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The Journal of Physiological Sciences :... May 2017Disseminated metastasis is associated with a poor prognosis, and its management in the peritoneal or pleural cavity is crucial in the treatment of cancer. Recent studies... (Review)
Review
Disseminated metastasis is associated with a poor prognosis, and its management in the peritoneal or pleural cavity is crucial in the treatment of cancer. Recent studies show that ion and water transporters play important roles in fundamental cellular functions, including the regulation of cell volume that would be involved in the cancer process. Here, we review the evidence for hypotonic treatments of cancer and evaluate the potential of the cellular physiological approach in clinical management. The regulation of extracellular osmolality is a promising method, with several studies demonstrating the cytocidal effects of hypotonic solution on cancer cells. Peritoneal lavage with distilled water (DW) during surgery is reported to improve the survival rate of patients with spontaneously ruptured hepatocellular carcinoma. The in vitro studies included in this review also indicate the cytocidal effects of hypotonic shock on esophageal, gastric, colonic, pancreatic, and liver cancer cells with several unique methods and apparatuses, such as a differential interference contrast microscope connected to a digital video camera, a high-resolution flow cytometer and re-incubation analysis. The in vivo studies demonstrate the safeness of a peritoneal injection of DW into mice and indicate that the development of dissemination nodules can be prevented by the pre-incubation of cancer cells with DW or the peritoneal injection of DW. We also demonstrate that the blockade of Cl channels/transporters enhances the cytocidal effects of hypotonic shock by inhibiting regulatory volume decrease in various cancer cells. A deeper understanding of molecular mechanisms may lead to the discovery of these cellular physiological approaches as a novel therapeutic strategy for disseminated metastasis.
Topics: Animals; Humans; Hypotonic Solutions; Neoplasm Metastasis; Neoplasms; Osmolar Concentration; Osmotic Pressure; Peritoneal Lavage
PubMed: 28185236
DOI: 10.1007/s12576-017-0528-x -
Annals of Surgery Apr 2017To compare the outcomes of laparoscopic lavage and sigmoid resection in perforated diverticulitis with purulent peritonitis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the outcomes of laparoscopic lavage and sigmoid resection in perforated diverticulitis with purulent peritonitis.
BACKGROUND
Peritonitis secondary to perforated diverticulitis has conventionally been managed by resection and stoma formation. Case series have suggested that patients can be safely managed with laparoscopic lavage, resulting in reduced mortality and stoma formation. Recently, 3 randomized controlled trials have published contradictory conclusions.
METHODS
MEDLINE from 1946 to present, Cochrane Database of Systematic Reviews, and Cochrane database of Registered clinical trials and EMBASE (all via OVID) were searched using the terms "laparoscopy" AND ("primary resection" OR "Hartmann procedure", OR "sigmoidectomy"), AND "Diverticulitis", AND "Peritonitis" AND "therapeutic irrigation" or "lavage" AND randomized controlled trial and any derivatives of those terms. We included all randomized controlled trials. Data were extracted from each study using a purpose-designed template. Statistical analysis was undertaken using Revman 5.
RESULTS
Three randomized controlled trials were identified from 48 potential studies. The analysis included 307 patients of whom 159 underwent laparoscopic lavage. Overall, the rate of reintervention within 30 days postoperatively was 45/159 (28.3%) in the lavage group and 13/148 (8.8%) in the resection group (relative risk 3.01, 95% confidence interval 1.15-7.90). There was no significant difference in Intensive Care Unit admissions, 30 and 90-day mortality, or stoma rates at 12 months.
CONCLUSION
Laparoscopic lavage used in the management of Hinchey grade III diverticulitis leads to more reinterventions within 30 days postoperatively, but does not increase the 30 or 90-day mortality rates compared with sigmoid resection.
Topics: Diverticulitis; Diverticulum, Colon; Female; Hospital Mortality; Humans; Laparoscopy; Male; Peritoneal Lavage; Peritonitis; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Survival Rate; Treatment Outcome
PubMed: 27631772
DOI: 10.1097/SLA.0000000000002005 -
Surgery, Gynecology & Obstetrics Dec 1987Peritoneal lavages performed in 161 patients who had sustained blunt (93 per cent) and penetrating (7 per cent) trauma were prospectively studied in order to assess our...
Peritoneal lavages performed in 161 patients who had sustained blunt (93 per cent) and penetrating (7 per cent) trauma were prospectively studied in order to assess our indications and technique, as well as to document the accuracy and complication rate in the hands of an Advanced Trauma Life Support trained resident staff. The most common indication for the performance of a lavage was blunt trauma to the abdomen associated with an altered mental status due to injury to the head or substance abuse. The semiopen technique was used 91.0 per cent of the time with a complication rate of 0.6 per cent. The open technique was used 9 per cent of the time on patients who had undergone previous limited abdominal operations, those who were pregnant, those with dilated intestine and for those patients with evidence of portal hypertension. Aspiration of greater than 10 milliliters of gross blood, an erythrocyte count greater than 100,000 per millimeter to the third power, or a white blood cell count greater than 500 per millimeter to the third power or an elevated amylase or bilirubin level in the lavage effluent, were the criteria used for a positive result in blunt trauma. The accuracy rate was 93 per cent with eight false-positive and three false-negative examinations. The sensitivity rate was 94 per cent and the specificity rate was 93 per cent. While most reported series classify lavage results as true-positive when intraperitoneal blood is found at exploration, even if secondary to trivial injuries which do not require surgical therapy (nontherapeutic laparotomy), we believe that these should be classified as false-positive results, as was done in this study. Computerized tomographic scanning may be more useful than peritoneal lavage in the evaluation of patients with pelvic fractures or other retroperitoneal injuries which often result in false-positive lavage. Peritoneal lavage is often an inaccurate indicator of isolated intestine and diaphragmatic or retroperitoneal injury. Given its simplicity, low complication rate and accuracy, peritoneal lavage can be safely performed by surgeons in training to evaluate the victim of trauma.
Topics: Abdominal Injuries; Boston; Emergencies; Emergency Medicine; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Humans; Internship and Residency; Peritoneal Lavage; Prospective Studies; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 3686314
DOI: No ID Found -
JAMA Surgery Dec 2019
Topics: Gastrectomy; Humans; Peritoneal Lavage; Stomach Neoplasms
PubMed: 31411661
DOI: 10.1001/jamasurg.2019.2667 -
JAMA Surgery Dec 2019
Topics: Gastrectomy; Humans; Peritoneal Lavage; Stomach Neoplasms
PubMed: 31411654
DOI: 10.1001/jamasurg.2019.2658 -
JAMA Surgery Dec 2019
Topics: Gastrectomy; Humans; Peritoneal Lavage; Stomach Neoplasms
PubMed: 31411655
DOI: 10.1001/jamasurg.2019.2661 -
The Canadian Veterinary Journal = La... Sep 2012This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative...
This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery. This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery.
Topics: Animals; Anti-Bacterial Agents; Bacteria; Dog Diseases; Dogs; Female; Intraoperative Care; Male; Peritoneal Lavage; Peritonitis; Pilot Projects; Treatment Outcome
PubMed: 23450861
DOI: No ID Found -
Transactions. Conference on Metabolic...
Topics: Peritoneal Lavage; Uremia; Urologic Diseases
PubMed: 20250865
DOI: No ID Found -
Early Human Development Jun 2016Necrotising enterocolitis (NEC) is a neonatal surgical emergency. At its early stages, the management of NEC is largely medical using broad-spectrum antibiotics, gut... (Review)
Review
Necrotising enterocolitis (NEC) is a neonatal surgical emergency. At its early stages, the management of NEC is largely medical using broad-spectrum antibiotics, gut rest and total parental nutrition. The only absolute indication for surgery is an intra-abdominal perforation. There are several relative indications for surgery based on clinical, biochemical and radiological parameters. Once the decision to intervene is made, several approaches may be taken. Peritoneal lavage can be used as a salvage procedure or definitive management in some cases. The most common approach taken is bowel resection with enterostomy formation. There is a role for primary anastomosis of bowel in limited NEC. In severe, multi-focal NEC a high diverting jejunostomy or "clip and drop technique" can be used. Laparoscopy has a limited role and is not widespread. The surgical complications of NEC include stoma related morbidity, anastomotic leak/stricture and short-bowel syndrome. Long-term data on neurodevelopmental outcomes is sparse but the present literature is suggestive of a negative impact in cases of surgically managed NEC.
Topics: Enterocolitis, Necrotizing; Enterostomy; Humans; Infant, Newborn; Peritoneal Lavage; Postoperative Complications
PubMed: 27032753
DOI: 10.1016/j.earlhumdev.2016.03.002 -
Anticancer Research Oct 2020The survival benefit of negative resection margins in patients who undergo gastrectomy with positive peritoneal lavage cytology (CY1) is unknown.
BACKGROUND/AIM
The survival benefit of negative resection margins in patients who undergo gastrectomy with positive peritoneal lavage cytology (CY1) is unknown.
PATIENTS AND METHODS
We reviewed the medical records of 128 patients with CY1 but no other distant metastases who had undergone R1 gastrectomy, 21 of whom had positive margins. We compared overall survival (OS) according to margin status.
RESULTS
The positive-margin group had poorer performance status scores (p=0.02), higher number of patients had undergone limited lymphadenectomy (p=0.01), had type 4 tumors (p=0.01), and undifferentiated type (p=0.02). Median OS was 19.0 and 16.9 months in the groups with negative and positive margins, respectively (HR=1.26, 95%CI=0.75-2.12, p=0.39). An inverse probability of treatment weighted analysis showed an OS of 13.1 and 11.9 months for the groups with negative and positive margins, respectively (HR=0.83, 95%CI=0.43-1.63, p=0.59).
CONCLUSION
The prognoses of patients with CY1 and negative or positive margins may be equivalent.
Topics: Cytodiagnosis; Female; Gastrectomy; Humans; Male; Margins of Excision; Middle Aged; Peritoneal Lavage; Prognosis; Stomach Neoplasms; Survival Rate
PubMed: 32988909
DOI: 10.21873/anticanres.14598