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Kamegai N, Kim H, Suzuki Y, Fukui S, Kojima H, Maruyama S, Morgan BP, Zelek WM, Mizuno M. Complement terminal pathway inhibition reduces peritoneal injuries in a rat peritonitis model. Clin Exp Immunol 2023; 214:209-218. [PMID: 37549240 PMCID: PMC10714190 DOI: 10.1093/cei/uxad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/07/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023] Open
Abstract
Peritonitis and the resulting peritoneal injuries are common problems that prevent long-term peritoneal dialysis (PD) therapy in patients with end-stage kidney diseases. Previously, we have analyzed the relationship between the complement system and progression of peritoneal injuries associated with PD, particularly focusing on the early activation pathways and effects of the anaphylatoxins. We here utilized a novel mAb 2H2 that blocks assembly of the membrane attack complex (MAC) to investigate roles of the complement terminal pathway in PD-associated peritoneal injury. We intraperitoneally injected mAb 2H2 anti-C5b-7 (2.5 or 5 mg/rat) once or twice over the five-day course of the experiment to investigate the effects of inhibiting formation of MAC in a fungal rat peritonitis model caused by repeated intraperitoneal administration of zymosan after methylglyoxal pretreatment (Zy/MGO model). Rats were sacrificed on day 5 and macroscopic changes in both parietal and visceral peritoneum evaluated. Peritoneal thickness, the abundance of fibrinogen and complement C3 and MAC deposition in tissue and accumulation of inflammatory cells were pathologically assessed. The results showed that mAb 2H2, but not isotype control mAb, reduced peritoneal thickness and accumulation of inflammatory cells in a dose and frequency-dependent manner in the Zy/MGO model. These effects were accompanied by decreased C3, MAC, and fibrinogen deposition in peritoneum. In conclusion, in the rat Zy/MGO model, complement terminal pathway activation and MAC formation substantially contributed to development of peritoneal injuries, suggesting that MAC-targeted therapies might be effective in preventing development of peritoneal injuries in humans.
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Affiliation(s)
- Naoki Kamegai
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hangsoo Kim
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sosuke Fukui
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kojima
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - B Paul Morgan
- Division of Infection and Immunity, and Dementia Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Wioleta Milena Zelek
- Division of Infection and Immunity, and Dementia Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Fischer A, Wannemacher J, Christ S, Koopmans T, Kadri S, Zhao J, Gouda M, Ye H, Mück-Häusl M, Krenn PW, Machens HG, Fässler R, Neumann PA, Hauck SM, Rinkevich Y. Neutrophils direct preexisting matrix to initiate repair in damaged tissues. Nat Immunol 2022; 23:518-531. [PMID: 35354953 PMCID: PMC8986538 DOI: 10.1038/s41590-022-01166-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/18/2022] [Indexed: 11/09/2022]
Abstract
Internal organs heal injuries with new connective tissue, but the cellular and molecular events of this process remain obscure. By tagging extracellular matrix around the mesothelium lining in mouse peritoneum, liver and cecum, here we show that preexisting matrix was transferred across organs into wounds in various injury models. Using proteomics, genetic lineage-tracing and selective injury in juxtaposed organs, we found that the tissue of origin for the transferred matrix likely dictated the scarring or regeneration of the healing tissue. Single-cell RNA sequencing and genetic and chemical screens indicated that the preexisting matrix was transferred by neutrophils dependent on the HSF-integrin AM/B2-kindlin3 cascade. Pharmacologic inhibition of this axis prevented matrix transfer and the formation of peritoneal adhesions. Matrix transfer was thus an early event of wound repair and provides a therapeutic window to dampen scaring across a range of conditions.
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Affiliation(s)
- Adrian Fischer
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Juliane Wannemacher
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Simon Christ
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Tim Koopmans
- Hubrecht Institute,, Developmental Biology and Stem Cell Research, Utrecht, the Netherlands
| | - Safwen Kadri
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Jiakuan Zhao
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Mahesh Gouda
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Haifeng Ye
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Martin Mück-Häusl
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Peter W Krenn
- Department of Molecular Medicine, Max Planck Institute of Biochemistry, Martinsried, Germany
- Department of Biosciences and Medical Biology, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Hans-Günther Machens
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Plastic and Hand Surgery, Munich, Germany
| | - Reinhard Fässler
- Department of Molecular Medicine, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Philipp-Alexander Neumann
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Stefanie M Hauck
- Metabolomics and Proteomics Core and Research Unit Protein Science, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany
| | - Yuval Rinkevich
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), München, Germany.
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Tong J, Xu W. CT Imaging Characteristics and Influence Factors of Renal Dialysis-Associated Peritoneal Injury. J Healthc Eng 2021; 2021:5591124. [PMID: 33986942 PMCID: PMC8079201 DOI: 10.1155/2021/5591124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
Peritoneal dialysis (PD), as one of the main renal replacement modalities for end-stage renal disease, gets the advantages of better protection of residual renal function and better quality of survival. However, ultrafiltration failure after peritoneal injury is an important reason for patients to withdraw from PD treatment. Peritonitis is a major complication of peritoneal dialysis, which results in an accelerated process of peritoneal injury due to direct damage from acute inflammation and local release of cytokine TGF-β. In this paper, the application of ultrasound to examine the peritoneum revealed a positive correlation between peritoneal thickness and the development of peritonitis. The results of this study also further confirmed the effect of peritonitis on peritoneal thickening. A multifactorial regression analysis also revealed that peritonitis and its severity were independent risk factors for peritoneal thickening and omental structural abnormalities. This paper reported a correlation between mural peritoneal thickness and peritoneal transit function. In this study, patients with high peritoneal transit and high mean transit were found to be more prone to omental structural abnormalities than patients with low mean and low transit and a higher proportion of patients with mural peritoneal thickening, but this did not reach statistical significance, which may be related to the still small number of cases.
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Affiliation(s)
- Jin Tong
- Department of Nephrology, Zhuji People's Hospital, Zhuji, Zhejiang 311800, China
| | - Wangda Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
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Jiang R, Sun Y, Wang H, Liang M, Xie X. Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients: A randomized controlled trial. Medicine (Baltimore) 2019; 98:e17520. [PMID: 31593122 PMCID: PMC6799792 DOI: 10.1097/md.0000000000017520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery. METHODS One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded. RESULTS Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05). CONCLUSION Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.
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Affiliation(s)
- Rongjuan Jiang
- Department of Anesthesiology, Chengdu Second People's Hospital
| | - Yan Sun
- Department of Anesthesiology, Chengdu Second People's Hospital
| | - Huaiming Wang
- Department of Anesthesiology, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Min Liang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xianfeng Xie
- Department of Anesthesiology, Chengdu Second People's Hospital
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Cullinane DC, Jawa RS, Como JJ, Moore AE, Morris DS, Cheriyan J, Guillamondegui OD, Goldberg SR, Petrey L, Schaefer GP, Khwaja KA, Rowell SE, Barbosa RR, Bass GA, Kasotakis G, Robinson BRH. Management of penetrating intraperitoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2019; 86:505-515. [PMID: 30789470 DOI: 10.1097/ta.0000000000002146] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons. METHODS Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications. RESULTS Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data. CONCLUSIONS In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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Affiliation(s)
- Daniel C Cullinane
- From the Department of Surgery, Marshfield Clinic, Marshfield, Wisconsin (D.C.C.); Division of Trauma, Stony Brook University School of Medicine, Stony Brook, New York (R.S.J.); Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio (J.J.C.); Department of Surgery, Holmes Medical Center, Melbourne, Florida (A.M.); Department of Surgery, Intermountain Health Care, Murray, Utah (D.S.M.); Department of Surgery, Kern Medical Center, Bakersfield, California (J.C.); Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (O.D.G.); Department of Surgery, Virginia Commonwealth University, Richmond, Virginia (S.R.G.); Department of Surgery, Baylor University Medical Center, Dallas, Texas (L.P.); Department of Surgery, West Virginia University Medical Center, Morgantown, West Virginia (G.S.); Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada (K.A.K.); Department of Surgery, Oregon Health & Science University, Portland, Oregon (S.E.R.); Department of Surgery, Legacy Emmanuel Medical Center, Portland, Oregon (R.R.B.); Department of Surgery, St. Vincent's Hospital, Dublin, Ireland (G.A.B.); Department of Surgery, Boston Medical Center, Boston, Massachusetts (G.K.); and Department of Surgery, University of Washington, Seattle, Washington (B.R.H.R.)
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6
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Tsai JM, Sinha R, Seita J, Fernhoff N, Christ S, Koopmans T, Krampitz GW, McKenna KM, Xing L, Sandholzer M, Sales JH, Shoham M, McCracken M, Joubert LM, Gordon SR, Poux N, Wernig G, Norton JA, Weissman IL, Rinkevich Y. Surgical adhesions in mice are derived from mesothelial cells and can be targeted by antibodies against mesothelial markers. Sci Transl Med 2018; 10:eaan6735. [PMID: 30487249 DOI: 10.1126/scitranslmed.aan6735] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/26/2017] [Accepted: 04/30/2018] [Indexed: 11/20/2023]
Abstract
Peritoneal adhesions are fibrous tissues that tether organs to one another or to the peritoneal wall and are a major cause of postsurgical and infectious morbidity. The primary molecular chain of events leading to the initiation of adhesions has been elusive, chiefly due to the lack of an identifiable cell of origin. Using clonal analysis and lineage tracing, we have identified injured surface mesothelium expressing podoplanin (PDPN) and mesothelin (MSLN) as a primary instigator of peritoneal adhesions after surgery in mice. We demonstrate that an anti-MSLN antibody diminished adhesion formation in a mouse model where adhesions were induced by surgical ligation to form ischemic buttons and subsequent surgical abrasion of the peritoneum. RNA sequencing and bioinformatics analyses of mouse mesothelial cells from injured mesothelium revealed aspects of the pathological mechanism of adhesion development and yielded several potential regulators of this process. Specifically, we show that PDPN+MSLN+ mesothelium responded to hypoxia by early up-regulation of hypoxia-inducible factor 1 alpha (HIF1α) that preceded adhesion development. Inhibition of HIF1α with small molecules ameliorated the injury program in damaged mesothelium and was sufficient to diminish adhesion severity in a mouse model. Analyses of human adhesion tissue suggested that similar surface markers and signaling pathways may contribute to surgical adhesions in human patients.
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Affiliation(s)
- Jonathan M Tsai
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rahul Sinha
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jun Seita
- AI based Healthcare and Medical Data Analysis Standardization Unit, Medical Sciences Innovation Hub Program, RIKEN, Tokyo 103-0027, Japan
| | - Nathaniel Fernhoff
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Simon Christ
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease,Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tim Koopmans
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease,Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Geoffrey W Krampitz
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of General Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kelly M McKenna
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Liujing Xing
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Sandholzer
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease,Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jennifer Horatia Sales
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease,Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Maia Shoham
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Melissa McCracken
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lydia-Marie Joubert
- Cell Sciences Imaging Facility, Beckman Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sydney R Gordon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nicolas Poux
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gerlinde Wernig
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeffrey A Norton
- Department of General Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Irving L Weissman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Ludwig Center for Cancer Stem Cell Biology and Medicine at Stanford University, Stanford, CA 94305, USA
| | - Yuval Rinkevich
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease,Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany.
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Abstract
BACKGROUND Biocompatible peritoneal dialysis (PD) solutions, including neutral pH, low glucose degradation product (GDP) solutions and icodextrin, have previously been shown to favourably influence some patient-level outcomes, albeit based on generally sub-optimal quality studies. Several additional randomised controlled trials (RCT) evaluating biocompatible solutions in PD patients have been published recently. This is an update of a review first published in 2014. OBJECTIVES This review aimed to look at the benefits and harms of biocompatible PD solutions in comparison to standard PD solutions in patients receiving PD. SEARCH METHODS The Cochrane Kidney and Transplant Specialised Register was searched up to 12 February 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All RCTs and quasi-RCTs in adults and children comparing the effects of biocompatible PD solutions (neutral pH, lactate-buffered, low GDP; neutral pH, bicarbonate(± lactate)-buffered, low GDP; glucose polymer (icodextrin)) in PD were included. Studies of amino acid-based solutions were excluded. DATA COLLECTION AND ANALYSIS Two authors extracted data on study quality and outcomes. Summary effect estimates were obtained using a random-effects model, and results were expressed as risk ratios and 95% confidence intervals (CI) for categorical variables, and mean differences (MD) or standardised mean differences (SMD) and 95% CI for continuous variables. MAIN RESULTS This review update included 42 eligible studies (3262 participants), including six new studies (543 participants). Overall, 29 studies (1971 participants) compared neutral pH, low GDP PD solution with conventional PD solution, and 13 studies (1291 participants) compared icodextrin with conventional PD solution. Risk of bias was assessed as high for sequence generation in three studies, allocation concealment in three studies, attrition bias in 21 studies, and selective outcome reporting bias in 16 studies.Neutral pH, low GDP versus conventional glucose PD solutionUse of neutral pH, low GDP PD solutions improved residual renal function (RRF) preservation (15 studies, 835 participants: SMD 0.19, 95% CI 0.05 to 0.33; high certainty evidence). This approximated to a mean difference in glomerular filtration rate of 0.54 mL/min/1.73 m2 (95% CI 0.14 to 0.93). Better preservation of RRF was evident at all follow-up durations with progressively greater preservation observed with increasing follow up duration. Neutral pH, low GDP PD solution use also improved residual urine volume preservation (11 studies, 791 participants: MD 114.37 mL/day, 95% CI 47.09 to 181.65; high certainty evidence). In low certainty evidence, neutral pH, low GDP solutions may make little or no difference to 4-hour peritoneal ultrafiltration (9 studies, 414 participants: SMD -0.42, 95% CI -0.74 to -0.10) which approximated to a mean difference in peritoneal ultrafiltration of 69.72 mL (16.60 to 122.00 mL) lower, and may increase dialysate:plasma creatinine ratio (10 studies, 746 participants: MD 0.01, 95% CI 0.00 to 0.03), technique failure or death compared with conventional PD solutions. It is uncertain whether neutral pH, low GDP PD solution use led to any differences in peritonitis occurrence, hospitalisation, adverse events (6 studies, 519 participants) or inflow pain (1 study, 58 participants: RR 0.51, 95% CI 0.24 to 1.08).Glucose polymer (icodextrin) versus conventional glucose PD solutionIn moderate certainty evidence, icodextrin probably reduced episodes of uncontrolled fluid overload (2 studies, 100 participants: RR 0.30, 95% CI 0.15 to 0.59) and augmented peritoneal ultrafiltration (4 studies, 102 participants: MD 448.54 mL/d, 95% CI 289.28 to 607.80) without compromising RRF (4 studies, 114 participants: SMD 0.12, 95% CI -0.26 to 0.49; low certainty evidence) which approximated to a mean creatinine clearance of 0.30 mL/min/1.73m2 higher (0.65 lower to 1.23 higher) or urine output (3 studies, 69 participants: MD -88.88 mL/d, 95% CI -356.88 to 179.12; low certainty evidence). It is uncertain whether icodextrin use led to any differences in adverse events (5 studies, 816 participants) technique failure or death. AUTHORS' CONCLUSIONS This updated review strengthens evidence that neutral pH, low GDP PD solution improves RRF and urine volume preservation with high certainty. These effects may be related to increased peritoneal solute transport and reduced peritoneal ultrafiltration, although the evidence for these outcomes is of low certainty due to significant heterogeneity and suboptimal methodological quality. Icodextrin prescription increased peritoneal ultrafiltration and mitigated uncontrolled fluid overload with moderate certainty. The effects of either neutral pH, low GDP solution or icodextrin on peritonitis, technique survival and patient survival remain uncertain and require further high quality, adequately powered RCTs.
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Affiliation(s)
- Htay Htay
- Singapore General HospitalDepartment of Renal Medicine20 College StreetSingaporeSingapore169856
| | - David W Johnson
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQueenslandAustralia4102
- University of QueenslandBrisbaneAustralia
| | | | - Sunil V Badve
- St George HospitalDepartment of NephrologyKogarahNSWAustralia
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- Flinders UniversityCollege of Medicine and Public HealthAdelaideSAAustralia5001
| | - Giovanni FM Strippoli
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- DiaverumMedical Scientific OfficeLundSweden
- Diaverum AcademyBariItaly
| | - Yeoungjee Cho
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQueenslandAustralia4102
- University of QueenslandBrisbaneAustralia
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8
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Abstract
Mucinous cystadenomas are the most frequent cystic benign tumors of the pancreas. They are characterized by a malignant potential. Acute pancreatitis is their most common complication. This manuscript reports a unique complication of mucinous cystadenomas of the pancreas: retroperitoneal rupture associated to acute pancreatitis. After resuscitation, the patient underwent surgery. A cystic mass of the pancreas tail with retroperitoneal rupture was found. Splenopancreatectomy was performed. Outcomes were straightforward. After 3 years of follow-up, no signs of recurrence are highlighted.
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Affiliation(s)
- A Haddad
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - A Sebai
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - R Rhaiem
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - A Ghedira
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - A Makni
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
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9
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Nishiwaki M, Mizuno C, Yano K, Oya H, Amano I, Matsumoto J, Tanaka I, Sawai N, Mizuno M, Shima T, Miyamoto Y, Okanoue T. Retroperitoneal Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent into Periampullary Diverticula. Intern Med 2018; 57:351-355. [PMID: 29093393 PMCID: PMC5827315 DOI: 10.2169/internalmedicine.9054-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. Selective bile duct cannulation was unsuccessful because of periampullary diverticula (PAD). A pancreatic spontaneous dislodgement stent (PSDS) (5F diameter, 3 cm, straight type) was inserted to prevent post-ERCP pancreatitis. Three days after ERCP, she complained of abdominal pain, and computed tomography revealed retroperitoneal perforation because of PSDS migration to the PAD. If the papillary orifice is observed at the diverticular rim or in the diverticula, a pigtailed PSDS on the duodenal side or flanged stent on the pancreatic ductal side should be inserted in order to prevent this rare adverse event.
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Affiliation(s)
- Masatake Nishiwaki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Kota Yano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Ichiro Amano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Junko Matsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Izumi Tanaka
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Naoki Sawai
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | | | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
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Peng Y, Yang H, Ye Q, Zhou H, Zheng M, Shi Y. Inhibition of peritoneal dissemination of colon cancer by hyperthermic CO2 insufflation: A novel approach to prevent intraperitoneal tumor spread. PLoS One 2017; 12:e0172097. [PMID: 28207849 PMCID: PMC5313196 DOI: 10.1371/journal.pone.0172097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The increasing use of laparoscopic surgery for advanced gastrointestinal cancer raises concerns about intra-peritoneal tumor spread. Prevention of peritoneal dissemination is extremely important but a preventive modality is lacking. The aim of this study was to examine a novel approach (hyperthermic CO2 insufflation, HT-CO2) for preventing peritoneal dissemination during laparoscopic surgery. METHODS A peritoneal dissemination model was established in Balb/c nu/nu mice by intraperitoneal injection of human colon cancer cells (SW1116, 1×106). The mice (n = 48) were subsequently randomized into two groups and subjected to hyperthermic CO2 (43°C, >95% humidity, HT-CO2 group) or standard normothermic CO2 (21°C, <1% relative humidity, NT-CO2 group) insufflation for 3 hours. The mice were sacrificed 28 days later. The peritoneal dissemination was quantitatively analyzed by counting and weighing the peritoneal nodules. The port sites and ascites volume were measured. The peritoneal damage of HT-CO2 was histologically examined with light microscopy and scanning electron microscopy. Intra-abdominal adhesions were evaluated 4 weeks later. RESULTS The number of peritoneal nodules in the HT-CO2 group was significantly less than that in the NT-CO2 group (10.21±3.72 vs. 67.12±5.49, P<0.01). The mean weight of metastatic tumors in the HT-CO2 group was significantly lower than that in the NT-CO2 group (0.31±0.10g vs. 2.16±0.31g, P<0.01). Massive ascites were found in the NT-CO2 group while significantly less ascites developed in HT-CO2- treated mice (8.26±0.31ml vs. 1.27±0.28ml, P<0.01). No port-site metastases were detected in the HT-CO2 group while the incidence of the NT-CO2 group was 12.5% (3/24). HT-CO2 subjection resulted in slight peritoneal damage; the peritoneum returned to normal within five days. No adhesions formed after HT-CO2 treatment. CONCLUSIONS HT-CO2 can suppress peritoneal dissemination of colon cancer cells and only causes slight and transient peritoneal damage. HT-CO2 may serve as a promising adjuvant treatment for preventing peritoneal dissemination in laparoscopic resection of advanced colorectal cancer.
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Affiliation(s)
- Yuanfei Peng
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
| | - Hua Yang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
| | - Qing Ye
- Department of Gastrointestinal Tumor Surgery, Fujian Provincial Tumor Hospital of Fujian Medical University, Fujian, China
| | - Houming Zhou
- Department of General Surgery, Shanghai Minimally Invasive Surgery Center, Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Minhua Zheng
- Department of General Surgery, Shanghai Minimally Invasive Surgery Center, Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yinghong Shi
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
- * E-mail:
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Puzio T, Shah M, Dineen H, Chen J, Caddell K, Charles A. A Case of Iliac Crest Avulsion with Peritoneal Disruption and Bowel Herniation after Blunt Trauma: A Case Report and Review of Literature. Am Surg 2016; 82:655-658. [PMID: 27457868 PMCID: PMC5171209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Thaddeus Puzio
- University of North Carolina, Chapel Hill, North Carolina, USA
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Lin S, Qin F, Song LY, Hou CQ, Hou LB. [Sodium tanshinone IIA sulfonate prevents postoperative peritoneal adhesions in rats by enhancing the activity of the peritoneal fibrinolytic system]. Nan Fang Yi Ke Da Xue Xue Bao 2016; 36:260-264. [PMID: 26922027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the effect of sodium tanshinone IIA sulfonate (STS) in preventing postoperative peritoneal adhesions in rats and explore the mechanisms. METHODS Sixty SD rats were randomized into 4 equal groups, including a blank control group, adhesion model group, and high-, moderate-, and low-dose STS-treated groups, and were subjected to injuries of the parietal peritoneum and cecum to induce peritoneal adhesions, followed by intraperitoneal administration of saline and STS at the doses of 20, 10, and 5 mg/kg for 7 consecutive days, respectively. Another 15 untreated rats served as the blank control group. The adhesion scores in each group were recorded after the treatments; the activity of tissue-type plasminogen activator (tPA) in peritoneal lavage fluid was measured, tPA/PAI-1 protein ratio in the peritoneal tissue was determined by ELISA, and the expressions of TGF-β1 and collagen I were detected by immunohistochemistry. The anastomotic healing model was used to assess the impact of STS on wound healing. RESULTS Intraperitoneal administration of STS effectively prevented peritoneal adhesion without affecting anastomotic healing in the rats. Compared with the adhesion model group, the STS-treated groups showed increased peritoneal lavage fluid tPA activity and tPA/PAI-1 ratio in the ischemic tissues with lowered TGF-β1 and collagen I expressions in the ischemic tissues. CONCLUSIONS Intraperitoneal administration of STS can prevent peritoneal adhesion and enhance local fibrinolysis in rats, and these effects may be mediated by TGF-β signaling pathway.
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Affiliation(s)
- Si Lin
- Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
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Siufi Neto J, Santos Siufi DF, Magrina JF. Trocar in conventional laparoscopic and robotic-assisted surgery as a major cause of iatrogenic trauma to the patient. Best Pract Res Clin Obstet Gynaecol 2016; 35:13-9. [PMID: 26723474 DOI: 10.1016/j.bpobgyn.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
All laparoscopic procedures, laparoscopic or robotic-assisted, start with a trocar entry. Unfortunately unknown to most, this is an extremely important part of the surgery, as 80% of major vascular injuries and 50% of intestinal injuries occur during this procedure. Laparoscopic first entry is often delegated to trainees with little experience, wrongly assuming that laparoscopic entry is similar to incisional entry at laparotomy. This may result in patient death (mortality of major vascular injuries is 11% and unrecognized intestinal injuries is 5%) or significant temporary or permanent morbidity.
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Affiliation(s)
- Joao Siufi Neto
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA; Surgical Oncologist, Sírio - Libanês Hospital, São Paulo, SP 01308-050, Brazil.
| | - Daniela Freitas Santos Siufi
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA; Surgical Oncologist, Sírio - Libanês Hospital, São Paulo, SP 01308-050, Brazil
| | - Javier F Magrina
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA
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Yin X, Cui L, Li F, Qi S, Yin Z, Gao J. Lateroconal fascia suspension for management of peritoneal tear and "curtain" effect during retroperitoneal laparoscopic operations. Int Urol Nephrol 2015; 48:201-6. [PMID: 26560474 DOI: 10.1007/s11255-015-1156-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/30/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the method of lateroconal fascia suspension for the management of peritoneal tear and curtain effect during retroperitoneal laparoscopic operations. MATERIALS AND METHODS Between May 2013 and October 2014, we performed lateroconal fascia suspension in 30 cases of retroperitoneal laparoscopic operations. Peritoneal tear occurred and retroperitoneal space collapsed in 18 cases of them during the operation, and free edge of the lateroconal fascia caused curtain effect and sheltered the field of view in another 12 cases after the lateroconal fascia was incised longitudinally. RESULTS The curtain effect of lateroconal fascia was eliminated successfully, and the sheltered field of view got normal in all the 12 cases. The collapsed retroperitoneal space due to peritoneal tear got enlarged effectively and was sufficient for the following operations in 15 patients of the overall 18 cases, while the collapsed retroperitoneal space did not get enlarged significantly in the other three cases. After the insertion of an extra 5-mm trocar into peritoneal space, the collapsed retroperitoneal space got enlarged eventually. Finally, retroperitoneal laparoscopic operations were continued and completed successfully in all these 30 patients. It took 4 min to complete the suspension procedure, and no related complications occurred during the whole suspension process. CONCLUSION Lateroconal fascia suspension method could manage most peritoneal tears and curtain effect effectively during retroperitoneal laparoscopic operations.
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Affiliation(s)
- Xiaotao Yin
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Liang Cui
- Department of Urology, General Hospital of Civil Aviation of China, Beijing, 100123, China
| | - Fanglong Li
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Siyong Qi
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhaoyang Yin
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiangping Gao
- Department of Urology, The First Affiliated Hospital of PLA General Hospital, No. 52 Fuxing Rd, Haidian District, Beijing, 100048, China.
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Gemici K, Kucukpinar T, Cifter C, Okus A, Ay S. The effect of hyaluronate-carboxymethyl-cellulose on the formation of postoperative adhesion in stomach visceral peritoneum damage. BRATISL MED J 2014; 115:749-52. [PMID: 25520221 DOI: 10.4149/bll_2014_144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this study, we aimed at investigating the effect of placing hyaluronate- carboxymethyl-cellulose membrane (HCMC) on the formation of adhesion postoperatively in a damaged area in the peritoneum of the anterior stomach wall. METHODS The study was conducted on 30 rabbits. A transverse peritoneal damage was inflicted on the stomach anterior walls of all rabbits. In the first treatment group, HCMC was placed on the sutured anterior wall of stomach of 15 rabbits. In the second control group, on the other hand, no treatment was conducted on 15 rabbits. On the 30th day after the operation, relaparatomy was performed on the rabbits and adhesions were evaluated by an independent surgeon according to seriousness and prevalence scores. RESULTS There were postoperative adhesions (POA) in 12 (80 %) rabbits in the control group. On the other hand, there were POA in 5 rabbits (33.3 %) in the treatment group. In the treatment group, adhesion was totally prevalent in 2 rabbits (13.3 %), whereas this ratio was 7 (46.6 %) in the control group (p < 0.01). CONCLUSIONS The study suggested that the use of hyaluronate-carboxymethyl-cellulose could be beneficial on damaged peritoneum surfaces following abdominal surgery in order to reduce POA development to a minimum (Tab. 3, Fig. 3, Ref. 22).
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Abstract
BACKGROUND The longevity of peritoneal dialysis (PD) is limited by high rates of technique failure, some of which stem from peritoneal membrane injury. 'Biocompatible' PD solutions have been developed to reduce damage to the peritoneal membrane. OBJECTIVES This review aimed to look at the benefits and harms of biocompatible PD solutions in comparison to standard PD solutions in patients receiving PD. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register (28 February 2013), through contact with the Trials Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE, and handsearching conference proceedings. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs in adults and children comparing the effects of biocompatible PD solutions (neutral pH, lactate-buffered, low glucose degradation product (GDP); neutral pH, bicarbonate (± lactate)-buffered, low GDP; glucose polymer (icodextrin)) in PD were included. Studies of amino acid-based PD solutions were excluded. DATA COLLECTION AND ANALYSIS Two authors extracted data on study quality and outcomes (including adverse effects). The authors contacted investigators to obtain missing information. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for categorical variables, and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous variables. MAIN RESULTS Thirty-six eligible studies (2719 patients) were identified: Neutral pH, lactate-buffered/bicarbonate (± lactate)-buffered, low GDP PD solution (24); icodextrin (12). Allocation methods and concealment were generally incompletely reported, and adequate in only ten studies (27.8%). Patients lost to follow-up ranged from 0% to 83.4%. Neutral pH, low GDP versus conventional glucose PD solutionBased on generally sub-optimal quality evidence, the use of neutral pH, low GDP PD solutions was associated with larger urine volumes at the end of the studies, up to three years of therapy duration (7 studies, 520 patients: MD 126.39 mL/d, 95% CI 26.73 to 226.05). Improved preservation of residual renal function was evident in studies with greater than 12 month follow-up (6 studies, 360 patients: SMD 0.31, 95% CI 0.10 to 0.52). There was no significant effect on peritonitis, technique failure or adverse events with the use of neutral pH, low GDP PD solutions. Glucose polymer (icodextrin) versus conventional glucose PD solutionThere was a significant reduction in episodes of uncontrolled fluid overload (2 studies, 100 patients: RR 0.30, 95% CI 0.15 to 0.59) and improvement in peritoneal ultrafiltration (4 studies, 102 patients, MD 448.54 mL/d, 95% CI 289.28 to 607.80) without compromising residual renal function (4 studies, 114 patients: SMD 0.12, 95% CI -0.26 to 0.49) or urine output (3 studies, 69 patients: MD -88.88 mL/d, 95% CI -356.88 to 179.12) with icodextrin use. A comparable incidence of adverse events with the icodextrin (four studies) was reported. AUTHORS' CONCLUSIONS Based on generally sub-optimal quality studies, use of neutral pH, low GDP PD solution led to greater urine output and higher residual renal function after use exceeded 12 months. Icodextrin prescription improved peritoneal ultrafiltration and mitigated uncontrolled fluid overload. There were no significant effects on peritonitis, technique survival, patient survival or harms identified with their use. Based on the best available evidence, the use of these 'biocompatible' PD solutions resulted in clinically relevant benefits without added risks of harm.
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Affiliation(s)
- Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, ARTS Building, Ipswich Rd, Woolloongabba, Queensland, Australia, 4012
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Tarik S, El Bachir B. L’abcès fessier: une complication inhabituelle du cancer du rectum. Pan Afr Med J 2014; 17:312. [PMID: 25328608 PMCID: PMC4198318 DOI: 10.11604/pamj.2014.17.312.4399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Souiki Tarik
- Service de Chirurgie Viscérale, Département de Chirurgie, Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, CHU Hassan II, Fès, Maroc
| | - Benjelloun El Bachir
- Service de Chirurgie Viscérale, Département de Chirurgie, Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, CHU Hassan II, Fès, Maroc
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Díaz-Rosales JDD, Enríquez-Domínguez L, Castillo-Moreno JR, Herrera-Ramírez F. [Preoperative leukocytosis as a predictor of intrabdominal injury in penetrating abdominal trauma]. CIR CIR 2012; 80:516-522. [PMID: 23336145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND in Mexico, the management of abdominal penetrating trauma doesn't follow the algorithms of Trauma Center level I, because of our limitations, and laparotomies are inevitable in this context. Is possible use some grade of leukocytosis suspect in-trabdominal lesion? METHODS study retrospective, descriptive and analytic that inclu-ded patients with abdominal penetrating trauma that suffered exploratory laparotomy. We excluded patients' whit severe damage to soft tissues in extremities, thoracic affection, fractures, or da-mage in nervous system. We divided the patients into 2 groups: group I (therapeutic laparotomy) and group II (non-therapeutic laparotomy). Dependent variables were; age, gender, type of injury, number of lesions, peripheral lesions, time between injury and, from a laboaratory blood sample, leukocytosis mean, percentage of neutrophils, leukocytosis ≥ 12,500 /mm(3), and hemoperitoneum. We compared variables between two groups and use Pearson's χ(2) test and T-Student, and percentages as summary of measures. RESULTS we included 231 patients, group I with 159 patients and group II with 72 patients. Leukocytosis global was 13.2 mil/mm(3) and neutrophil range of 70.3%. 26% of patients did not have leukocytosis at arrival and evaluation, however they were laparotomized because of present peritoneal irritation. Leukocytosis ≥ 12.5 mil/mm(3) was statistically significant in patients with intrabdominal lesions (74.2% vs 27.7%, p < 0.001). CONCLUSIONS leukocytosis ≥ 12.5 mil/mm(3) could be an early serum marker abdominal penetrating trauma.
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MESH Headings
- Abdominal Injuries/blood
- Abdominal Injuries/diagnosis
- Abdominal Injuries/epidemiology
- Abdominal Injuries/surgery
- Adolescent
- Adult
- Female
- Hemoperitoneum/epidemiology
- Hemoperitoneum/etiology
- Humans
- Laparotomy/methods
- Laparotomy/statistics & numerical data
- Length of Stay/statistics & numerical data
- Leukocyte Count
- Leukocytosis/etiology
- Male
- Mexico/epidemiology
- Middle Aged
- Peritoneum/injuries
- Predictive Value of Tests
- Preoperative Care
- Retrospective Studies
- Trauma Centers/statistics & numerical data
- Triage
- Viscera/injuries
- Viscera/surgery
- Wounds, Gunshot/blood
- Wounds, Gunshot/diagnosis
- Wounds, Gunshot/epidemiology
- Wounds, Gunshot/surgery
- Wounds, Penetrating/blood
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/epidemiology
- Wounds, Penetrating/surgery
- Wounds, Stab/blood
- Wounds, Stab/diagnosis
- Wounds, Stab/epidemiology
- Wounds, Stab/surgery
- Young Adult
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Affiliation(s)
- Juan de Dios Díaz-Rosales
- Servicio de Cirugía General, Hospital General de Ciudad Juárez, División de Posgrado, Universidad Autónoma de Ciudad Juárez, Chihuahua, Mexico.
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Wang N, Li Q, Zhang L, Lin H, Hu J, Li D, Shi S, Cui S, Zhou J, Ji J, Wan J, Cai G, Chen X. Mesenchymal stem cells attenuate peritoneal injury through secretion of TSG-6. PLoS One 2012; 7:e43768. [PMID: 22912904 PMCID: PMC3422344 DOI: 10.1371/journal.pone.0043768] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/24/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mesothelial cell injury plays an important role in peritoneal fibrosis. Present clinical therapies aimed at alleviating peritoneal fibrosis have been largely inadequate. Mesenchymal stem cells (MSCs) are efficient for repairing injuries and reducing fibrosis. This study was designed to investigate the effects of MSCs on injured mesothelial cells and peritoneal fibrosis. METHODOLOGY/PRINCIPAL FINDINGS Rat bone marrow-derived MSCs (5 × 10(6)) were injected into Sprague-Dawley (SD) rats via tail vein 24 h after peritoneal scraping. Distinct reductions in adhesion formation; infiltration of neutrophils, macrophage cells; number of fibroblasts; and level of transforming growth factor (TGF)-β1 were found in MSCs-treated rats. The proliferation and repair of peritoneal mesothelial cells in MSCs-treated rats were stimulated. Mechanically injured mesothelial cells co-cultured with MSCs in transwells showed distinct increases in migration and proliferation. In vivo imaging showed that MSCs injected intravenously mainly accumulated in the lungs which persisted for at least seven days. No apparent MSCs were observed in the injured peritoneum even when MSCs were injected intraperitoneally. The injection of serum-starved MSCs-conditioned medium (CM) intravenously reduced adhesions similar to MSCs. Antibody based protein array of MSCs-CM showed that the releasing of TNFα-stimulating gene (TSG)-6 increased most dramatically. Promotion of mesothelial cell repair and reduction of peritoneal adhesion were produced by the administration of recombinant mouse (rm) TSG-6, and were weakened by TSG-6-RNA interfering. CONCLUSIONS/SIGNIFICANCE Collectively, these results indicate that MSCs may attenuate peritoneal injury by repairing mesothelial cells, reducing inflammation and fibrosis. Rather than the engraftment, the secretion of TSG-6 by MSCs makes a major contribution to the therapeutic benefits of MSCs.
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Affiliation(s)
- Nan Wang
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- Medical College, NanKai University, Tianjin, China
| | - Qinggang Li
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Li Zhang
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Hongli Lin
- Department of Nephrology, the First Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Jie Hu
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Diangeng Li
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Suozhu Shi
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Shaoyuan Cui
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Jianhui Zhou
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Jiayao Ji
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- Medical College, NanKai University, Tianjin, China
| | - Jiajia Wan
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- Medical College, NanKai University, Tianjin, China
| | - Guangyan Cai
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- * E-mail: (XC); (GC)
| | - Xiangmei Chen
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- * E-mail: (XC); (GC)
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Morino M, Allaix ME, Famiglietti F, Caldart M, Arezzo A. Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery? Surg Endosc 2012; 27:181-8. [PMID: 22717799 DOI: 10.1007/s00464-012-2418-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 05/21/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritoneal perforation (PP) is frequently reported as a complication of transanal endoscopic microsurgery (TEM). Nevertheless, these concerns have only rarely been addressed in the literature, with no mention of the long-term oncologic consequences of PP. METHODS A prospective database was analyzed with the intent to evaluate the influence of PP on the short- and long-term outcomes for patients undergoing TEM. RESULTS Peritoneal perforation occurred in 28 (5.8%) of 481 patients who underwent TEM for a rectal neoplasm. The conversion rate to abdominal surgery was 10.7% (3/28). All the conversions occurred during the first 100 TEM procedures (3/100 vs 0/381; p = 0.007). The postoperative morbidity rate was 3.6% (1/28), and the 30-day mortality was nil. Compared with the group of patients who had no peritoneal perforation, the PP group showed a significantly longer operating time (120 vs 60 min; p < 0.001) and a significantly longer hospital stay (6 vs 4 days; p = 0.003). Nevertheless, the global morbidity rate and the type of complications according to Dindo's classification were similar. In the multivariate analysis, the only independent predictor of PP was tumor distance from the anal verge (p = 0.010). During a median follow-up period of 48 months (range, 12-150 months), no liver or peritoneal metastases were detected in 13 patients with rectal cancer. CONCLUSIONS Peritoneal perforation does not seem to affect short-term or oncologic outcomes for patients submitted to TEM with full-thickness resection for upper rectum neoplasms. The use of TEM to resect rectal lesions involving the intraperitoneal rectum may therefore represent an intermediate step toward the development of transrectal natural orifice translumenal endoscopic surgery (NOTES) techniques.
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Affiliation(s)
- Mario Morino
- Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Dipartimento di Discipline Medico-Chirurgiche, University of Torino, Torino, Italy.
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Gesslein M, Bail HJ, Schaser KD, Schwabe P. [Emergency checklist: abdominal stab wounds]. MMW Fortschr Med 2011; 153:36-37. [PMID: 21776903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- M Gesslein
- Centrum für Muskuloskeletale Chirurgie, Charité--Universitätsmedizin Berlin.
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Díaz Mancebo R, Del Peso Gilsanz G, Rodríguez M, Fernández B, Ossorio González M, Bajo Rubio MA, Selgas Gutiérrez R. [Pleuroperitoneal communication in patients on peritoneal dialysis. One hospital's experience and a review of the literature]. Nefrologia 2011; 31:213-217. [PMID: 21461016 DOI: 10.3265/nefrologia.pre2011.jan.10762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2011] [Indexed: 05/30/2023] Open
Abstract
Peritoneal dialysis is a treatment alternative in patients with advanced chronic kidney disease. The infusion of liquid into the peritoneal cavity leads to an increase in intra-abdominal pressure, which can sometimes produce leaks to the chest, giving rise to pleuroperitoneal communication. This is not a common complication, but it brings about high drop-out rates among patients using the technique. Diagnosis is easy and must be suspected in patients with sudden dyspnoea with low ultrafiltration and pleural effusion in the chest x-ray. Peritoneal rest and a temporary transfer to haemodialysis, and pleurodesis can be effective treatment strategies.
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Affiliation(s)
- R Díaz Mancebo
- Servicio de Nefrología, Hospital Universitario La Paz, Paseo de la Castellana, Madrid.
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ten Broek RPG, Wilbers J, van Goor H. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection. Surg Endosc 2010; 25:1827-34. [PMID: 21140171 PMCID: PMC3109994 DOI: 10.1007/s00464-010-1474-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/11/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimizing peritoneal tissue injury during abdominal surgery has the benefit of reducing postoperative inflammatory response, pain, and adhesion formation. Ultrasonic dissection seems to reduce tissue damage. This study aimed to compare electrocautery and ultrasonic dissection in terms of peritoneal tissue ischemia measured by microdialysis. METHODS In this study, 18 Wistar rats underwent a median laparotomy and had a peritoneal microdialysis catheter implanted in the left lateral sidewall. The animals were randomly assigned to receive two standard peritoneal incisions parallel to the catheter by either ultrasonic dissection or electrocautery. After the operation, samples of microdialysis dialysate were taken every 2 h until 72 h postoperatively for measurements of pyruvate, lactate, glucose, and glycerol, and ratios were calculated. RESULTS The mean lactate-pyruvate ratio (LPR), lactate-glucose ratio (LGR), and glycerol concentration were significantly higher in the electrocautery group than in the ultrasonic dissection group until respectively 34, 48, and 48 h after surgery. The mean areas under the curve (AUC) of LPR, LGR, and glycerol concentration also were higher in the electrocautery group than in the ultrasonic dissection group (4,387 vs. 1,639, P=0.011; 59 vs. 21, P=0.008; 7,438 vs. 4,169, P=0.008, respectively). CONCLUSION Electrosurgery causes more ischemic peritoneal tissue damage than ultrasonic dissection.
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Affiliation(s)
- Richard P. G. ten Broek
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joyce Wilbers
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Abdullah M, Al-Salamah SM. Extensive retroperitoneal hematoma in blunt trauma. Saudi Med J 2010; 31:1232-1237. [PMID: 21063654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To report our experience of managing extensive retroperitoneal hematoma (RH) in patients with blunt trauma and to determine any associated factors affecting causation and mortality. METHODS In this retrospective observational study, patients diagnosed with extensive RH following blunt trauma admitted to King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia between January 2004 and December 2009 were included. Patient data were explored for injury severity score (ISS), associated injuries, location of hematoma, amount of blood transfusions, coagulation profile, operative management, hospital stay, and mortality. The outcomes in surviving and non-surviving patients were compared. RESULTS Out of 290 patients presenting with RH, extensive RH was found in 46 patients (15.8%). The overall mortality was 32.6%. The pelvis was the most frequent location of RH in combination with lateral and central zones (65.2%). The lower extremity and pelvic fractures were the most common injury. Associated intra-peritoneal injuries were present in 39.1% patients. An exploratory laparotomy was performed in 58.7% patients (n=27). A high ISS (55.9 versus 35.5, p<0.0001), abnormal coagulation profile (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.974-30.932, p=0.005, and associated chest injuries OR 5.94, 95% CI 1.528-23.19, p=0.014) were independent factors associated with mortality. CONCLUSION Multiple musculoskeletal injuries in addition to intra-abdominal injuries and abnormal coagulation are major factors associated with the presence of extensive RH. High ISS, abnormal coagulation, and associated chest injuries are independent factors associated with mortality.
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Affiliation(s)
- Muhammad Abdullah
- From the Department of Surgery, University Surgical Unit, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Zhao BY, Li GX, Wang YN, Hu YF, He W, Yu J. [Peritoneal structural injury in laparoscopic versus open radical resection for colorectal cancer: a prospective controlled study]. Zhonghua Wei Chang Wai Ke Za Zhi 2010; 13:193-196. [PMID: 20336537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the differences in peritoneal microstructure injury between laparoscopic and open radical resection for colorectal cancer. METHODS A total of 50 patients with colorectal cancer were consecutively assigned into laparoscopic group (LO, n=27) and conventional laparotomy group (CO, n=23). Prospectively comparative analyses of operative time, intraoperative blood loss, number of lymph node harvest, positive rate of lymph nodes, length of specimen and resection margin involvement were performed. Optical microscope and scanning electron microscope were used to detect postoperative peritoneal injury between patients who received laparoscopic surgery or open surgery. RESULTS Compared with the CO group, operative time [(150.6+/-39.5) min vs (183.0+/-39.2) min, P<0.05] and intraoperative blood loss [(80.0+/-75.2) ml vs (234.5+/-235.3) ml, P<0.01] were significantly less in the LO group. No significant differences were found between two groups in length specimen, number of lymph nodes harvest, positive rate of lymph nodes, and all resection margins were negative (P>0.05). Optical microscope indicated less serosal injury in the LO group as compared to the CO group with regard to serosal integrity, continuity of covering adipocyte and mesothelial cell, and the aggregation level of erythrocytes and inflammatory cells (P<0.01). Scanning electronic microscopy showed more severe injury to colorectal serosa, mesothelium and basement membrane in the CO group as compared to the LO group. CONCLUSION With equal degree of radical resection, laparoscopic technique for colorectal cancer causes less peritoneal structural injury as compared with open surgery.
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Affiliation(s)
- Bao-yu Zhao
- Department of General Surgery, Southern Medical University, Guangzhou 510515, China
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Affiliation(s)
- B Sharma
- Department of Obstetrics & Gynaecology, James Paget Hospital, Great Yarmouth, Norfolk, UK.
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Harris BT, Franklin GA, Harbrecht BG, Richardson JD. Impact of hollow viscus injuries on outcome of abdominal gunshot wounds. Am Surg 2009; 75:378-384. [PMID: 19445287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Abdominal gunshot wounds (GSW) are a source of morbidity and mortality. Limited data are available on the effect of hollow viscus injuries (HVI) secondary to gunshot wounds. GSW sustained in the Louisville area from 2004 to 2007 were reviewed. Attention was given to the impact of HVI from abdominal GSW. Statistical significance was determined. One-hundred ten patients sustained GSW with peritoneal violation. Eighty-six had HVI. Eighteen died after laparotomy with 15 having an HVI. Patients undergoing damage control (DC) have a significant increase in mortality compared with those not requiring DC. Exsanguination was the major cause of mortality (67%). Mortality directly related to HVI was found in 11 per cent. Twenty patients underwent DC with 11 deaths. Isolated HVI did not show a significantly increased mortality compared with other injury patterns involving solid organ or major vascular structures. Various methods of repair showed no significant survival advantage. Recognition and repair of HVI in abdominal GSW is crucial to patient salvage. Definitive repair of HVI at the initial operation should be considered. Primary repair of HVI is preferred although no survival disadvantage is seen in other forms of repair in marginally stable patients. Definitive repair at the initial operation decreases complications.
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Affiliation(s)
- Brady T Harris
- Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
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Tumialán LM, Walkup RR, Gupta SK. Minimally invasive retrieval of a bullet from the L5-S1 neural foramina after transperitoneal gunshot wound. Spine J 2009; 9:169-73. [PMID: 18468958 DOI: 10.1016/j.spinee.2008.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/07/2008] [Accepted: 03/11/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In victims of gunshot wounds with retained bullet fragments in the central nervous system, delayed neurological deficit may result from copper-induced neurotoxicity. The mainstay of therapy involves surgical exploration and retrieval of fragments. PURPOSE A patient who presented with delayed neurological deficit after a transperitoneal gunshot wound is presented. STUDY DESIGN Technical report. METHODS A 25-year-old male, who was the victim of a transperitoneal gunshot wound with a copper-jacketed bullet, presented several weeks after recovering from his abdominal injury. The patient presented with a worsening radiculopathy in the L5 distribution and progressive dorsiflexion weakness. Subsequent imaging demonstrated a bullet lodged lateral to the L5-S1 neural foramina. RESULTS A minimally invasive approach with the use of a tubular retractor was used to retrieve the retained bullet. The lateral location of the bullet, the proximity of the nerve root to the bullet, and the limited visualization of the operative field from a minimally invasive approach, placed the nerve root at increased risk. Intraoperative myelography and electrophysiological monitoring were used to locate the nerve root in relation to the bullet and guide the extraction of the bullet. Postoperatively, the patient had complete resolution of his preoperative symptoms. CONCLUSIONS In cases where proximity to neural structures and limited visualization of bony landmarks may increase the risk of injury when extracting a foreign body, intraoperative myelography and electrophysiological monitoring are valuable adjuncts to further elucidate the surgical anatomy for a minimally invasive approach.
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Affiliation(s)
- Luis M Tumialán
- Emory University School of Medicine, Grady Memorial Hospital, Department of Neurosurgery, Atlanta, GA, USA.
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Abstract
Emergency practitioners routinely encounter patients who suffer from abdominal trauma, be it blunt or penetrating. These injuries are often confounded by altered mental status, distracting injuries, or lack of historical information, and may present challenges in management. However, in the last several years new approaches to the diagnosis and management of abdominal trauma, including bedside ultrasound, newer generation computed tomography scans, laparoscopy, and the ability for selected nonoperative management expedite identification of life threatening injury and offer new options in treatment.
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Affiliation(s)
- Jennifer L Isenhour
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
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Weinberg JA, Magnotti LJ, Edwards NM, Claridge JA, Minard G, Fabian TC, Croce MA. "Awake" laparoscopy for the evaluation of equivocal penetrating abdominal wounds. Injury 2007; 38:60-4. [PMID: 17129583 DOI: 10.1016/j.injury.2006.08.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 08/30/2006] [Accepted: 08/30/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND Diagnostic laparoscopy is useful for the assessment of equivocal penetrating abdominal wounds, and has become the modality of choice for the evaluation of such wounds at our institution. We hypothesised that, in appropriate patients, diagnostic "awake" laparoscopy (AL) could be performed under local anaesthesia in the emergency department (ED), allowing for expedited discharge and potential cost savings. METHODS Selected haemodynamically stable patients with penetrating abdominal injury underwent AL. Suitability for AL was at the discretion of the attending surgeon. Identification of peritoneal penetration by AL led to exploratory laparotomy in the operating room. Patients with no evidence of peritoneal penetration were discharged from the ED (ALneg). These patients were matched to a cohort of 24 patients who underwent diagnostic laparoscopy in the OR which was negative for peritoneal penetration (DLneg). Length of stay and hospital charges were compared. RESULTS Over a 30-month period, 15 patients underwent AL without complication. No peritoneal penetration was found in 11 patients. The remaining four patients underwent exploratory laparotomy, of which two were positive for intra-abdominal injury. Mean time to discharge was 7h in the ALneg group versus 18 h in the DLneg group (p=0.0003). Cost savings on hospital charges averaged 2227 US dollars per patient in the ALneg group compared with the DLneg group. CONCLUSIONS AL may be safely performed in the ED, allowing for expedited patient discharge. Cost savings are achieved by the avoidance of charges inherent to diagnostic laparoscopy performed in the operating room.
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Affiliation(s)
- Jordan A Weinberg
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ariel P, Sebastián V, Sergio L, Nicolini FF. [Minilaparoscopy in penetrating abdominal trauma emergency room procedure with local anesthesia]. Rev Fac Cien Med Univ Nac Cordoba 2007; 64:40-44. [PMID: 18770935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND There are a number of unnecessary laparotomies in penetrating trauma, with a non worthless percentage of complications. When the peritoneal injury is identified, surgical exploration of the abdomen should be evaluated. OBJECTIVE Evaluate the penetration of the peritoneum, using a diagnose method with direct vision. SETTING Hospital de Urgencias de Córdoba. Trauma Hospital. DESIGN To evidence peritoneum trespassing, laparoscopy was performed with local anaesthesia in patients with penetrating abdominal trauma without signs of abdominal injury in the imaging methods and doubts in the physical examination, in a prospective setting. POPULATION Patient with penetrating abdominal trauma, treated between May 2004 to January 2005, with doubtful diagnose of peritoneal violation. METHOD Under sedation and local anaesthesia, a 5 millimetres laparoscope with 90 degrees vision was placed at umbilicus. The anterior abdominal wall, flanks and diaphragm were exanimate, looking for the peritoneal wound or free fluid. RESULTS Laparotomy could be avoided in four patients. In the four remaining, laparoscopy or conventional surgery was performed. Two presented hollow viscera injury, one hemoperitoneo and the other, minimum liver damage. There were not complications in both groups. The average hospital stay of the first group was 13 hours. CONCLUSIONS In selected patients, the minilaparoscopy is useful in decreased the percentage of unnecessary laparotomies and general anaesthesia, and its complications.
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Affiliation(s)
- Peralta Ariel
- Servicio de Cirugía General, Hospital Municipal de Urgencias de Córdoba, Catamarca 441.
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Abstract
As laparoscopic surgery evolves, a growing number of different abdominal operations can now be performed. This necessitates the use of multiple large trocars. Herniation through the fascial defect created by trocar entry in laparoscopic interventions has been reported at a rate of 1-6%. We describe a simple closure technique for fascial defects at trocar sites after laparoscopic surgery. To facilitate the closure of the fascial defects of > or = 10 mm trocar entry sites, the surgeon places the upper end of a dissecting forceps through the fascial defect and tilts it so that the abdominal of the peritoneum comes into contact with its flat surface. The assistant retracts the skin and subcutaneous tissue and the "J" needle with the appropriate suture material is then used to take a stitch through the fascia under direct vision. The sharp end of the needle is prevented from coming into contact with any deeper structure as it slides on the flat surface of the dissecting forceps. The stitch is then pulled up to lift the edge of the fascia and the needle is passed from the opposite edge of the fascia in the same manner and then the suture is ligated. The aforementioned technique is easy to perform and facilitates the closure of the fascial defect at trocar sites, and there is no extra cost for the procedure.
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Affiliation(s)
- Mustafa Sahin
- Department of Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey.
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Kwon AH, Qiu Z, Hiraon Y. Effect of plasma fibronectin on the incisional wound healing in rats. Surgery 2006; 141:254-61. [PMID: 17263983 DOI: 10.1016/j.surg.2006.06.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 06/22/2006] [Accepted: 06/23/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Abdominal wall repair after celiotomy is important because insufficient incisional wound strength results in wound failures such as fascial dehiscence and herniation. Plasma fibronectin (pFn) has been shown to play an important role in wound healing. The purpose of this study was to investigate whether pFn improves incisional wound healing in a rat skin incision and celiotomy model. METHODS Rats underwent a linear skin incision in the dorsal plane or a full-thickness incisional wound (celiotomy) in the abdominal wall. The same operative procedures were performed on rats whose pFn levels were reduced by antirat pFn serum. The wounds were sutured, and purified human pFn or albumin was given intravenously. RESULTS After the celiotomy, pFn levels decreased immediately and reached a minimum at 3 h after incision. A single injection of pFn (10 mg/kg) significantly increased the breaking strength of the skin and the bursting pressure of the abdominal wall. The amount of hydroxyproline in the skin incisional wound with pFn was significantly greater than with an injection of albumin as control. In rats with pFn levels decreased by antirat pFn serum, a single administration of pFn significantly increased the breaking strength of the skin and the bursting pressure of the abdominal wall compared to a control injection of albumin. CONCLUSIONS It is important for wound healing to maintain sufficiently high levels of pFn. A single intravenous injection of pFn after celiotomy may be useful in the prevention of fascial dehiscence and herniation.
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Affiliation(s)
- A-Hon Kwon
- Department of Surgery, Kansai Medical University, Osaka, Japan.
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Muzio G, Bernard K, Polliand C, Rizk N, Champault G. Impact of peritoneal tears on the outcome and late results (4 years) of endoscopic totally extra-peritoneal inguinal hernioplasty. Hernia 2006; 10:426-9. [PMID: 16932845 DOI: 10.1007/s10029-006-0129-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Accepted: 07/27/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The reported rate of intra-operative peritoneal laceration during endoscopic extra-peritoneal hernioplasty (TEP) ranges from 10 to 64%. AIMS To evaluate in a prospective study the predictive factors of peritoneal tears, their consequences in terms of outcome and late results. PATIENTS AND METHODS Between July 1994 and December 2000, we performed 467 endoscopic extra-peritoneal hernia repairs (TEP). In 14.8% of the cases, single or multiples recurrences after conventional open herniotomy were treated. One hundred and forty-nine patients (38%) had had previous surgery (appendectomy); 277 procedures (70.8%) were performed by experienced surgeons and 114 (29.2%) by surgical trainees. We used a diathermic hook in 26.3% of the procedures. The mean follow-up period was 68 months (48-100). RESULTS Peritoneal tears occurred in 43 patients (10.9%). Six of them (13%) required operative closure, and six a conversion (four Lichtenstein, one Shouldice, and one TAPP). In 37 cases (86%), the tears were not closed. Peritoneal tears were significantly correlated with surgical experience, Nyhus classification, scar adhesion from previous surgery and the use of sharp instruments. Peritoneal tears interfere significantly (P=0.001) with the operating time (82 vs. 63 min) and conversion rate (13.9 vs. 1.7%). It does not affect the outcome and late results in terms of recurrences, pain, or small bowel obstruction. CONCLUSION Our data suggest that peritoneal tears in the vast majority of cases may be safely managed without peritoneal closure. In case of peritoneal laceration, the operative time was significantly longer, and the conversion rate was increased. These situations do not affect the outcome and late complications compared with the procedures without peritoneal tears.
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Affiliation(s)
- G Muzio
- Service de Chirurgie Digestive, Université Paris XIII, CHU Jean Verdier, Avenue du 14 Juillet, 93143, Bondy Cedex, France
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Cruz ME, Flores A, Palafox MT, Meléndez G, Rodríguez JO, Chavira R, Domínguez R. The role of the muscarinic system in regulating estradiol secretion varies during the estrous cycle: the hemiovariectomized rat model. Reprod Biol Endocrinol 2006; 4:43. [PMID: 16923184 PMCID: PMC1564398 DOI: 10.1186/1477-7827-4-43] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 08/21/2006] [Indexed: 11/10/2022] Open
Abstract
There is evidence that one gonad has functional predominance. The present study analyzed the acute effects of unilateral ovariectomy (ULO) and blocking the cholinergic system, by injecting atropine sulfate (ATR), on estradiol (E2) serum concentrations during the estrous cycle. The results indicate that ULO effects on E2 concentrations are asymmetric, vary during the estrous cycle, and partially depend on the cholinergic innervation. Perforation of the left peritoneum resulted in lower E2 serum concentrations in the three stages of the estrous cycle. At proestrus, unilateral or bilateral perforation of the peritoneum resulted in lower E2 serum concentrations.ULO of the right ovary (left ovary in situ) resulted in significantly higher E2 concentrations than animals with ULO of the left ovary (right ovary in situ). ATR treatment to ULO rats on D1 resulted in a significant drop of E2 serum concentrations. ULO rats treated with ATR on D2 or P, resulted in an asymmetrical E2 secretion response; when the right ovary remained in situ an increase in E2 was observed, and a decrease when the left ovary remained in situ. The results obtained in the present study suggest that each ovary's ability to compensate the secretion of E2 from the missing ovary is different and varies during the estrous cycle. The results also suggest that the cholinergic system participates in regulating ovarian E2 secretion. Such participation varies according to the ovary remaining in situ and the stage of the estrous cycle of the animal. The results agree with previously stated hypothesis of a neural pathway arising from the peritoneum that participates in regulating E2 secretion, and also supports the idea of cross-talk between the ovaries, via a neural communication, that modulates E2 secretion.
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Affiliation(s)
- María E Cruz
- Unidad de Investigación en Biología de la Reproducción. FES Zaragoza. UNAM, México
| | - Angélica Flores
- Unidad de Investigación en Biología de la Reproducción. FES Zaragoza. UNAM, México
| | - María T Palafox
- Unidad de Investigación en Biología de la Reproducción. FES Zaragoza. UNAM, México
| | - Griselda Meléndez
- Unidad de Investigación en Biología de la Reproducción. FES Zaragoza. UNAM, México
| | - Jorge O Rodríguez
- Unidad de Investigación en Biología de la Reproducción. FES Zaragoza. UNAM, México
| | - Roberto Chavira
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán," México
| | - Roberto Domínguez
- Unidad de Investigación en Biología de la Reproducción. FES Zaragoza. UNAM, México
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Hiramatsu Y, Noma M, Horigome H, Takahashi-Igari M, Sakakibara Y. Biventricular Repair of Ebstein's Anomaly With Pulmonary Atresia in a Low Birth Weight Neonate. J Card Surg 2006; 21:421-2. [PMID: 16846428 DOI: 10.1111/j.1540-8191.2006.00261.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cyanotic neonates with Ebstein's anomaly associated with pulmonary atresia are a subgroup with the high mortality rate in pediatric cardiac surgery. We report a case of a severely symptomatic low birth weight neonate with Ebstein's anomaly and pulmonary atresia. A biventricular repair with Danielson-type tricuspid valve repair was performed. The baby tolerated the procedure with adequate hemodynamics, but died of peritoneal hemorrhage on the second postoperative day. This report could be an addition to the recent literature regarding the feasibility of biventricular repair for symptomatic neonates with Ebstein's anomaly even in low birth weight neonates.
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Affiliation(s)
- Yuji Hiramatsu
- Department of Cardiac Surgery, University of Tsukuba, Tsukuba, Japan.
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Hirahara I, Kusano E, Yanagiba S, Miyata Y, Ando Y, Muto S, Asano Y. Peritoneal injury by methylglyoxal in peritoneal dialysis. Perit Dial Int 2006; 26:380-92. [PMID: 16722033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Peritonealdialysis (PD) is a common treatment for patients with reduced or absent renal function. Long-term PD leads to peritoneal injury with structural changes and functional decline, such as ultrafiltration loss. At worst, peritoneal injury leads to encapsulating peritoneal sclerosis, a serious complication of PD. Glucose degradation products contained in PD fluids contribute to the bioincompatibility of conventional PD fluids. Methylglyoxal (MGO) is an extremely toxic glucose degradation product. The present study examined the injurious effect of MGO on peritoneum in vivo. METHODS Male Sprague-Dawley rats (n = 6) were administered PD fluids (pH 5.0) containing 0, 0.66, 2, 6.6, or 20 mmol/L MGO every day for 21 days. On day 22, peritoneal function was estimated by the peritoneal equilibration test. Drained dialysate was analyzed for type IV collagen-7S, matrix metalloproteinase (MMP), and vascular endothelial growth factor (VEGF). Histological analysis was also performed. RESULTS In rats receiving PD fluids containing more than 0.66 mmol/L MGO, peritoneal function decreased significantly and levels of type IV collagen-7S and MMP-2 in drained dialysate increased significantly. In the 20-mmol/L MGO-treated rats, loss of body weight, expression of VEGF, thickening of the peritoneum, and formation of abdominal cocoon were induced. MMP-2 and VEGF were produced by infiltrating cells in the peritoneum. Type IV collagen was detected in basement membrane of microvessels. CONCLUSION MGO induced not only peritoneal injury but also abdominal cocoon formation in vivo. The decline of peritoneal function may result from reconstitution of microvessel basement membrane or neovascularization.
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Affiliation(s)
- Ichiro Hirahara
- Department of Nephrology, Jichi Medical School, Kawachi-gun, Tochigi, Japan.
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40
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Herbrig K, Pistrosch F, Gross P, Palm C. Resumption of peritoneal dialysis after transcutaneous treatment of a peritoneal leakage using fibrin glue. Nephrol Dial Transplant 2006; 21:2037-8. [PMID: 16520352 DOI: 10.1093/ndt/gfl080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Abstract
Post-operative peritonitis usually results from intra-operative or delayed injury to a digestive organ; it is accompanied by a high mortality rate. Prognosis is directly related to early diagnosis and appropriate re-intervention. Clinical and laboratory signs of gravity impose prompt re-operation. Imaging exams such as CT will aid in diagnosis and guide the therapeutic approach. Treatment specifically adapted to the etiologic cause must be thorough and complete from the start.
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Affiliation(s)
- C Mariette
- Service de Chirurgie Digestive et Générale, Hôpital C. Huriez, CHU, Lille.
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42
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Abstract
Attacks on humans by wild animals causing fatal injuries are not uncommon in rural and forest areas of India. But death occurring due to attack by a wild boar is rare. As the victims of boar attack are usually recovered from dense forest areas, the investigating officers could be misled as to the nature of infliction of these multiple, fatal penetrating injuries to a possible homicide. Unlike the injuries inflicted by wild cats, canines and bulls, the hallmark of boar attack is the infliction of multiple penetrating injuries to the lower part of the body. This case is reported for its rarity, for the awareness of the possible injuries in such unnatural deaths, and for the factors predisposing to a boar attack.
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Affiliation(s)
- Shahnavaz Manipady
- Department of Forensic Medicine, Kasturba Medical College, Mangalore-575001, India.
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43
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Fenollosa MA, García García R, Escobedo JM, Giménez Edo M, Martínez Sanjuán V, Pérez García A. [Magnetic resonance hydrography in peritoneal dialysis]. Nefrologia 2006; 26:726-33. [PMID: 17227251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- M A Fenollosa
- Servicio de Nefrología, Hospital General de Castellón, Avenida Benicasim s/n, 12004 Castellón.
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Blaivas M. Emergency diagnostic paracentesis to determine intraperitoneal fluid identity discovered on bedside ultrasound of unstable patients. J Emerg Med 2005; 29:461-5. [PMID: 16243208 DOI: 10.1016/j.jemermed.2005.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 12/03/2004] [Accepted: 02/28/2005] [Indexed: 11/15/2022]
Abstract
Patients presenting with hypotension may be evaluated with a FAST (Focused Abdominal Sonography for Trauma) examination as recent literature has suggested its utility in the unstable patient. Those who are found to have intraperitoneal fluid on the FAST examination may have solid organ injury from unknown trauma, ruptured abdominal aortic aneurysm (AAA), hemorrhaging ovarian cyst, ruptured ectopic pregnancy, or other disease process responsible for intra-periteal blood. However, because ultrasound does not assist in fluid identification, it is possible that the fluid present is not blood, but ascites. Further, a decision may need to be made regarding emergent surgical intervention or blood transfusion vs. aggressive fluid resuscitation or pressors followed by other testing such as computed tomography. This case series illustrates the utility of an ultrasound guided, emergent diagnostic paracentesis in the management of unstable patients found to have a positive FAST examination. Six unstable patients were evaluated with the FAST examination and found to have large quantities of intraperitoneal fluid. In each case the fluid was sampled and proposed management changed due to fluid identification.
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Affiliation(s)
- Michael Blaivas
- Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia 30912-4007, USA
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45
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Ahmed N, Whelan J, Brownlee J, Chari V, Chung R. The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg 2005; 201:213-6. [PMID: 16038818 DOI: 10.1016/j.jamcollsurg.2005.04.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 02/24/2005] [Accepted: 04/01/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penetrating abdominal wounds are traditionally explored by laparotomy. We investigated prospectively the role of laparoscopy within a defined protocol for management of penetrating abdominal wounds to determine its safety and advantages over traditional operative management. STUDY DESIGN The study inclusion criteria were: stab and gun shot abdominal wounds, including junction zone injuries; stable vital signs; and absence of contraindications for laparoscopy. Diagnostic end points included detection of peritoneum or diaphragm violation, visceral injuries, and other indications for laparotomy. Systematic examination was undertaken using a multiport technique whenever the peritoneum or diaphragm had been violated. All repairs were done by open operation. RESULTS A total of 40.6% of patients with penetrating trauma fulfilled study criteria (52 patients). Of these, 33% had no peritoneal penetration; 29% had no visceral injuries despite violation of peritoneum or diaphragm; 38% had visceral injuries, of which 40% (mainly liver and omentum) required no intervention. Twelve patients (23% of total) had open repairs. No missed injuries or death occurred in the study. Overall, 77% of penetrating injuries with stable vital signs avoided exploratory laparotomy. Compared with National Trauma Data Bank information for patients with the same Injury Severity Scores, hospitalization was reduced by more than 55% for the entire series. CONCLUSIONS Laparoscopy for penetrating abdominal injuries in a defined set of conditions was safe and accurate, effectively eliminating nontherapeutic laparotomy and shortening hospitalization.
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MESH Headings
- Abdominal Injuries/complications
- Abdominal Injuries/diagnosis
- Abdominal Injuries/mortality
- Abdominal Injuries/surgery
- Algorithms
- Decision Trees
- Hospital Costs/statistics & numerical data
- Hospitals, Teaching
- Humans
- Injury Severity Score
- Laparoscopy/adverse effects
- Laparoscopy/economics
- Laparoscopy/methods
- Laparotomy
- Length of Stay/statistics & numerical data
- Methylene Blue
- Patient Selection
- Peritoneum/injuries
- Prospective Studies
- Pulmonary Embolism/etiology
- Respiratory Distress Syndrome/etiology
- Safety
- Statistics, Nonparametric
- Surgical Wound Infection/etiology
- Tomography, X-Ray Computed
- Trauma Centers
- Treatment Outcome
- Wounds, Gunshot/complications
- Wounds, Gunshot/diagnosis
- Wounds, Gunshot/mortality
- Wounds, Gunshot/surgery
- Wounds, Stab/complications
- Wounds, Stab/diagnosis
- Wounds, Stab/mortality
- Wounds, Stab/surgery
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Affiliation(s)
- Naveed Ahmed
- Department of Surgery, Huron Hospital, Cleveland Clinic Health System, Cleveland, OH 44112, USA
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46
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Bringman S, Wollert S, Osterberg J, Heikkinen T. Early results of a randomized multicenter trial comparing Prolene and VyproII mesh in bilateral endoscopic extraperitoneal hernioplasty (TEP). Surg Endosc 2005; 19:536-40. [PMID: 15759178 DOI: 10.1007/s00464-004-9100-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 10/04/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The use of mesh in inguinal hernia surgery has become increasingly popular despite the potentially harmful effects that foreign material may exert on human tissue. The purpose of this study was to compare the use of a lightweight mesh vs a standard hernia mesh in bilateral endoscopic hernioplasty. METHODS This single-blinded multicenter trial, 140 men with bilateral inguinal hernias were randomized to undergo totally extraperitoneal endoscopic hernioplasty (TEP) with either Prolene or VyproII. The randomization and all data management were done via the Internet. RESULTS A total of 139 patients were operated on as allocated. The follow-up was complete in 94% of the patients. The median (range) operating times were 85 min (45-140) and 73 min (35-165) for the Prolene and VyproII groups, respectively. (p = 0.01). The difference was due to uneven distribution of the allocated patients to study groups among individual surgeons. The time to return to work was similar (11 vs 9 days, p = 0.08). The time to return to normal daily activities was 19 days (1-133) in the Prolene group and 12.5 days (0-237) in the VyproII group (p = 0.06). There were no significant differences between the groups in their scores on the Visual Analogue Scale or SF-36 Health Scores during the 8-week follow-up. CONCLUSIONS The use of Prolene and VyproII meshes in bilateral endoscopic repair of inguinal hernia seems to result in similar short-term outcome and quality of life. However, there was a tendency toward faster return to normal activity among VyproII patients.
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Affiliation(s)
- S Bringman
- Center for Surgical Sciences, Karolinska Institutet, Sodertalje Hospital, SE-15286, Sodertalje, Sweden.
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47
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Abstract
The role of diagnostic laparoscopy (DL) in abdominal stab wounds (ASWs) is not clearly defined. We hypothesized that peritoneal penetration (PP) during DL was a valid indication to convert to an exploratory laparotomy (EL). Retrospective review of hemodynamically stable ASWs requiring operation. A total of 161 patients with ASWs were identified, with 36 of 92 patients (39.1%) undergoing DL converted to EL. All 36 patients had PP; 20 of 36 (55.6%) ELs were therapeutic (TL). The number of nontherapeutic laparotomies (NTLs) prevented was 56 (60.9%). Five of 92 patients had PP on DL but did not undergo EL. Twenty-four of 69 patients who underwent initial EL had an NTL (34.8%). If this group had undergone an initial DL, and PP was used to determine need for EL, the number of NTLs would have been reduced to 10 (14.5%), a 58.3% reduction. Evidence of PP during DL is a reasonable indicator to determine the need for EL and reduce the number of NTLs.
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Affiliation(s)
- Robert A Cherry
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA.
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48
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Margetts PJ, Oh KH, Kolb M. Transforming growth factor-beta: importance in long-term peritoneal membrane changes. Perit Dial Int 2005; 25 Suppl 3:S15-7. [PMID: 16048248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
We have provided evidence from adenovirus-mediated gene transfer to the peritoneum that transforming growth factor-beta1 mimics many of the functional and structural changes in the peritoneum in patients on long-term peritoneal dialysis, including fibrosis, increased submesothelial thickness, angiogenesis, increased solute transport, and ultrafiltration dysfunction. We review several key properties of this important fibrogenic molecule.
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Affiliation(s)
- Peter J Margetts
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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49
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Shpitz B, Lansberg L, Bugayev N, Tiomkin V, Klein E. Should peritoneal tears be routinely closed during laparoscopic total extraperitoneal repair of inguinal hernias? A reappraisal. Surg Endosc 2004; 18:1771-3. [PMID: 15809787 DOI: 10.1007/s00464-004-9001-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 05/26/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (LTEP) repair of groin hernias. Most endoscopic surgeons advocate routine closure of these tears. Our approach is not to perform routine closure of PTs. The aim of this study was to evaluate the possible effect of our approach on the intra- and postoperative course of patients in whom PTs were left opened. METHODS Prospective data were collected for LTEP repairs of 298 hernias performed in 166 consecutive patients. RESULTS There were 134 primary and 34 recurrent hernias. In 23% of patients, unilateral or bilateral PTs were observed during the course of operation. Of these, the prevalence of tears was 21.8% for primary repair and 41% for recurrent repair. In 40 patients with PTs, the procedure was accomplished successfully laparoscopically. The early postoperative course was uncomplicated in all patients. Results of outpatient follow-up with a mean observation time of 16 months (range, 2-30) did not reveal any complications that could be attributed to PTs. CONCLUSIONS These data demonstrate that PTs do not have to be routinely closed and the majority of cases may be safely managed without peritoneal closure. We have not observed any intra- or postoperative complications that could be attributed to peritoneal tears.
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Affiliation(s)
- B Shpitz
- Department of Surgery B, Meir General Hospital, Tel Aviv University, Sackler Medical School, Kfar Sava , Ramat Aviv, 44281, Israel.
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50
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Abstract
Traumatic abdominal wall herniation (TAWH) caused by direct trauma from bicycle handlebars are rare. There are only 21 reported cases of handlebar hernias. An 11-year-old boy presented to the emergency room soon after falling from his bicycle and hitting his right lower quadrant on the handlebars. The patient's vital signs and initial laboratory studies were normal. Physical exam showed a soft tissue bulge in the right lower quadrant with superficial ecchymosis and tenderness to palpation. Computed tomography showed intestinal loops protruding through a defect in the abdominal wall into the subcutaneous space. Surgical exploration found a defect throughout his entire abdominal wall including the fascia, muscular layers, and peritoneum, with bowel protruding into the subcutaneous space. The defect was repaired in layers, and the child's postoperative course was unevenful. The authors recommend a high level of clinical suspicion for TAWH in all patients with traumatic abdominal wall injuries. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.
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Affiliation(s)
- J Goliath
- Department of General Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA
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