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Yang Q, Ding J, Zhang Y, Ning N, Wang M. Cecal volvulus: A rare cause of intestinal obstruction after peritoneal dialysis catheter insertion. Nephrology (Carlton) 2023. [PMID: 37209084 DOI: 10.1111/nep.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Qinghua Yang
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Jiaxiang Ding
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Yankai Zhang
- Department of Gastrointestinal Surgery, Peking University International Hospital, Beijing, China
| | - Ning Ning
- Department of Gastrointestinal Surgery, Peking University International Hospital, Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University International Hospital, Beijing, China
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Negrini D. Morphological, Mechanical and Hydrodynamic Aspects of Diaphragmatic Lymphatics. BIOLOGY 2022; 11:biology11121803. [PMID: 36552311 PMCID: PMC9775868 DOI: 10.3390/biology11121803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
The diaphragmatic lymphatic vascular network has unique anatomical characteristics. Studying the morphology and distribution of the lymphatic network in the mouse diaphragm by fluorescence-immunohistochemistry using LYVE-1 (a lymphatic endothelial marker) revealed LYVE1+ structures on both sides of the diaphragm-both in its the muscular and tendinous portion, but with different vessel density and configurations. On the pleural side, most LYVE1+ configurations are vessel-like with scanty stomata, while the peritoneal side is characterized by abundant LYVE1+ flattened lacy-ladder shaped structures with several stomata-like pores, particularly in the muscular portion. Such a complex, three-dimensional organization is enriched, at the peripheral rim of the muscular diaphragm, with spontaneously contracting lymphatic vessel segments able to prompt contractile waves to adjacent collecting lymphatics. This review aims at describing how the external tissue forces developing in the diaphragm, along with cyclic cardiogenic and respiratory swings, interplay with the spontaneous contraction of lymphatic vessel segments at the peripheral diaphragmatic rim to simultaneously set and modulate lymph flow from the pleural and peritoneal cavities. These details may provide useful in understanding the role of diaphragmatic lymphatics not only in physiological but, more so, in pathophysiological circumstances such as in dialysis, metastasis or infection.
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Affiliation(s)
- Daniela Negrini
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
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Newallo DS, Chataigne M, Muzahir S. The Role of SPECT/CT in Peritoneal Scintigraphy in the Era of Low-Dose Imaging: A Case Report. World J Nucl Med 2022; 21:65-68. [PMID: 35502280 PMCID: PMC9056127 DOI: 10.1055/s-0042-1748030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Peritoneal scintigraphy, although rarely used, plays a vital role in the diagnosis of peritoneal dialysis catheter complications. Reported complications include spontaneous hydrothorax secondary to a pleuroperitoneal fistula, which requires the abandonment of peritoneal dialysis, given that a delay in diagnosis can lead to worsening clinical status. Previously reported peritoneal scintigraphy protocols recommended intraperitoneal instillation of radiotracer and moderate-to-large volumes of dialysate or sterile saline ranging from 350 to 2,000 mL. However, smaller volumes, in conjunction with the use of single-photon emission computed tomography/computed tomography, are not verified in patients receiving peritoneal scintigraphy imaging.
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Affiliation(s)
- Domnique S. Newallo
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States
| | | | - Saima Muzahir
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States
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Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review. Case Rep Nephrol 2020; 2020:8832080. [PMID: 32934854 PMCID: PMC7479454 DOI: 10.1155/2020/8832080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022] Open
Abstract
Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.
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Balaguer D, Abreu P, Mut T, Reyes M, Plancha M, Caballero E. Hidrotórax secundario a diálisis peritoneal detectado mediante gammagrafía peritoneal. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Balaguer D, Abreu P, Mut T, Reyes M, Plancha M, Caballero E. Hidrotórax secundario a diálisis peritoneal detectado mediante gammagrafía peritoneal. Rev Esp Med Nucl Imagen Mol 2018; 37:118-120. [DOI: 10.1016/j.remn.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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Peritoneal-pericardial communication in an adolescent on peritoneal dialysis. Pediatr Nephrol 2016; 31:153-6. [PMID: 26386589 DOI: 10.1007/s00467-015-3206-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/27/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dialysate leakage into the pericardium is a rare but potentially life-threatening complication of peritoneal dialysis (PD). There has been one reported pediatric case of spontaneous peritoneo-pericardial fistula in a 2-year-old boy with tissue fragility due to malnutrition and two reported adult cases in PD patients with a history of previous cardiac surgery and/or pericardiocentesis. CASE-DIAGNOSIS/TREATMENT We describe a 15-year-old girl with end-stage renal disease secondary to granulomatosis with polyangiitis, with recurrent pericardial effusions secondary to a peritoneo-pericardial fistula while on continuous cycling peritoneal dialysis (CCPD). She had previously presented with chylous pericardial effusion that required pericardiocentesis and subsequently developed recurrent pericardial effusions when she was commenced on CCPD 9 months later. Pericardial fluid chemistry revealed a sterile, serous fluid containing 15.1 mmol/L of glucose and <0.11 mmol/L of triglycerides. Peritoneal scintigraphy with Tc-99m labeled sulfur colloid injected intra-peritoneally confirmed the presence of a peritoneo-pericardial fistula. The pericardial effusions resolved upon switching the patient to hemodialysis (HD). CONCLUSIONS Our case of recurrent pericardial effusions in a child on PD secondary to a peritoneo-pericardial fistula highlights the need for close follow-up in patients with a history of previous pericardiocentesis who are commenced on PD.
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Dufek S, Holtta T, Fischbach M, Ariceta G, Jankauskiene A, Cerkauskiene R, Schmitt CP, Schaefer B, Aufricht C, Wright E, Stefanidis CJ, Ekim M, Bakkaloglu S, Klaus G, Zurowska A, Vondrak K, Vande Walle J, Edefonti A, Shroff R. Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis-A survey from the European Paediatric Dialysis Working Group. Pediatr Nephrol 2015; 30:2021-7. [PMID: 26054713 DOI: 10.1007/s00467-015-3137-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD). METHODS We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF. RESULTS Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66%. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were <3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success. CONCLUSION In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of <3 years, herniae and recent abdominal surgery.
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Affiliation(s)
- Stephanie Dufek
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - Tuula Holtta
- Renal Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | - Gema Ariceta
- Renal Unit, Hospital Cruces, Barakaldo, Vizcaya, Spain.
| | | | | | - Claus Peter Schmitt
- Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany.
| | - Betti Schaefer
- Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany.
| | | | - Elizabeth Wright
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | | | - Mesiha Ekim
- Renal Unit, Ankara University Hospital, Ankara, Turkey.
| | | | - Günter Klaus
- Renal Unit, KfH Pediatric Kidney Center, Marburg, Germany.
| | | | - Karel Vondrak
- Renal Unit, University Hospital Motol, Prague, Czech Republic.
| | | | - Alberto Edefonti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Rukshana Shroff
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
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