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The American Surgeon Apr 2023Peritoneal tuberculosis is a rare form of tuberculosis, which involves parietal and visceral peritoneum, omentum, and intestinal mesentery. Its incidence is increasing...
Peritoneal tuberculosis is a rare form of tuberculosis, which involves parietal and visceral peritoneum, omentum, and intestinal mesentery. Its incidence is increasing in developed countries due to HIV infection and immigration. We present a case of peritoneal tuberculosis in a twenty two-year-old patient misdiagnosed with appendicitis. A laparoscopic surgery was performed showing multiple implants on serosal surfaces and adhesions. Laparoscopic appendectomy and peritoneal biopsies were performed. As peritoneal tuberculosis was suspected, an early antituberculous treatment was initiated. A pathological examination of the samples revealed epithelioid granulomas with a centrale caseous necrosis and acid-fast bacilli. Peritoneal tuberculosis is a challenging diagnosis that can mimic other pathologies and should be kept in mind to establish an early antituberculosis treatment avoiding the high morbidity and mortality associated with a late treatment initiation. In case of suspicion of peritoneal tuberculosis, laparoscopy with guided biopsies is useful for the establishment of a correct diagnosis.
Topics: Humans; Young Adult; HIV Infections; Laparoscopy; Peritoneum; Peritonitis, Tuberculous; Tuberculosis
PubMed: 33629874
DOI: 10.1177/0003134821998670 -
Ugeskrift For Laeger Mar 2023It is well known that biological treatment increases the risk of opportunistic infections. Guidelines recommend tuberculosis screening prior to treatment. This is a case...
It is well known that biological treatment increases the risk of opportunistic infections. Guidelines recommend tuberculosis screening prior to treatment. This is a case report of a woman who had morbus Crohn and developed peritoneal tuberculosis even though she completed a preventive tuberculosis eradication before initiating treatment with anti-TNF-inhibitor. She appeared with ascites and was examined very thoroughly, and eventually a peritoneal biopsy revealed tuberculosis. Tuberculosis is difficult to diagnose, and eradication is no guarantee that tuberculosis cannot relapse during biological treatment.
Topics: Female; Humans; Tumor Necrosis Factor Inhibitors; Peritonitis, Tuberculous; Tuberculosis; Crohn Disease; Peritoneum
PubMed: 36999296
DOI: No ID Found -
American Journal of Surgery Oct 1958
Topics: Foreign Bodies; Gangrene; Intestine, Large; Intestines; Peritoneal Diseases; Peritoneum
PubMed: 13571556
DOI: 10.1016/0002-9610(58)90984-x -
Taiwanese Journal of Obstetrics &... Feb 2015
Topics: Aged; Diagnosis, Differential; Female; Hemorrhage; Humans; Laparoscopy; Necrosis; Ovarian Neoplasms; Peritoneal Fibrosis; Peritoneum; Tomography, X-Ray Computed
PubMed: 25675930
DOI: 10.1016/j.tjog.2014.11.015 -
Journal de Radiologie Feb 2004
Comparative Study
Topics: Adult; Cell Division; Diagnosis, Differential; Diagnostic Imaging; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liposarcoma; Male; Necrosis; Neovascularization, Pathologic; Peritoneal Neoplasms; Peritoneum; Sensitivity and Specificity
PubMed: 15094621
DOI: 10.1016/s0221-0363(04)97553-1 -
Peritoneal Dialysis International :... Mar 2022Peritoneal dialysis induces the inflammatory response within the peritoneal cavity, which contributes to the progressive damage of the peritoneum. Due to close contact...
BACKGROUND
Peritoneal dialysis induces the inflammatory response within the peritoneal cavity, which contributes to the progressive damage of the peritoneum. Due to close contact of the peritoneal cavity and the intestines, there is the possibility that the visceral disorders can affect the intraperitoneal inflammation during peritoneal dialysis.
OBJECTIVES
Study of the effect of acute colitis on the intraperitoneal inflammation in conditions of peritoneal dialysis and evaluation of the protective effect of hyaluronan in that scenario.
METHODS
In rats with the dextran sulphate-induced colitis, 6-h peritoneal dialysis was performed with dianeal 2.5% +/- hyaluronan 10 mg/dL. In the control group, rats without colitis were studied. Peritoneal permeability and dialysate inflammation were studied at the end of the dialysate exchange.
RESULTS
In rats with colitis, intraperitoneal inflammatory reaction was increased as compared with the control group and reflected by the following studied parameters: dialysate cell count (+26%, < 0.01), number of neutrophils (+75%, < 0.01), generation of free radicals in the leukocytes (+70%, < 0.05), dialysate level of elastase (+102%, < 0.01), tumor necrosis factor α (+48%, < 0.01) and monocyte chemoattractant protein-1 (+42%, < 0.01). Drained dialysate volume was lower (-21%, < 0.01) and peritoneal permeability increased in rats with colitis (+55%, < 0.01). In animals with the hyaluronan supplemented dialysis fluids, the intensity of the intraperitoneal inflammation was reduced.
CONCLUSIONS
Visceral inflammation during colitis induces the inflammatory reaction within the peritoneal cavity that may accelerate damage to the peritoneum. Supplementation of the dialysis fluid with hyaluronan reduces the intensity of that effect.
Topics: Animals; Colitis; Dialysis Solutions; Humans; Hyaluronic Acid; Inflammation; Peritoneal Dialysis; Peritoneum; Peritonitis; Rats; Rats, Wistar
PubMed: 33998321
DOI: 10.1177/08968608211014568 -
Postoperative Uterine Necrosis and Peritonitis Following Laparoscopic Radiofrequency Myoma Ablation.Journal of Minimally Invasive Gynecology Oct 2022
Topics: Catheter Ablation; Female; Humans; Laparoscopy; Leiomyoma; Myoma; Necrosis; Peritonitis; Uterine Neoplasms
PubMed: 35691549
DOI: 10.1016/j.jmig.2022.06.006 -
Medicine Oct 2015Intestinal necrosis is a life-threatening disease, and its prompt and accurate diagnosis is very important. This study aimed to evaluate the value of D-dimer as a marker...
Intestinal necrosis is a life-threatening disease, and its prompt and accurate diagnosis is very important. This study aimed to evaluate the value of D-dimer as a marker for early diagnosis of bowel necrosis. From 2009 to 2013, patients undergoing operation due to acute intestinal obstruction were retrospectively analyzed. Clinicopathologic characteristics were compared among no ischemia group, reversible ischemia group, and bowel necrosis group. There were totally 274 patients being included for analyses. Patients with bowel necrosis had a significant highest level of D-dimer compared with other 2 groups (P = .007) when FEU unit was applied. The optimal cutoff value of D-dimer levels as an indicator in diagnosing bowel necrosis was projected to be 1.965 mg/L, which yielded a sensitivity of 84.0%, a specificity of 45.6%, a positive predictive value of 60.7%, and a negative predictive value of 74.0%. And the sensitivity of 84.0% and specificity of 70.0% were detected, when 1.65 mg/L of D-dimer was set as the cutoff value to distinguish the reversible ischemia and bowel necrosis. The corresponding results in patients with no or slight peritoneal irritation signs were 85.2%, 44.7%, 35.4% and 89.5% respectively. The sensitivity and negative predictive value were 96.0% and 91.7%, respectively, when D-dimer and peritoneal irritation signs were combined to perform the parallel analysis. The combination of D-dimer and peritoneal irritation signs could generate a reliable negative predictive value, which is helpful to exclude the diagnosis of intestinal necrosis. However, it should also be proved in well-designed large-scale prospective study.
Topics: Biomarkers; Female; Fibrin Fibrinogen Degradation Products; Humans; Intestinal Obstruction; Ischemia; Male; Middle Aged; Necrosis; Peritoneum; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity
PubMed: 26448003
DOI: 10.1097/MD.0000000000001564 -
Critical Care Medicine Jun 2005Polymorphonuclear neutrophil (PMN) influx and peritoneal tumor necrosis factor (TNF)-alpha production are key host defense mechanisms during peritonitis. The aim of this...
Regulation of peritoneal and systemic neutrophil-derived tumor necrosis factor-alpha release in patients with severe peritonitis: role of tumor necrosis factor-alpha converting enzyme cleavage.
OBJECTIVE
Polymorphonuclear neutrophil (PMN) influx and peritoneal tumor necrosis factor (TNF)-alpha production are key host defense mechanisms during peritonitis. The aim of this study was to explore the potential interactions between TNF-alpha production and TNF-alpha converting enzyme (TACE) expression by PMN in the blood and peritoneum of patients with severe peritonitis.
DESIGN
A prospective study.
SETTING
A surgical adult intensive care unit in a university hospital.
PATIENTS
A total of 29 consecutive immunocompetent patients with severe sepsis within 48 hrs of onset were enrolled and underwent laparotomy for a diffuse secondary peritonitis. Thirteen volunteers served as controls.
MEASUREMENTS
Blood and peritoneal fluid recovered during laparotomy were analyzed and compared for 1) soluble TNF-alpha, soluble L-selectin, and type I and II TNF-alpha receptor levels; 2) PMN membrane TNF-alpha, membrane L-selectin, and TACE expression (flow cytometry); and 3) TNF-alpha production by cultured PMN. Correlations between these forms of PMN-derived TNF-alpha and the severity of the peritonitis and patient's outcome were investigated.
MAIN RESULTS
Elevated soluble TNF-alpha levels in both plasma and peritoneal fluid from the patients were found, together with decreased expression of membrane TNF-alpha and TACE up-regulation at the PMN surface. Soluble L-selectin and type I and II TNF receptors were highly released, suggesting also the role of TACE. In contrast, the capacity of both blood and peritoneal PMN to synthesize TNF-alpha in vitro, in optimal conditions of stimulation (lipopolysaccharide + interferon-gamma), was impaired as compared with controls' blood PMN. Regulation of PMN-derived TNF-alpha was similar in the two compartments, but responses were more pronounced in the peritoneum. TACE up-regulation at the surface of blood-derived PMN correlated with the Sequential Organ Failure Assessment score and vital outcome.
CONCLUSION
These human data demonstrate that mTACE is up-regulated at the PMN surface during severe peritonitis. This finding could be related to a paracrine regulatory loop involving some TACE substrates such as TNF-alpha, L-selectin, and TNF receptors.
Topics: ADAM Proteins; ADAM17 Protein; Biomarkers; Case-Control Studies; Cells, Cultured; Female; Humans; L-Selectin; Male; Metalloendopeptidases; Middle Aged; Neutrophils; Peritoneum; Peritonitis; Prospective Studies; Receptors, Tumor Necrosis Factor; Sepsis; Severity of Illness Index; Tumor Necrosis Factor-alpha; Up-Regulation
PubMed: 15942356
DOI: 10.1097/01.ccm.0000166359.47577.57 -
Translational Research : the Journal of... Feb 2022Trimethylamine-N-oxide (TMAO), a gut microbiota-produced metabolite, is accumulated in chronic kidney disease (CKD) patients. It is well known to contribute to...
Trimethylamine-N-oxide (TMAO), a gut microbiota-produced metabolite, is accumulated in chronic kidney disease (CKD) patients. It is well known to contribute to CKD-related cardiovascular complications. However, the effect of TMAO on peritoneal dialysis (PD)-related peritonitis remains largely unknown. Here, we demonstrate that serum concentrations of TMAO were positively correlated with C-reactive protein levels, and the appearance rate of dialysate IL-6 and PAI-1, in PD patients. During the follow-up period of 28.3 ± 8.0 months, patients with higher TMAO levels (≥50 μM) had a higher risk of new-onset peritonitis (HR, 3.60; 95%CI, 1.18-10.99; P=0.025) after adjusting for sex, age, diabetes, PD duration, BUN, rGFR, C-reactive protein, BMI and β2-M. In CKD rat models, TMAO significantly promoted peritoneal dialysate-induced inflammatory cell infiltration, inflammatory cytokines production in the peritoneum. In vitro study revealed that TMAO directly induced primary peritoneal mesothelial cell necrosis, together with increased production of pro-inflammatory cytokines including CCL2, TNF-α, IL-6, and IL-1β. In addition, TMAO significantly increased TNF-α-induced P-selectin production in mesothelial cells, as well as high glucose-induced TNF-α and CCL2 expression in endothelial cells. In conclusion, our data demonstrate that higher levels of TMAO exacerbate peritoneal inflammation and might be a risk factor of incidence of peritonitis in PD patients.
Topics: Adult; Animals; Cell Death; Cytokines; Epithelium; Female; Gastrointestinal Microbiome; Glucose; Human Umbilical Vein Endothelial Cells; Humans; Inflammation; Inflammation Mediators; Male; Metabolome; Methylamines; Middle Aged; P-Selectin; Peritoneal Dialysis; Peritoneum; Peritonitis; Rats, Sprague-Dawley; Renal Insufficiency, Chronic; Risk Factors; Up-Regulation; Rats
PubMed: 34673277
DOI: 10.1016/j.trsl.2021.10.001