled marker (125I-polyvinyl pyrollidone [PVP]) were determined at 20-30 min intervals in dialysate and every 90 min in plasma. Intraperitoneal volumes and lymphatic flows were calculated from rates of dilution and disappearance of 125I-PVP. Intratreatment lymphatic flow rate averaged 76 +/- 15 ml/hr. Although lower than observed in small animal models and reported by some clinical groups, this level of lymphatic drainage was still sufficient to decrease net patient weight loss by approximately 50% and to resorb approximately 15% of metabolites in the peritoneal cavity, independent of molecular weight. Transcapillary ultrafiltration ranged from 7.4 +/- 1.5 ml/min at 10 min into the exchange to 1.3 +/- 1.5 ml/min at 345 min. Reverse ultrafiltration, from the peritoneal cavity back through capillary vasculature to the patient, was not observed in any patient in this study.

Characterization of a 54 kDa, alpha 1-antitrypsin-like protein isolated from ascitic fluid of an endometrial cancer patient

A protein factor which stimulated [3H]thymidine uptake into free hepatocytes prepared from normal mouse liver was detected in the ascitic fluid of gynecological cancer patients. The factor was subsequently further purified from the ascitic fluid of an endometrial cancer patient by DEAE-Sephacel, Sephadex G-150 and Phenyl-Sepharose CL-4B column chromatographies, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed a single protein band of 54,000 Da, designated tentatively as 54K ascitic protein (54K-AP). 54K-AP was similar to human alpha 1-antitrypsin (alpha 1-AT) in terms of SDS-PAGE and immunological behavior, but was slightly different in terms of amino acid sequence and isoelectric point. Although 54K-AP inhibited the activities of bovine trypsin and alpha-chymotrypsin as did human alpha 1-AT, 54K-AP inhibited the plasminogen activator released from human endometrial cancer Ishikawa cells more efficiently than alpha 1-AT. Because, in contrast to normal serum, the serum from the endometrial cancer patients stimulated [3H]thymidine uptake into hepatocytes, the possibility arises that 54K-AP could be produced by the cancer host as a defence mechanism against the cancer.

Peritoneal macrophages from patients on continuous ambulatory peritoneal dialysis have an increased capability to release tumour necrosis factor during peritonitis

We have reported previously that human peritoneal macrophages collected from patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) during an episode of peritonitis secrete increased amounts of interleukin-1 (IL-1), as compared to those collected during an infection free period, provided the cells were stimulated in vitro by LPS. We now report that such macrophages release also higher amounts of Tumor Necrosis Factor (TNF), if collected during peritonitis and stimulated subsequently in vitro by LPS. The increase in release of TNF was ascertained by radio-immunoassays as well as by bioassay of cytostatic effect against the highly sensitive TNF target-cell line L929 murine transformed fibroblasts. The present reported results, in addition to previously reported data on release of IL-1, indicate that induction of release of cytokines from human peritoneal macrophages is a dual stepwise process: first priming in vivo in an inflammatory environment and, secondly stimulation in vitro by LPS.

Peritoneal fluid fractions from patients with endometriosis do not promote two-cell mouse embryo growth

Peritoneal fluid (PF) from 10 infertile patients with endometriosis, obtained during the follicular phase of the cycle during laparoscopy, did not promote two-cell mouse embryo growth to the extent observed by fluid obtained from seven normal controls. Five molecular weight (MW) fractions were obtained by ultrafiltration, and each was used as media supplement in the assay and compared with PF fractions from normal controls. All fractions of PF from patients with endometriosis inhibited mouse embryo growth to a greater extent than did normal controls. However, the MW fractions greater than 100,000 daltons showed greater inhibition of embryo development than did fractions less than 100,000 daltons. This study of cell-free PF suggests the presence of a humoral factor greater than 100,000 daltons that is inhibitory on mouse embryo growth.

Pathophysiology of mild endometriosis: review of literature

Endometriosis is a puzzling condition and the literature is characterized by a large number of uncontrolled reports on its aetiology and pathophysiology. In particular the relationship between mild endometriosis and subfecundity is uncertain. This paper critically reviews the published literature on the pathogenesis, prevalence, menstrual symptomatology and natural history of endometriosis. Furthermore, factors implicated in causing subfecundity in relation to endometriosis and the impact of various treatments in enhancing fertility among women with mild endometriosis have been assessed.

The modulation of prostaglandin synthesis by peritoneal fluids

Biological fluids from several sources (e.g. blood, fetal urine, amniotic fluid) have been shown to contain factors that modulate prostaglandin (PG) synthesis. In this study, we investigated the possibility that peritoneal fluid contains substances that may regulate PG synthesis. Peritoneal fluids were obtained from women undergoing diagnostic laparoscopy for infertility. Fluids from women without evident pelvic pathology were incubated with prostaglandin synthase prepared from bull seminal vesicles in the presence of excess arachidonic acid, and the production of PGE2, PGF2 alpha, and 6-keto-PGF1 alpha was quantified by specific radioimmunoassay. The untreated fluids inhibited potently the synthesis of PGE2 but such inhibitory activity was not extractable by chloroform:methanol. An ultrafiltrate of the fluid containing molecules smaller than 10,000 Daltons stimulated PGF2 alpha synthesis but this activity was also lost after extraction. The extracted fluid did, however, stimulate the synthesis of prostacyclin (as reflected by 6-keto-PGF1 alpha).

Epidermal growth factor and transforming growth factor alpha induce ascitic fluid in mice

Recent studies have suggested that pleural or peritoneal effusion associated with metastatic tumors is induced by some mediators produced by the tumor cells. We studied the ability of well-characterized peptide growth factors to produce ascites in mice. Peritoneal administration of epidermal growth factor (EGF, 10 to 40 micrograms/mouse/wk) or transforming growth factor alpha (TGF-alpha, 10 to 40 micrograms/mouse/wk) via osmotic minipumps resulted in formation of bloody ascites. The amount of ascites produced was dependent on the dose of growth factors. Vehicle alone or insulin-like growth factor I (40 micrograms/mouse/wk) was without effect. Indomethacin, a blocker of prostaglandin synthesis, significantly reduced the ascites accumulation induced by EGF, suggesting that prostaglandins are involved in ascites formation induced by EGF. Dexamethasone was also effective in attenuating the effect of EGF. Thus, it is possible that peritoneal effusion associated with disseminated tumors is, at least in part, due to EGF-like materials (most likely TGF-alpha) produced by tumor cells. The mechanism by which these peptides induce bloody ascites is not known for certain, but it may be due to the reported activity for neovascularization or increased vascular permeability.

Transperitoneal fluid dynamics in rabbit liver

The peritoneal cavity of 18 anesthetized spontaneously breathing supine rabbits was opened through a midline section. One or two hollow capsules (surface area 0.8 cm2) were glued to the exposed liver surface, filled with whole or 25% diluted plasma, and connected to a transducer and a graduated pipette. Various hydraulic pressures (Pcap) were set in the capsule; at each Pcap the liquid flow per unit surface area (V/S) between the Disse's interstitial space and the capsule was measured from the rate of liquid displacement in the pipette. The slope of the V/S vs. Pcap linear regression was utilized to estimate the hydraulic conductivity of the Glissonian-peritoneal membrane and averaged 5.1 x 10(-3) +/- 4.7 x 10(-3) (SD) ml.h-1.cmH2O-1.cm-2 (n = 25). Hydraulic pressure in the Disse's space (Pd) was measured by closing the capsule against the transducer disconnected from the pipette. At portal and hepatic venous pressures of 7.6 +/- 2.9 and 2.6 +/- 1 cmH2O, respectively, Pd was 2.05 +/- 2 cmH2O. Physiologically, Starling pressure gradients cause fluid transfer from the sinusoids to the Disse's space; transperitoneal fluid filtration only occurs through the liver surface that faces the diaphragm, which corresponds to one-fifth of the total hepatic surface.

Single, total paracentesis for tense ascites: sequential hemodynamic changes and right atrial size

Hemodynamic changes induced by a single, total paracentesis were evaluated in 21 patients with tense ascites from whom 4 to 16 L of ascites were drained over 2 to 8 hr with no serious complications. At 60 min, compared to baseline, there was an increase in cardiac output (7.7 +/- 0.5 to 8.5 +/- 0.6 L/min, p less than 0.02) and a tendency for right atrial pressure to decrease (9.3 +/- 0.8 to 7.50 +/- 0.8 mm Hg, NS), with no change in pulmonary capillary wedge pressure (10.9 +/- 0.9 to 10.7 +/- 0.9 mm Hg). Between 3 and 12 hr later, there was a drop in right atrial pressure, pulmonary capillary wedge pressure and cardiac output to 5.6 +/- 0.6 (p less than 0.02), 7.2 +/- 0.8 mm Hg (p less than 0.002) and 7.2 +/- 0.6 L/min (NS) respectively, indicative of the development of relative hypovolemia and suggesting that therapeutic plasma expansion is appropriate at this time. Two-dimensional echocardiography before paracentesis (n = 8) showed a reduction in the right to left atrium area ratio as compared with values in patients with minimal ascites (0.54 +/- 0.04 vs 0.82 +/- 0.02, p less than 0.0001). This technique may help in identifying patients with right atrial compression caused by tense ascites.