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The Yale Journal of Biology and Medicine Aug 1962
Topics: Animals; Mice; Peritoneal Cavity; Peritonitis; Staphylococcal Infections; Staphylococcus aureus
PubMed: 13880376
DOI: No ID Found -
The British Journal of Surgery Nov 2011Current views on the pathogenesis of adhesion formation are based on the 'classical concept of adhesion formation', namely that a reduction in peritoneal fibrinolytic... (Review)
Review
BACKGROUND
Current views on the pathogenesis of adhesion formation are based on the 'classical concept of adhesion formation', namely that a reduction in peritoneal fibrinolytic activity following peritoneal trauma is of key importance in adhesion development.
METHODS
A non-systematic literature search (1960-2010) was performed in PubMed to identify all original articles on the pathogenesis of adhesion formation. Information was sought on the role of the fibrinolytic, coagulatory and inflammatory systems in the disease process.
RESULTS
One unifying concept emerged when assessing 50 years of studies in animals and humans on the pathogenesis of adhesion formation. Peritoneal damage inflicted by surgical trauma or other insults evokes an inflammatory response, thereby promoting procoagulatory and antifibrinolytic reactions, and a subsequent significant increase in fibrin formation. Importantly, peritoneal inflammatory status seems a crucial factor in determining the duration and extent of the imbalance between fibrin formation and fibrin dissolution, and therefore in the persistence of fibrin deposits, determining whether or not adhesions develop.
CONCLUSION
Suppression of inflammation, manipulation of coagulation as well as direct augmentation of fibrinolytic activity may be promising antiadhesion treatment strategies.
Topics: Animals; Ascitic Fluid; Biopsy; Blood Coagulation; Fibrinolysis; Humans; Peritoneum; Peritonitis; Plasminogen Activators; Plasminogen Inactivators; Postoperative Complications; Rats; Tissue Adhesions
PubMed: 21877324
DOI: 10.1002/bjs.7657 -
British Journal of Hospital Medicine... Jan 2008
Review
Topics: Adult; Analgesics; Anti-Bacterial Agents; Child; Female; Humans; Intubation, Gastrointestinal; Male; Peritoneum; Peritonitis; Prognosis
PubMed: 18293728
DOI: 10.12968/hmed.2008.69.Sup1.28050 -
Peritoneal Dialysis International :... 2016♦
UNLABELLED
♦
BACKGROUND
Preservation of the peritoneum is required for long-term peritoneal dialysis (PD). We investigated the effect of multiple peritonitis episodes on peritoneal transport. ♦
METHODS
Prospectively collected data from 479 incident PD patients treated between 1990 and 2010 were analyzed, using strict inclusion criteria: follow-up of at least 3 years with the availability of a Standard Peritoneal Permeability Analysis (SPA) in the first year after start of PD and within the third year of PD, without peritonitis preceding the first SPA. For the purpose of the study, we only included patients who remained peritonitis-free (n = 28) or who experienced 3 or more peritonitis episodes (n = 16). ♦
RESULTS
At baseline the groups were similar with regard to small solute and fluid transport. However, the frequent peritonitis group had lower peritoneal protein clearances compared to the no peritonitis group, resulting in lower dialysate concentrations of proteins: albumin 196.5 mg/L vs 372.5 mg/L, IgG 36.4 mg/L vs 65.0 mg/L, and α-2-macroglobulin (A2M) 1.9 mg/L vs 3.6 mg/L, p <0.01. No differences in serum concentrations were present. A comparison between the transport slopes over time in both groups showed a positive time trend of mass transfer area coefficient (MTAC) creatinine (p = 0.03) and glucose absorption (p = 0.09) and a negative trend of transcapillary ultrafiltration (p = 0.06), when compared to the no peritonitis group. Frequent peritonitis did not affect free water transport. ♦
CONCLUSIONS
Slow initial peritoneal transport rates of serum proteins result in lower dialysate concentrations, and likely a lower opsonic activity, which is a risk factor for peritonitis. Patients with frequent peritonitis show an increase in small solute transport and a concomitant decrease of ultrafiltration. In long-term peritonitis-free PD patients, small solute transport decreased, while ultrafiltration increased. This suggests that frequent peritonitis leads to an increase of the vascular peritoneal surface area without all the structural membrane alterations that may develop after long-term PD.
Topics: Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritoneum; Peritonitis; Prospective Studies
PubMed: 25395498
DOI: 10.3747/pdi.2014.00115 -
Advances in Renal Replacement Therapy Jul 1998Peritonitis is the most frequent complication and a leading cause of discontinuation of peritoneal dialysis (PD). Intact epithelial lining, sufficient blood flow, and... (Review)
Review
Peritonitis is the most frequent complication and a leading cause of discontinuation of peritoneal dialysis (PD). Intact epithelial lining, sufficient blood flow, and adequate immunologic responses are vital to eradicate infection. In long-term PD, various pathological changes such as denudation of peritoneal mesothelial cells, duplication of submesothelial and/or capillary basement membranes, submesothelial fibrin deposit, and peritoneal fibrosis have been reported. Causes of these changes of the peritoneum are multifactorial. Commonly used dialysis solutions that are acidic, hypertonic, containing high concentrations of glucose and lactate, contaminated by glucose and/or plastic degradation products are not biocompatible and may induce chronic immune reactions in the peritoneal cavity. Long-term exposure of the peritoneum to dialysis solutions, the peritoneal catheter, and recurrent episodes of peritonitis all contribute to peritoneal injury. In addition, long-term exposure of peritoneal cells such as macrophages, mesothelial cells, and fibroblasts to dialysis solutions may also alter the normal immunologic reactions against bacteria. Peritoneal concentrations of opsonins such as Ig, complement, and protease are approximately 1% of the serum levels and far below the level sufficient to eradicate bacteria due to continuous peritoneal lavage and dilution with dialysis solutions. Furthermore, glycation of IgG induces chronic activation of macrophages and decreases normal opsonic activities against bacteria. Fibrin deposits, collagen accumulation, and cellular desert of the peritoneum observed in long-term peritoneal dialysis patients may serve as a safe shelter for bacteria from contact with inflammatory cells and opsonin and delay eradication of bacteria. In conclusion, peritonitis is often more severe in patients on long-term PD. In this setting, peritonitis needs special attention to prevent life-threatening infection and further damage of the peritoneum.
Topics: Collagen; Dialysis Solutions; Epithelium; Fibrin; Glucose; Glycosylation; Humans; Immunoglobulin G; Macrophages; Membrane Lipids; Peritoneal Dialysis; Peritoneum; Peritonitis; Phospholipids; Time Factors
PubMed: 9686629
DOI: 10.1016/s1073-4449(98)70031-7 -
Compendium (Yardley, PA) Oct 2011Septic peritonitis is an inflammatory condition of the peritoneum that occurs secondary to microbial contamination. This clinically important condition has a wide... (Review)
Review
Septic peritonitis is an inflammatory condition of the peritoneum that occurs secondary to microbial contamination. This clinically important condition has a wide variety of clinical courses as well as high morbidity and mortality due to secondary multiorgan dysfunction. This article reviews the etiology and pathophysiology of this condition and its diagnosis in small animals; a companion article addresses treatment and prognosis.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Peritoneum; Peritonitis; Sepsis
PubMed: 22012841
DOI: No ID Found -
Blood Purification 2003This paper reviews some important recent findings on the molecular biology of the peritoneal membrane. It attempts to correlate in vitro and in vivo experimental results... (Review)
Review
This paper reviews some important recent findings on the molecular biology of the peritoneal membrane. It attempts to correlate in vitro and in vivo experimental results with the possible clinical consequences. The most common functional alteration during long-term CAPD is increased peritoneal small-solute transport rate, resulting in impaired ultrafiltration and decreased dialysis efficiency. This contribution first discusses the most relevant advances in the biochemistry and molecular biology of the peritoneal membrane following peritonitis and as consequence of the continuous exposure to unphysiological dialysis fluids. In a second part the preliminary experimental and clinical experience with more biocompatible fluids is summarized. The most relevant structural and functional alterations of the membrane following repeated peritonitis is the consequence of the response of the peritoneum to infective organisms involving the inflammatory cytokines and the interaction between membrane resident cell populations: macrophages, mesothelial cells and fibroblasts. In this setting, human biopsy studies and animal experiments have identified an increase in the peritoneal-associated vasculature, which seems to be the primary cause of increased solute transport. The structural and functional alterations in the membrane in long-term peritoneal dialysis are thought to be the consequence of the toxicity of glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end-products. In particular, an important role for vascular endothelial growth factor and nitric oxide as downstream mediators of the alterations has been suggested. Finally, the last part of this paper reviews the actual and future research aimed at an amelioration of the biocompatibility of the dialysis fluids. Replacing glucose by other osmotic agents, changing the sterilization process, replacing the lactate buffer by bicarbonate, blocking the formation of reactive carbonyl products and of the neoangiogenesis are the most promising changes to enhance the biocompatibility. Finally, gene therapy may in the future have an important contribution. Ex vivo gene therapy involves harvesting peritoneum samples to isolate mesothelial cells that will be genetically modified before re-implantation into the peritoneal cavity.
Topics: Animals; Biocompatible Materials; Dialysis Solutions; Humans; Peritoneal Dialysis; Peritoneum; Peritonitis; Uremia
PubMed: 12566656
DOI: 10.1159/000067867 -
Medicinski Arhiv 2007Peritonitis signifies inflammation of peritoneum, whose cause is not specific. It can be regarded as local equivalent of systemic inflammatory response which is seen... (Review)
Review
Peritonitis signifies inflammation of peritoneum, whose cause is not specific. It can be regarded as local equivalent of systemic inflammatory response which is seen after any trigger of inflammation and referred to as "systemic inflammatory response syndrome (SIRS)". Intraabdominal infection is actually peritonitis caused by bacteria (local systemic inflammatory process caused by bacteria and their toxins). It can be regarded as a local equivalent of systemic sepsis. Because most of clinically significant peritonitis are caused by bacteria, both of terms are used simultaneously. Peritonitis takes place together with many, complex pathophysiological changes on systemic and cellular level. Consequences of peritonitis depend on the result of the battle between two main forces: the patient's systemic and peritoneal defense on one side, and the nature and duration of contamination on other side.
Topics: Bacterial Infections; Humans; Peritoneum; Peritonitis; Systemic Inflammatory Response Syndrome
PubMed: 17629147
DOI: No ID Found -
Journal of Nephrology 2013
Review
Topics: Biomarkers; Biopsy; CA-125 Antigen; Dialysis Solutions; Humans; Interleukin-6; Kidney; Membrane Proteins; Pain; Peritoneal Dialysis; Peritoneum; Peritonitis; Renal Dialysis; Vascular Endothelial Growth Factor A
PubMed: 24307440
DOI: 10.5301/JN.2013.11634 -
Peritoneal Dialysis International :... 2000Current definitions of encapsulating peritoneal sclerosis are practical and clinically relevant. It is important to adhere to a more uniform use of the proper... (Review)
Review
Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis.
Current definitions of encapsulating peritoneal sclerosis are practical and clinically relevant. It is important to adhere to a more uniform use of the proper terminology, and it is the recommendation of the authors that EPS be adopted as the more appropriate term. The best literal definition of EPS is based on clinical-pathologic criteria. Differentiation of EPS from the general category of ultrafiltration failure is required. Further, better appreciation of the diverse pathways that can lead to the same final common clinical-pathologic picture should not be overshadowed by the requirement of uniform terminology. Incidence and prevalence of the syndrome have been defined in some large populations and a few single-center experiences. The former show an incidence of less than 1%, while higher percentages are reported in the latter. The reported increased incidence with duration on therapy requires validation. The epidemiology of the syndrome offers limited insight into its pathogenesis. A list of factors, both dialysis-related and non dialysis-related. has been accumulated. Except in a few categories where agents are clearly related to the development of EPS, the majority of the listed factors for dialysis-related BPS remain, at best, associations and at worst, simple conjecture. The same limitations that plague the issue of etiology apply in the area of pathogenesis. More basic, focused work is required. The diagnosis of EPS remains based on clinical suspicion confirmed with, primarily, radiologic findings. Pathologic confirmation is obtained in cases that come to surgery for management or for catheter removal. Radiologic studies are precise enough for confirmation, but none have been evaluated for early diagnosis for possible early intervention or prevention. Studies based on transport characteristics or effluent dialysate constituents are not useful for EPS. At present, there are no reliable predictive tests for BPS that can be used in individual patients. Therapy of BPS is based on anecdotal evidence. The possible variable etiologies and probable distinct pathways leading to the syndrome may make a uniform therapeutic approach unlikely. Further, the limited number of cases and the sporadic pattern of occurrences make therapeutic trials not readily feasible. This is distinct from the case of ultrafiltration failure, where significant advances in mechanism elucidation and rationale-based interventions have been made.
Topics: Humans; Peritoneal Dialysis; Peritoneum; Peritonitis; Sclerosis
PubMed: 11098928
DOI: No ID Found