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BMJ Case Reports Dec 2017This is a case report of a 45-year-old Caucasian man with chronic alcoholism. No history of liver disease or asbestos exposure. He complained of ascites during the last...
This is a case report of a 45-year-old Caucasian man with chronic alcoholism. No history of liver disease or asbestos exposure. He complained of ascites during the last 3 years with worsening in the last year with severe ascites development. Diagnostic paracentesis showed SAAG 1.1 and high cellularity with neutrophil count >250 cells/µL. Ascitic fluid cytology revealed reactive mesothelial hyperplasia. Thoracoabdominopelvic ultrasonography/CT/MRI and fludeoxyglucose positron emission tomography/CT showed 'omental cake' pattern suggesting peritoneal carcinomatosis. An exploratory laparoscopy revealed moderate interloop adhesions and necrosis with whitish exudate in the right pelvic excavation. Biochemical/cytological/histological/microbiological study only revealed reactive mesothelial cells, necrosis and lymphohistiocytic inflammatory infiltrate. A second exploratory laparoscopy with liver and peritoneal biopsies and appendectomy/mesoappendix excision showed a well-differentiated tubulopapillary mesothelioma. The patient was referred for intraperitoneal chemotherapy and is undergoing monthly therapeutic paracentesis.
Topics: Alcoholism; Ascites; Biopsy; Humans; Liver; Male; Mesothelioma; Middle Aged; Peritoneal Neoplasms; Peritoneum
PubMed: 29197848
DOI: 10.1136/bcr-2017-222565 -
Annals of the Royal College of Surgeons... Jan 2021Fat necrosis occurs more frequently in patients who have obesity and diabetes mellitus and is linked to worsening of diabetes. Little evidence is available about...
Fat necrosis occurs more frequently in patients who have obesity and diabetes mellitus and is linked to worsening of diabetes. Little evidence is available about surgical complications that are related to inflammation and necrosis of adipose tissue. We report two cases of young women with diabetes who underwent bariatric surgery and had complications resulting from extensive inflammation and necrosis of adipose tissue. The first patient was diagnosed with omental infarction, which is a type of fat necrosis that is rarely associated with obesity and bariatric surgery. The second patient had an intraoperative finding of mesenteric panniculitis, which resulted in an intra-operative change in the choice of bariatric surgery to do a sleeve gastrectomy instead of a gastric bypass. Surgeons who perform surgery on bariatric patients must be aware of complications related to excessive amount of adipose tissue.
Topics: Adult; Bariatric Surgery; Diabetes Mellitus, Type 2; Female; Humans; Infarction; Intraoperative Period; Middle Aged; Obesity, Morbid; Omentum; Panniculitis, Peritoneal; Postoperative Complications
PubMed: 32969263
DOI: 10.1308/rcsann.2020.0198 -
International Urology and Nephrology Jun 2018Long-term exposure of conventional peritoneal dialysis (PD) fluid is associated with structural membrane alterations and technique failure. Previously, it has been shown... (Comparative Study)
Comparative Study
Differences in peritoneal response after exposure to low-GDP bicarbonate/lactate-buffered dialysis solution compared to conventional dialysis solution in a uremic mouse model.
BACKGROUND
Long-term exposure of conventional peritoneal dialysis (PD) fluid is associated with structural membrane alterations and technique failure. Previously, it has been shown that infiltrating IL-17-secreting CD4+T cells and pro-fibrotic M2 macrophages play a critical role in the PD-induced pathogenesis. Although more biocompatible PD solutions are recognized to better preserve the peritoneal membrane integrity, the impact of these fluids on the composition of the peritoneal cell infiltrate is unknown.
MATERIALS AND METHODS
In a uremic PD mouse model, we compared the effects of daily instillation of standard lactate (LS) or bicarbonate/lactate-buffered solutions (BLS) and respective controls on peritoneal fibrosis, vascularisation, and inflammation.
RESULTS
Daily exposure of LS fluid during a period of 8 weeks resulted in a peritoneal increase of αSMA and collagen accompanied with new vessel formation compared to the BLS group. Effluent from LS-treated mouse showed a higher percentage of CD4 IL-17 cell population while BLS exposure resulted in an increased macrophage population. Significantly enhanced inflammatory cytokines such as TGFβ1, TNFα, INFγ, and MIP-1β were detected in the effluent of BLS-exposed mice when compared to other groups. Further, immunohistochemistry of macrophage subset infiltrates in the BLS group confirmed a higher ratio of pro-inflammatory M1 macrophages over the pro-fibrotic M2 subset compared to LS.
CONCLUSION
Development of the peritoneal fibrosis and angiogenesis was prevented in the BLS-exposed mice, which may underlie its improved biocompatibility. Peritoneal recruitment of M1 macrophages and lower number of CD4 IL-17 cells might explain the peritoneal integrity preservation observed in BLS-exposed mouse.
Topics: Actins; Animals; Bicarbonates; Buffers; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Chemokine CCL4; Collagen; Dialysis Solutions; Disease Models, Animal; Female; Interferon-gamma; Interleukin-17; Lactic Acid; Macrophages; Macrophages, Peritoneal; Mice; Peritoneal Dialysis; Peritoneum; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha; Uremia
PubMed: 29728994
DOI: 10.1007/s11255-018-1872-3 -
Postgraduate Medical Journal Oct 1974A young female, who presented with acute appendicitis and peritonitis, is described. Following laparotomy she developed a series of intraperitoneal abscesses. After...
A young female, who presented with acute appendicitis and peritonitis, is described. Following laparotomy she developed a series of intraperitoneal abscesses. After drainage of a subphrenic abscess a necrosed gallbladder was discharged several days later through the drainage wound in the abdominal wall.
Topics: Appendicitis; Child; Cholecystectomy; Drainage; Female; Gallbladder; Gallbladder Diseases; Humans; Infarction; Male; Necrosis; Peritonitis; Subphrenic Abscess
PubMed: 4467864
DOI: 10.1136/pgmj.50.588.655 -
Kidney International Jul 2003Dysregulation of peritoneal cell death may contribute to the complications of peritoneal dialysis (PD). Chronic peritoneal dialysis and acute peritonitis are both...
BACKGROUND
Dysregulation of peritoneal cell death may contribute to the complications of peritoneal dialysis (PD). Chronic peritoneal dialysis and acute peritonitis are both associated with loss of mesothelial cells. In addition, acute peritonitis is characterized by sudden changes in the number of peritoneal leukocytes. However, the factors regulating peritoneal cell survival are poorly understood.
METHODS
Peritoneal effluent cells and mesothelial cells cultured from peritoneal dialysis patients were studied. Reverse transcriptase-polymerase chain reaction (RT-PCR) and flow cytometry were used to assess the expression of FasL and Fas mRNA and protein. Western blot was used to assess FasL and tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL). RT-PCR was used to study TRAIL and TRAIL receptor mRNA. Apoptosis was quantified by flow cytometry of DNA content and confirmed by morphology.
RESULTS
Apoptotic cells, including apoptotic mesothelial cells, were present in the peritoneal effluent of stable peritoneal dialysis patients and patients with bacterial peritonitis. The lethal cytokines FasL and TRAIL were expressed by peritoneal effluent cells, while cultured mesothelial cells expressed FasL, Fas, and TRAIL receptors. Cultured mesothelial cells were sensitive to FasL-induced apoptosis. IFNgamma increased the cell surface expression of Fas and the sensitivity of mesothelial cells to FasL-induced apoptosis. In contrast to the effect of FasL, TNFalpha and TRAIL did not induce apoptosis in human mesothelial cells from peritoneal dialysis patients.
CONCLUSION
Lethal cytokines, such as FasL, may contribute to peritoneal cell turnover and the loss of mesothelium in peritoneal dialysis. The role of other cytokines, such as TRAIL, remains undefined. Approaches in limiting mesothelial cell injury that interferes with apoptosis should be considered.
Topics: Aged; Apoptosis; Cells, Cultured; Cytokines; Epithelial Cells; Fas Ligand Protein; Female; Humans; Leukocytes; Male; Membrane Glycoproteins; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Receptors, Tumor Necrosis Factor; fas Receptor
PubMed: 12787425
DOI: 10.1046/j.1523-1755.2003.00062.x -
Kidney International Jul 2003Connective tissue growth factor (CTGF) is a fibrogenic cytokine that is highly expressed in wound healing and fibrotic lesions. The role of transforming growth...
BACKGROUND
Connective tissue growth factor (CTGF) is a fibrogenic cytokine that is highly expressed in wound healing and fibrotic lesions. The role of transforming growth factor-beta (TGF-beta) in fibrosis is well documented, and the emerging understanding that its fibrogenic actions are mediated through CTGF has provided an attractive target molecule for the modulation of matrix overproduction in fibrotic disease. The involvement of CTGF in the pathogenesis of peritoneal membrane fibrosis in peritoneal dialysis (PD) patients has not been investigated, and so the aim of this study was to ascertain whether CTGF is produced in the peritoneal cavity of PD patients and to investigate its regulation by cytokines.
METHODS
Reverse transcription-polymerase chain reaction (RT-PCR), Northern blotting, and Western blotting were used to study CTGF expression by cultured human peritoneal mesothelial cells (HPMC) from peritoneal dialysis patients. Western blotting was used to detect CTGF expression in spent peritoneal dialysate from patients with and without peritonitis.
RESULTS
RT-PCR analysis demonstrated the expression of CTGF mRNA in cultured primay HPMCs isolated from spent peritoneal effluent. The production of the major 36 to 38 kD CTGF protein doublet by HPMC in addition to a 23 to 25 kD proteolytically processed form was confirmed by Western blotting. Several molecular weight forms of CTGF (18 to 38 kD) were also detected by Western blotting in peritoneal dialysate, with levels markedly elevated during episodes of peritonitis. Northern and Western blot analysis revealed that CTGF mRNA and protein production by HPMC was up-regulated by TGF-beta, with mRNA levels significantly increasing above the control (P < 0.01). In contrast, platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and tumor necrosis factor-alpha (TNF-alpha) had no measurable effects on CTGF mRNA expression.
CONCLUSION
These results are the first to demonstrate the production of CTGF by HPMC and its presence in the peritoneal cavity of PD patients. The marked increase in CTGF levels by factors implicated in the development of peritoneal membrane fibrosis suggests its involvement in the underlying pathophysiologic mechanism(s).
Topics: Base Sequence; Blotting, Northern; Blotting, Western; Case-Control Studies; Connective Tissue Growth Factor; Humans; Immediate-Early Proteins; Intercellular Signaling Peptides and Proteins; Molecular Sequence Data; Peritoneal Dialysis; Peritoneum; Peritonitis; RNA, Messenger; Reverse Transcriptase Polymerase Chain Reaction; Transforming Growth Factor beta; Up-Regulation
PubMed: 12787426
DOI: 10.1046/j.1523-1755.2003.00069.x -
The Kaohsiung Journal of Medical... Sep 2016This study aimed to investigate the protective effects of oridonin (ORI) on cecal ligation and puncture (CLP)-induced sepsis in mice. Male C57BL/6 mice weighing 22-30 g...
This study aimed to investigate the protective effects of oridonin (ORI) on cecal ligation and puncture (CLP)-induced sepsis in mice. Male C57BL/6 mice weighing 22-30 g and aged 8-10 weeks were randomly assigned to three groups: Sham group, CLP group, or CLP plus ORI group. In the CLP group and ORI group, CLP was induced, and intraperitoneal injection of normal saline and oridonin (100 μg/kg) was conducted, respectively. The survival rate was determined within the following 7 days. The blood, liver, and lung were collected at 24 hours after injury. Hematoxylin-eosin staining of the lung, detection of lung wet-to-dry ratio, and serum cytokines (tumor necrosis factor [TNF]-α and interleukin [IL]-6), and examination of intraperitoneal and blood bacterial clearance were conducted to evaluate the therapeutic efficacy. Results showed that ORI treatment significantly reduced the lung wet-to-dry ratio, decreased serum TNF-α and IL-6, and improved liver pathology compared with the CLP group (p < 0.05). Moreover, the intraperitoneal and blood bacterial clearance increased markedly after ORI treatment (p < 0.05). The 7-day survival rate in the ORI group was also dramatically higher than in the CLP group (p < 0.05). Our findings indicate that ORI can attenuate liver and lung injuries and elevate bacterial clearance to increase the survival rate of sepsis mice.
Topics: Animals; Colony Count, Microbial; Diterpenes, Kaurane; Interleukin-6; Liver; Lung; Male; Mice, Inbred C57BL; Organ Size; Peritoneum; Protective Agents; Sepsis; Survival Analysis; Tumor Necrosis Factor-alpha
PubMed: 27638404
DOI: 10.1016/j.kjms.2016.07.013 -
Kidney International Nov 1994Dialysate and serum concentrations of tumor necrosis factor-alpha (TNF-alpha), soluble TNF-receptor I (sTNFRI) and soluble TNF-receptor II (sTNFRII) were measured during...
Dialysate and serum concentrations of tumor necrosis factor-alpha (TNF-alpha), soluble TNF-receptor I (sTNFRI) and soluble TNF-receptor II (sTNFRII) were measured during stable and infectious CAPD to determine whether these mediators are released intraperitoneally or derived from the circulation. Dialysate/serum ratios were compared to those of various marker proteins for peritoneal transport and to interleukin-6 (IL-6), which is locally produced. Peritoneal immunoreactive TNF-alpha could be detected in 19 of 20 stable CAPD patients after a night dwell, but only occasionally and in lower concentrations during and after a standard four-hour peritoneal permeability test. Both sTNFRs highly exceeded TNF-alpha dialysate concentrations. In case of peritonitis a median 16-fold increase in dialysate TNF-alpha occurred on the first day, which declined towards control values during a longitudinal follow-up of eight consecutive days. sTNFRI and sTNFRII in dialysate increased three- to fourfold. Their peaks, however, appeared on the second peritonitis day. Bioactive TNF-alpha was only detected when immunoreactive levels exceeded 1000 pg/ml. Serum values of all variables were not altered during infection; sTNFRs exceeded TNF-alpha 300- to 400-fold. During stable CAPD indirect evidence was obtained for transperitoneal transport from plasma to dialysate of TNF-alpha (molecular wt 17 kD), sTNFRI (55 kD) and sTNFRII (75 kD). Dialysate/serum (D/S) ratios were higher, the lower the molecular weight; they were related to D/S ratios of those marker proteins with the nearest molecular weight; D/S ratios were unrelated to the intraperitoneally produced IL-6. Furthermore, the observed D/S ratios were as expected theoretically for their molecular weights.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Aged; Biological Transport, Active; Chromatography, Gel; Dialysis Solutions; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Receptors, Tumor Necrosis Factor; Solubility; Tumor Necrosis Factor-alpha
PubMed: 7853803
DOI: 10.1038/ki.1994.414 -
Journal of Medicine and Life May 2011We performed this study with the purpose of revealing different aspects of the systemic inflammatory response syndrome in peritonitis.
RATIONALE
We performed this study with the purpose of revealing different aspects of the systemic inflammatory response syndrome in peritonitis.
OBJECTIVES
The aim of the presentation was to make a research on some of the immune response mediators in secondary peritonitis and to observe their capacity to anticipate the evolution towards septic complications.
METHODS AND RESULTS
We have undertaken a study on a group of 100 patients with acute diffuse peritonitis, between 2009 and 2011, in which we have accomplished the dosage of IL-1 beta, IL-6 and TNF alpha cytokines in the serum of patients, in dynamics, for 7 days by using the Elisa method. Subsequently, we have compared the results to the ones of a control group. The data obtained indicated high levels of proinflammatory cytokines in the patients who subsequently suffered an unfavorable evolution towards septic complications.
DISCUSSION
The study of IL-1 beta, IL-6 and TNF alpha blood dynamics, offers valuable information about the severity of a systemic inflammatory response syndrome in peritonitis. They can be valuable biomarkers in establishing the unfavorable evolution of patients, helping the physician to establish a sustained and specific treatment, even from the early phases of the illness.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cytokines; Humans; Inflammation Mediators; Interleukin-1beta; Interleukin-6; Middle Aged; Peritonitis; Sepsis; Tumor Necrosis Factor-alpha; Young Adult
PubMed: 21776298
DOI: No ID Found -
PloS One 2013High mobility group box 1 (HMGB1), a DNA-binding nuclear protein, has been implicated as an endogenous danger signal in the pathogenesis of infection diseases. However,...
High mobility group box 1 (HMGB1), a DNA-binding nuclear protein, has been implicated as an endogenous danger signal in the pathogenesis of infection diseases. However, the potential role and source of HMGB1 in the peritoneal dialysis (PD) effluence of patients with peritonitis are unknown. First, to evaluate HMDB1 levels in peritoneal dialysis effluence (PDE), a total of 61 PD patients were enrolled in this study, including 42 patients with peritonitis and 19 without peritonitis. Demographic characteristics, symptoms, physical examination findings and laboratory parameters were recorded. HMGB1 levels in PDE were determined by Western blot and ELISA. The concentrations of TNF-α and IL-6 in PDE were quantified by ELISA. By animal model, inhibition of HMGB1 with glycyrrhizin was performed to determine the effects of HMGB1 in LPS-induced mice peritonitis. In vitro, a human peritoneal mesothelial cell line (HMrSV5) was stimulated with lipopolysaccharide (LPS), HMGB1 extracellular content in the culture media and intracellular distribution in various cellular fractions were analyzed by Western blot or immunofluorescence. The results showed that the levels of HMGB1 in PDE were higher in patients with peritonitis than those in controls, and gradually declined during the period of effective antibiotic treatments. Furthermore, the levels of HMGB1 in PDE were positively correlated with white blood cells (WBCs) count, TNF-α and IL-6 levels. However, pretreatment with glycyrrhizin attenuated LPS-induced acute peritoneal inflammation and dysfunction in mice. In cultured HMrSV5 cells, LPS actively induced HMGB1 nuclear-cytoplasmic translocation and release in a time and dose-dependent fashion. Moreover, cytosolic HMGB1 was located in lysosomes and secreted via a lysosome-mediated secretory pathway following LPS stimulation. Our study demonstrates that elevated HMGB1 levels in PDE during PD-related peritonitis, at least partially, from peritoneal mesothelial cells, which may be involved in the process of PD-related peritonitis and play a critical role in acute peritoneal dysfunction.
Topics: Adult; Aged; Enzyme-Linked Immunosorbent Assay; HMGB1 Protein; Humans; Interleukin-6; Lipopolysaccharides; Middle Aged; Peritoneal Dialysis; Peritoneum; Peritonitis; Tumor Necrosis Factor-alpha
PubMed: 23359306
DOI: 10.1371/journal.pone.0054647