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American Journal of Surgery Jan 2002Peritonitis may cause a reduction in abdominal fibrinolytic activity. The reduced local fibrinolysis seems to be an important process in the subsequent development of...
BACKGROUND
Peritonitis may cause a reduction in abdominal fibrinolytic activity. The reduced local fibrinolysis seems to be an important process in the subsequent development of adhesion formation. The aim of the study was to evaluate peritoneal fibrinolytic capacity in inflamed and normal peritoneum.
METHODS
Peritoneal biopsy specimens were taken at the beginning of operation from 15 patients with peritonitis and 10 patients who underwent elective operation. Levels of tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor (PAI) type 1 (PAI-1) and type 2 (PAI-2), and tPA/PAI complex in tissue extracts were determinated by commercially available enzyme-linked immunosorbent assay kits.
RESULTS
tPA was significantly reduced in peritonitis compared with normal peritoneum (P <0.001), whereas it was found that the levels of PAI-1, PAI-2, uPA, and tPA/PAI complex in peritonitis were significantly higher than those in normal controls.
CONCLUSIONS
Plasminogen activator activity was significantly reduced in peritoneal biopsy samples from patients with peritonitis compared with those from patients without peritonitis.
Topics: Adolescent; Adult; Aged; Biopsy; Female; Fibrinolysis; Humans; Inflammation; Male; Middle Aged; Peritoneal Diseases; Peritoneum; Peritonitis; Plasminogen Activators; Tissue Adhesions
PubMed: 11869706
DOI: 10.1016/s0002-9610(01)00850-9 -
Advances in Peritoneal Dialysis.... Jan 2017Peritonitis is an important cause of morbidity, mortality, and technique failure in patients on peritoneal dialysis (PD). The most effective approach to peritonitis is...
Peritonitis is an important cause of morbidity, mortality, and technique failure in patients on peritoneal dialysis (PD). The most effective approach to peritonitis is prevention, which includes careful patient training and follow-up. Although peritonitis as a result of contiguous spread of bacteria or fungi during invasive procedures, or as a result of seeding of the peritoneum during bacteremia, is uncommon, the likelihood of such spread is often predictable, and the risk can be mitigated with antibiotic prophylaxis. Here, we describe the rationale for, and approach to, antibiotic prophylaxis in PD patients for the prevention of infective episodes.
Topics: Antibiotic Prophylaxis; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Peritoneum; Peritonitis
PubMed: 29668433
DOI: No ID Found -
Abdominal Imaging Mar 2015The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a... (Review)
Review
The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a variety of benign and malignant processes. While secondary involvement of the peritoneum is more common, primary tumors can be a diagnostic challenge. Knowledge of the anatomy is crucial in understanding the various pathologic processes. Cross-sectional imaging plays an important role in diagnosing and evaluating the extent of the disease processes. This article reviews the imaging anatomy of the peritoneum and mesentery and the common pathologies involving it.
Topics: Humans; Infarction; Mesentery; Omentum; Panniculitis, Peritoneal; Peritoneal Diseases; Peritoneum; Peritonitis; Pseudomyxoma Peritonei
PubMed: 25189130
DOI: 10.1007/s00261-014-0232-8 -
Clinica Chimica Acta; International... Jan 2017The role of microRNA (miRNA) in peritoneal fibrosis and longitudinal change in transport is uncertain. (Observational Study)
Observational Study
BACKGROUND
The role of microRNA (miRNA) in peritoneal fibrosis and longitudinal change in transport is uncertain.
METHODS
We studied 80 new peritoneal dialysis (PD) patients. Peritoneal transport was determined by standard peritoneal equilibration test (PET) of creatinine at baseline. Based on published literature, PD effluent levels of 10 miRNA targets were quantified. PET and miRNA quantification were repeated one year later in 46 patients.
RESULTS
Baseline PD effluent levels of all targets tested had modest but significant correlation with peritoneal transport parameters. PD effluent miR-21 and miR-589 levels correlated with dialysate-to-plasma creatinine concentration at 4h (D/P4) at baseline (r=0.377, p=0.001 and r=0.237, p=0.037, respectively) and after one year of PD (r=0.362, p=0.014 and r=0.402, p=0.007). The change in PD effluent -21 and miR-589 levels over one year correlated with the corresponding change in D/P4 (r=0.470, p=0.001 and r=0.479, p=0.002). The number of peritonitis episodes during follow up significantly correlated with the change in PD effluent miR-21 (r=0.387, p=0.009) and miR-589 (r=0.336, p=0.027) levels. There was no significant correlation between PD effluent miRNA level and ultrafiltration volume.
CONCLUSION
Amongst the 10 miRNA targets tested, miR-21 and miR-589 showed consistently significant relation with peritoneal transport. Further studies are needed to delineate their mechanisms of regulating peritoneal transport.
Topics: Biological Transport; Cohort Studies; Female; Humans; Longitudinal Studies; Male; MicroRNAs; Middle Aged; Peritoneal Dialysis; Peritoneum; Peritonitis
PubMed: 27867039
DOI: 10.1016/j.cca.2016.11.020 -
Clinical Nephrology Dec 2017The longitudinal effects of peritoneal dialysis (PD) peritonitis on small solute clearance and ultrafiltration are controversial.
BACKGROUND
The longitudinal effects of peritoneal dialysis (PD) peritonitis on small solute clearance and ultrafiltration are controversial.
MATERIALS AND METHODS
We identified 27 patients with PD peritonitis over a 4-year period at a tertiary hospital. Adequacy tests at an "early" (1 - 3 months), "intermediate" (6 ± 2 months), and a "late" (12 ± 2 months) time period after the episode were compared with a pre-peritonitis baseline. The effect of time on serum albumin, weekly creatinine clearance, Kt/V, and net fluid volume removal was assessed.
RESULTS
At 12 months, 16/27 (59.3%) patients were no longer on PD. Ten were transferred to hemodialysis, predominantly due to peritonitis (60%). Five patients died, and 1 received a renal allograft. Total daily fluid volume removal significantly decreased over time with an aggregated mean reduction of 523 mL/day between the baseline and 12-month test (1,624 ± 139 mL vs. 1,101 ± 160 mL; p = 0.02). This was due to an equivalent loss of both ultrafiltration and residual urine output, although the separate decline in these individual parameters was not statistically significant. There was no significant change in Kt/V, creatinine clearance, or serum albumin indicating preserved solute transport in those patients with sustained technique survival post peritonitis.
CONCLUSION
Peritonitis is a common cause for transfer to hemodialysis. Fluid volume removal is the most significantly affected parameter at 12 months post peritonitis, driven by the combination of both ultrafiltration reduction and loss of residual diuresis. Clinicians should be aware that peritonitis identifies patients at high risk for technique failure. These findings should prompt clinicians to closely surveil volume status and consider backup dialytic strategies as early as 12 months post peritonitis. .
Topics: Aged; Female; Humans; Longitudinal Studies; Male; Middle Aged; Peritoneal Dialysis; Peritoneum; Peritonitis; Renal Dialysis
PubMed: 29139376
DOI: 10.5414/CN109071 -
Peritoneal Dialysis International :... 1997
Review
Topics: Anticoagulants; Epithelium; Fibrin; Fibrinolysis; Humans; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis
PubMed: 9159830
DOI: No ID Found -
Peritoneal Dialysis International :... 2008
Review
Topics: Ascitic Fluid; Gentamicins; Gram-Negative Bacterial Infections; Humans; Imipenem; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Sphingomonas
PubMed: 18708553
DOI: No ID Found -
Journal of Nephrology Sep 2023Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of...
BACKGROUND
Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap.
METHODS
Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7 days of hospital discharge and developed symptoms of peritonitis within 3 days of the hospital discharge.
RESULTS
Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95 g/L vs. 25.76 g/L, p = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm vs. 3183.50/mm, p < 0.01 and 1037.00/mm vs. 2800.00/mm, p < 0.01, respectively). Higher proportions of peritonitis due to Pseudomonas spp. (9.5% vs. 3.7%, p = 0.020) and vancomycin-resistant Enterococcus (2.4% vs. 0.0%, p = 0.009), lower rates of complete cure (39.3% vs. 61.7%, p < 0.001), higher rates of refractory peritonitis (39.3% vs. 16.4%, p < 0.001) and higher all-cause mortality within 30 days of peritonitis diagnosis (28.6% vs. 3.3%, p < 0.001) were observed in the hospital-acquired peritonitis group compared to the community-acquired peritonitis group, respectively.
CONCLUSIONS
Despite having lower peritoneal dialysis effluent leucocyte counts at the time of diagnosis, patients with hospital-acquired peritonitis had poorer outcomes, including lower rates of complete cure, higher rates of refractory peritonitis and higher rates of all-cause mortality within 30 days of diagnosis, compared to those with community-acquired peritonitis.
Topics: Adult; Humans; Retrospective Studies; Peritoneal Dialysis; Peritonitis; Peritoneum; Hospitals
PubMed: 36913080
DOI: 10.1007/s40620-023-01597-w -
Peritoneal Dialysis International :... 1993The role of peritoneal lymphocytes in host immunity for continuous ambulatory peritoneal dialysis (CAPD) patients is just beginning to be understood. CAPD therapy... (Review)
Review
The role of peritoneal lymphocytes in host immunity for continuous ambulatory peritoneal dialysis (CAPD) patients is just beginning to be understood. CAPD therapy increases the proportion of peritoneal lymphocytes, most of which demonstrate signs of activation. There are decreased peritoneal T cells and increased peritoneal B cells as compared to the patients' peripheral blood. When studies examine immunophenotypes of peripheral and peritoneal lymphocytes over time, no significant changes are found. Although changes in peritoneal lymphocyte subsets occur during peritonitis episodes, there are no changes in peripheral blood lymphocytes. The purpose of this article is to provide a brief review of research that has studied lymphocytes in CAPD patients.
Topics: Humans; Immunophenotyping; Lymphocytes; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Renal Dialysis
PubMed: 8399587
DOI: No ID Found -
Advances in Renal Replacement Therapy Jul 1998One of main challenges of peritoneal dialysis (PD) is the functional and vital long-term stability of the peritoneal membrane. Few longitudinal and controlled studies on...
One of main challenges of peritoneal dialysis (PD) is the functional and vital long-term stability of the peritoneal membrane. Few longitudinal and controlled studies on peritoneal function have been published, and the results are somewhat contradictory. We have performed a longitudinal study with 90 patients. The overall analysis has shown that creatinine mass transfer coefficient (MTC) significantly increases and ultrafiltration (UF) capacity decreases over time. Nevertheless, urea MTC remained unaltered and MTC ratios significantly decreased after the third year. Subsequently, we examined the clinical outcomes and identified 19 patients who required peritoneal resting periods for Type I UF failure and 71 patients who did not require such a procedure. The latter patients did not show any significant functional change over time, whereas the former 19 patients showed an increase of peritoneal creatinine transport and a loss of UF capacity. These data corroborate changes in long-term peritoneal function in approximately 20% of PD patients. These changes consist of an increase in effective exchange area, peritoneal permeability, or both, accompanied by signs suggestive of mesothelial regenerative capacity loss. Infectious peritoneal injuries, especially appearing during late PD periods, are deleterious to the peritoneum. The remainder of the functional-structural changes are related to the effects of currently used dialysate. Early diagnosis, preemptive, and therapeutic measures should permit better management of long-term PD patients. The particular response to these injuries has individual characteristics that when addressed permit PD to be used long-term.
Topics: Analysis of Variance; Creatinine; Dialysis Solutions; Glycosylation; Humans; Longitudinal Studies; Peritoneal Dialysis; Peritoneum; Peritonitis; Prognosis; Sclerosis; Transforming Growth Factor beta; Ultrafiltration
PubMed: 9686627
DOI: 10.1016/s1073-4449(98)70029-9