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PubMed2004

A randomized trial of washed red blood cell and platelet transfusions in adult acute leukemia [ISRCTN76536440].

BACKGROUND: Platelet transfusion is universally employed in acute leukemia. Platelet concentrate supernatants contain high concentrations of biologic mediators that might impair immunity. We investigated whether washed platelet and red cell transfusions could improve clinical outcomes in adult patients with acute leukemia. METHODS: A pilot randomized trial of washed, leukoreduced ABO identical transfusions versus leukoreduced ABO identical transfusions was conducted in 43 adult patients with acute myeloid or lymphoid leukemia during 1991-94. Primary endpoints to be evaluated were platelet transfusion refractoriness, infectious and bleeding complications and overall survival. RESULTS: There were no significant differences in infectious or major bleeding complications and only one patient required HLA matched platelet transfusions. Minor bleeding was more frequent in the washed, leukoreduced arm of the study. Confirmed transfusion reactions were more frequent in the leukoreduced arm of the study. Overall survival was superior in the washed arm of the study (40% versus 22% at 5 years), but this difference was not statistically significant (p = 0.36). A planned subset analysis of those </=50 years of age found that those in the washed, leukoreduced arm (n = 12) had a 75% survival at five years compared with 30% in the leukoreduced arm (n = 10) (p = 0.037) CONCLUSION: This study provides the first evidence concerning the safety and efficacy of washed platelets, and also raises the possibility of improved survival. We speculate that transfusion of stored red cell and platelet supernatant may compromise treatment, particularly in younger patients with curable disease. Larger trials will be needed to assess this hypothesis.

Journal Article↗

PubMed2005

Evaluation of KO-Tab 1-2-3: a wash-resistant 'dip-it-yourself' insecticide formulation for long-lasting treatment of mosquito nets.

INTRODUCTION: Insecticide-treated nets (ITN) are an important method of preventing malaria. To remain effective, they need to be re-treated with pyrethroid insecticide at approximately yearly intervals. Systems for re-treating nets in Africa are limited, and the vast majority of nets in use have never been treated or were treated only once. Bayer Environmental Science (BES) has developed a long-lasting formulation 'KO-Tab 1-2-3' which can be applied to the net post-manufacture, under field conditions, and renders the insecticide wash-resistant. METHODS: The performance of polyester nets treated with three kinds of BES long-lasting formulations, a conventional ITN (treated with standard KO-Tab) and PermaNet 2.0 were evaluated after washing samples of treated netting up to 30 times using standard WHO procedures. Performance was measured using 'three-minute exposure' and 'median time to knockdown' bioassay tests and by measuring the levels of deltamethrin using high-pressure liquid chromatography. RESULTS: The conventional ITN was largely stripped of deltamethrin within 5-10 washes and insecticidal efficacy in bioassay declined to suboptimal levels. With PermaNet and KO-Tab 1-2-3 the loss of deltamethrin was much slower: insecticide content halved within 20 washes and there was no loss of biological efficacy in three-minute exposure bioassays in WHO cylinders even after 30 washes. After 30 washes there remained on the netting 16% (4.4 mg/m2) of the loading dose of KO-Tab 1-2-3 and 28% (18.8 mg/m2) of the loading dose of PermaNet. CONCLUSION: KO-Tab 1-2-3 was confirmed to be a long-lasting insecticide formulation. This finding raises the prospect of conventional polyester nets being converted into long-lasting insecticidal nets through simple dipping in the community or at home. This single development, if widely adopted, could transform the malaria control landscape in Africa and have a major impact on malaria.

Animals↗

PubMed2001

[Effect of mouth wash on the removing fluticasone propionate delivered by dry powder inhaler in mouth].

The effect of mouth wash on the removal of drug residues in both mouth and pharynx after the use of fluticasone propionate dry powder inhaler (FP-DPI) was studied. The concentration of FP in mouth wash after sprinkle and inhalation of Flutide 50, 100, 200 Rotadisk was determined by HPLC-UV. The total amount of the removed FP was measured by the sum of the concentration of FP in 5 times of mouth washes. The mouth wash procedures removed totally 79.3 +/- 4.4% (50 micrograms), 68.5 +/- 3.6% (100 micrograms), 69.3 +/- 3.4% (200 micrograms) of sprinkled amount of FP and 29.5 +/- 11.1% (50 micrograms), 35.6 +/- 6.6% (100 micrograms), 31.6 +/- 8.3% (200 micrograms) of inhaled, respectively. It was required for the removal of 90% of the totally recovered FP to do two times of mouth washes in each case. These data suggest that the mouth wash is an effective precaution for candidiasis induced by FP delivered by DPI.

Administration, Inhalation↗

PubMed2002

Transitional cell carcinoma of the renal pelvis the diagnostic role of pelvic washings.

One hundred renal pelvic washings were reviewed blindly for 12 cytologic features. Of 52 washings with tissue confirmation, the cytologic diagnosis suggestive of or positive for transitional cell carcinoma (TCC) was made in 36 cases; 11 were negative, and 5 were unsatisfactory. Of 36 positive washings, histology confirmed the TCC diagnosis in 35 but revealed only reactive changes in 1. Of 11 negative washings, 9 were histologically negative for TCC, and 2 were positive for high-grade TCC. Among 48 washings without tissue confirmation, 33 were negative for TCC or showed reactive changes, 12 were negative for high-grade dysplasia or malignancy, but low-grade TCC could not be ruled out, 1 was suggestive of malignancy, and 2 were unsatisfactory. Clinical follow-up revealed no TCC. Predictive cytologic features of high-grade TCC were high nuclear/cytoplasmic ratio, isolated cells, anisonucleosis, nuclear hyperchromasia, and coarse chromatin; for low-grade they were presence of more than 5 papillary groups, cellular overlapping, anisonucleosis, and hyperchromasia. The sensitivity and specificity for the cytologic diagnosis were 89% and 97% for high-grade TCC and 100% and 78% for low-grade TCC, respectively. Renal pelvic washings can be used to accurately diagnose TCC of the renal pelvis. The positive predictive value for high-grade TCC is 93%, but for low-grade tumors it is 43%.

Carcinoma, Transitional Cell↗

PubMed2006

Wash resistance and bioefficacy of Olyset net--a long-lasting insecticide-treated mosquito net against malaria vectors and nontarget household pests.

During recent years, long-lasting insecticide-treated nets (LLINs) have been developed to overcome the problems of low retreatment rates, washing, and erratic dose of the insecticide resulting in the dilution of efficacy of the conventional insecticide-treated mosquito nets. These nets are treated at factory level with insecticide either incorporated into or coated around fibers. Olyset net, a polyethylene net with 2% permethrin incorporated within fibers, is one type of LLIN. Therefore, these nets were evaluated for their wash resistance and bioefficacy against malaria vectors Anopheles culicifacies Giles and Anopheles fluviatilis James (Diptera: Culicidae) and other nontarget species. Cone bioassay tests produced 100% mortality in these two vector species with 3-min exposure. Results of the bioassays on washed nets showed 100% mortality in An. fluviatilis even after 20 washings, whereas in An. culicifacies 100% mortality up to 11 washings and 80% mortality up to 20 washings were observed. Cone bioassay tests also were performed on nontarget mosquito species Culex quinquefasciatus Say; house fly, Musca domestica L.; American cockroach, Periplaneta americana (L.); head louse, Pediculus humanus capitis De Geer; and bed bug, Cimex lectularius L. with 30-min exposure. Except for bed bugs, 100% mortality was observed in these nontarget species after 24-h recovery period. In bed bugs, only 25% mortality was observed. The density of An. culicifacies and An. fluviatilis was significantly reduced in houses with Olyset nets compared with those with untreated nets or no nets. Thus, it may be concluded that Olyset nets are highly effective against malaria vectors and moderately against other nontarget household insects.

Animals↗

PubMed2006

A washing procedure to mobilize mixed contaminants from soil: II. Heavy metals.

We conducted a laboratory study to assess the efficiency of nonionic and anionic surfactants in combination with a sparing quantity of ethylenediaminetetraacetate (EDTA) to simultaneously extract heavy metals (HMs) and polychlorinated biphenyl (PCB) compounds from a field-contaminated soil. A soil wash that mobilized both HMs and PCBs was combined with back-extraction with hexane to remove PCBs from the aqueous wash. The aqueous washing suspension was then regenerated by precipitation of the HMs induced by corrosion and hydrolysis of zero-valent Mg to provide a cleaned soil and innocuous extract. Finally, the washing suspension was recycled twice to mobilize more contaminants from the soil particulate fraction. After ultrasonic equilibration, EDTA in admixture with a nonionic surfactant did not appreciably change the efficiency of mobilization of most heavy metals (Al, Cd, Cr, Fe Mn, Ni, and Zn), but did increase the recovery of Cu and Pb. The release of EDTA from HM complexes was efficient for most metals (99%) but was influenced by the chemical characteristics of the surfactant. The EDTA recovery (62-65%) after three cycles of soil washing, hexane back-extraction, and Mg(0) treatment was similar for all reagent combinations. In toto, these studies demonstrate that after treatment with ultrasound, selected heavy metals can be coextracted efficiently from soil with a single washing suspension containing EDTA and a nonionic surfactant.

Adsorption↗

PubMed1989

Effect of sperm washing and swim-up on antibodies bound to sperm membrane: use of immunobead/sperm cervical mucus contact tests.

The direct immunobead test (IBT) and the sperm cervical mucus contact (SCMC) test were used to evaluate the effect of sperm washes and swim-up on antibodies bound to the sperm membrane in 11 patients with autosperm antibodies (30-100% IgA and 30-100% IgG) but otherwise normal semen measurements. The tests were performed on semen samples before and after a wash/swim-up procedure in Ham F10 + 10% human blood serum. Sperm-bound antibodies in washed spermatozoa that were able to swim into a layer of medium did not differ from those in unwashed samples. The IBT and the SCMC test on unwashed and washed spermatozoa were also not significantly different. However, all other washed semen parameters were improved. Correct washing of semen samples is important when performing the IBT to prevent false negative results. Eight of the 11 partners (73%) of the patients tested became pregnant after treatment with washed sperm. The ongoing pregnancy rate was 64%.

Animals↗

PubMedDate not supplied

Effect of sperm washing on levels of reactive oxygen species in semen.

The possibility was evaluated that the production of reactive oxygen species (ROS) by human sperm is stimulated by the repeated cycles of centrifugation and resuspension involved in conventional sperm preparation. ROS generation by human sperm was monitored before and after the washing of sperm from 55 men (43 men with suspected subfertility and 12 normal volunteers). The ROS activity of all 55 specimens before washing was inversely correlated with original sperm motility (r = .278, p < .05). The mean level of ROS activity was significantly higher after washing than before processing (p < .05) for the 26 specimens with normal sperm motility, the 20 specimens with normal sperm morphology, and the 12 specimens with both normal motility and normal morphology. In contrast, the mean ROS level was not significantly changed after washing in the 27 specimens with poor sperm motility, the 16 specimens with abnormal sperm morphology, or the 13 specimens with both abnormal motility and abnormal morphology. It would appear that repeated centrifugation, resuspension, and vortexing cause excessive generation of ROS in the motile sperm population of the washed specimen. Washing procedures involving excessive manipulation of sperm may, in fact, cause the most harm to motile sperm, i.e., those that the method is trying to select. Procedures that minimize multiple centrifugation, resuspension, and vortexing steps should therefore be used for the preparation of semen specimens for assisted-reproduction techniques.

Cell Separation↗

PubMed2006

Detection of carcinoembryonic antigen mRNA in peritoneal washes from gastric cancer patients and its clinical significance.

AIM: To establish a more sensitive method for detection of free cancer cells in peritoneal washes from gastric cancer patients during surgery and to evaluate its clinical significance. METHODS: The carcinoembryonic antigen (CEA) mRNA levels in peritoneal washes from 65 cases of gastric cancer were detected by real-time RT-PCR. Peritoneal lavage cytology (PLC) was applied simultaneously to detection of free cancer cells.Negative controls included peritoneal washes from 5 cases of benign gastric disease and blood samples from 5 adult healthy volunteers. RESULTS: There was no CEA mRNA in peritoneal washes from benign gastric disease patients and in blood of adult healthy volunteers. The positive percentage of free cancer cells detected by real-time RT-PCR was 47.7% and only 12.3% by PLC. The positive rate of CEA mRNA was significantly related with serosa invasion between peritoneal metastasis and stage of gastric cancer. CONCLUSION: Real-time RT-PCR is a sensitive and rapid method for the detection of free cancer cells in peritoneal washes. The presence of free cancer cells in peritoneal washes is related to the pathologic stage of gastric cancer.

Adult↗

PubMed1998

Efficacy of washing and sanitizing trailers used for swine transport in reduction of Salmonella and Escherichia coli.

Healthy pigs can carry Salmonella in their intestine and may shed this pathogen because of stresses incurred during transportation, contaminating trailer floors and bedding material. If not cleaned and sanitized between trips, trailers and bedding have the potential to infect other farms, the abattoir environment, or other animals with Salmonella. Floors and bedding material from pig trailers were sampled to determine the efficacy of the abattoir-developed washing and sanitizing regime on the level of Salmonella before and after a single haul. Escherichia coli levels were an indicator of high contamination. The study also determined the effect of ambient temperature (during four seasons) and of the distance the pigs traveled in the haulers (> 500 miles or < 500 miles) on bacterial levels. Salmonella was isolated from 80% of the bedding material tested. Of the 188 floor samples taken, 41.5% were positive for Salmonella before washing, and 2.7% were positive after washing and sanitizing. E. coli was isolated from all bedding material and floor samples before washing, but washing and sanitizing significantly decreased levels (P < 0.05) by 2 logs. There was no significant difference (P > 0.05) in the number of Salmonella- or E. coli-positive trailers attributable to distance traveled or season of the year. These results demonstrate that washing and sanitizing the trailers after each load significantly reduced levels of Salmonella and its possible spread by the contaminated trailer and bedding, which ultimately could promote improvement in food safety.

Animals↗

PubMed1998

Evaluation of an enzyme-linked immunosorbent assay, direct immunofluorescent filter technique, and multiplex polymerase chain reaction for detection of Escherichia coli O157:H7 seeded in beef carcass wash water.

In commercial beef processing, carcasses are customarily washed with water to remove physical and microbial contamination. Assaying the water that is shed from the carcasses after washing is a convenient method to determine whether the carcass is contaminated with Escherichia coli O157:H7 or other bacterial pathogens. E. coli O157:H7 was inoculated into carcass wash water at various levels and the bacteria were then concentrated by filtration. After collection of bacteria in the filter units, the nylon membranes were cut out and placed in tubes containing growth medium, and the tubes were mixed vigorously to dislodge the bacteria from the membranes. Prior to enrichment, samples were removed for testing by a multiplex polymerase chain reaction (PCR) and a direct immunofluorescent filter technique (DIFT). The remaining samples were subjected to 4-h enrichment culturing at 37 degrees C, after which aliquots were removed for testing by multiplex PCR, DIFT, and an enzyme-linked immunosorbent assay (ELISA). Following 4-h enrichment culturing, E. coli O157:H7 was detected in wash water samples initially inoculated with ca. 100, 0.1, and 1 CFU/ml by ELISA, DIFT, and multiplex PCR, respectively. Testing of the wash water using the ELISA and the DIFT can be accomplished in less than 8 h. On the basis of these results, assaying carcass wash water by ELISA, DIFT, or multiplex PCR can be useful for detection of E. coli O157:H7 beef carcass contamination and can potentially be employed to identify carcasses for further processing to inactivate the organism.

Animals↗

PubMed2000

Comparison of telomerase activity in bladder carcinoma and exfoliated cells collected in urine and bladder washings, using a quantitative assay.

Telomerase activity was measured with a quantitative assay, based on a modification of telomeric repeat amplification protocol method, in bladder cancers and apparently normal mucosa in 33 patients. In the same patients, the enzyme was also measured in exfoliated cells collected both with voided urine and bladder washings. Results obtained in urine were compared with those from 20 healthy subjects. Telomerase activity was present in 31 (94%) bladder cancer tissues and in 23 (72%) apparently normal mucosa samples. However, the levels of enzyme activity were significantly higher in cancer tissues in comparison with normal mucosa (mean +/- SD, 47.3 +/- 23.2 and 14.9 +/- 6.1 ng DNA/microg protein, respectively; P < 0.0001). Telomerase activity in bladder cancer tissues was not related to tumor stage and grade. Enzyme activity was present in 27 urine samples and in 27 (82%) bladder washings collected from cancer patients. We did not find correlation between the activity in urine and washings, and their mean levels were not different (22.2 +/- 10.1 and 20.7 +/- 8.0, respectively). Telomerase activity in bladder cancer tissues was correlated to its activity in urine (r = 0.650, P < 0.001) and in bladder washings (r = 0.410, P < 0.05). Only 2 of 20 urine samples from control subjects were found to express telomerase activity at a very low level. This was the first attempt to correlate telomerase activity in exfoliated cells from urine and bladder washings with the activity in corresponding bladder cancers. According to these results we postulate that telomerase activity in urine sediment reflects the activity in bladder cancers better than bladder washings and, for its easy collection, is to be preferred as diagnostic marker in this tumor.

Epithelial Cells↗

PubMed2004

Treatment techniques for the recycling of bottle washing water in the soft drinks industry.

The soft drink production is an important sector in the manufacturing industry of Mexico. Water is the main source in the production of soft drinks. Wastewater from bottle washing is almost 50% of the total wastewater generated by this industry. In order to reduce the consumption of water, the water of the last bottle rinse can be reused in to the bottle pre-rinse and pre-washing cycles. This work presents the characterization of the final bottle washing rinse discharge and the treatability study for the most appropriate treatment system for recycling. Average characteristics of the final bottle wash rinse were as follows: Turbidity 40.46 NTU, COD 47.7 mg/L, TSS 56 mg/L, TS 693.6 mg/L, electrical conductivity 1,194 microS/cm. The results of the treatability tests showed that the final rinse water can be used in the pre-rinse and pre-washing after removing the totality of the suspended solids, 80% of the COD and 75% of the dissolved solids. This can be done using the following treatment systems: filtration-adsorption-reverse osmosis, or filtration-adsorption-ion exchange. The installation of these treatment techniques in the soft drink industry would decrease bottle washing water consumption by 50%.

Carbonated Beverages↗

PubMed2004

Gas chromatographic evaluation of pesticide residue contents in nectarines after non-toxic washing treatments.

Washing with aqueous solutions of citric acid, ethanol, glycerol, hydrogen peroxide, potassium permanganate, sodium metabisulfite, sodium laurylsulfate (SLS), sodium hypochlorite, and urea is evaluated for pesticide residue reduction in nectarines and compared with simple tap water washing. Residues of pesticides commonly utilized in nectarines (chlorpyrifos, fenarimol, iprodione, malathion, methidathion, myclobutanil, parathion and pirimicarb) are extracted with ethyl acetate and anhydrous sodium sulfate, extract is concentred and analyzed by GC with nitrogen-phosphorus detection. The formation of possible toxic by-products (chlorpyrifos oxon, malaoxon, methidaoxon and paraoxon methyl) is studied by GC-MS. No toxic by-products are identified in the extracts of the washed samples for the washing-time and concentrations studied, but high levels of sodium hypochlorite, hydrogen peroxide and potassium permanganate form oxons from the organophosphorus pesticides. Ethanol, glycerol and SLS solutions removed near the 50% of the pesticide residues. The other solutions were not more effective than tap water washing. The amount of pesticide removed by washings is related to its water solubility and octanol-water partition coefficient.

Chromatography, Gas↗

PubMed1990

[Improving the quality of washed and buffy coat-free erythrocyte concentrates].

Washing buffy-coat free erythrocyte concentrates three times in bottles used for blood storage will diminish their leukocyte content to 0.22 +/- 0.11 x 10(9) per TE (= 9% of the initial value in whole blood, and the thrombocyte content to 0.3 +/- 0.5 x 10(9) per day (= 2% of the initial value in whole blood). Even 50% of leukocytes (mainly lymphocytes) and 80% of thrombocytes are eliminated simply by buffy coat separation. 30% of erythrocytes are lost by the washing process. Due to increasing haemolysis (0.22%) a subsequent storage of 24 hours should not be exceeded for washed erythrocyte concentrates. Further quality parameters, such as morphological index, pH, ATP, 2,3-P2G and K+ and Na+, were investigated. As far as selected quality parameters are concerned, washing erythrocyte concentrates three times in bottles for blood storage may be compared with washing them once in blood bags. The present findings confirm the conclusion that the washing of erythrocyte concentrates with a solution of sodium chloride in order to eliminate leukocytes may for the most part exclude non-haemolytic febrile transfusion reactions, but not immunization. More effective procedures of eliminating leukocytes, such as filtration, TTK or even glycerin, treatment of erythrocyte concentrates without cryoconservation, are indispensable.

2,3-Diphosphoglycerate↗

PubMed1984

Quantitative distribution of locally applied lindane in human skin and subcutaneous fat in vitro. Dependence of penetration on the applied concentration, skin state, duration of action and nature and time of washing.

Commercial concentrations of radiolabelled lindane emulsion were applied to human skin specimens. Penetration of the substance into the different layers of the skin was examined quantitatively under the common conditions of therapy, but with variation of the period of action (3, 10 and 24 h), condition of skin specimens (intact, stripped), concentration of the emulsion applied (0.3 and 1%) and washing with water only or water and soap after different periods of action (3 and 10 h) and examination at different times after the washing procedure (7 and 14 h). The flux of lindane in the skin was found to be time-dependent. Generally, the concentration increased with the depth of the layer. An increased availability of lindane (in absence of the stratum corneum, and at long application period) resulted in a preferential accumulation in the epidermis and not in the subcutaneous fat. When the intact skin had been washed with soap and water 3 h after application, the concentration of lindane found in the layer below the stratum corneum 7 h later was higher than the one found when the skin had not been washed. When intact skin had been washed after a short penetration period (3 h), this resulted in an introduction of lindane by the washing process. This effect did not occur with stripped skin. Lindane could be more efficiently removed from the stratum corneum with soap and water than with water alone. A threefold increase of the lindane concentration applied resulted in a threefold increase of the concentration in all layers of intact skin specimens. In stripped skin specimens, an increase could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

PubMed1983

Emergency autotransfusion: partial cleansing of bacteria-laden blood by cell washing.

Intraoperative autotransfusions for selected patients can ease demands on blood banks. In 33 cases (trauma, elective vascular, and cardiac procedures), we saved 80.7 L of blood with a cell washer blood recovery system (Cell Saver). In eight trauma cases, including three with intestinal perforation, cell washing salvaged 31.5 L of shed blood as a lifesaving emergency procedure. This stimulated interest in defining the limits of the instrumentation in cleansing blood of bacteria. In 18 in vitro experiments, discarded banked blood was inoculated with Escherichia coli to simulate light, moderate, or heavy bacterial contamination. Volumes of blood (500 ml) containing a total of 6.3 X 10(5), 4.8 X 10(7), or 3.2 X 10(10) bacteria were processed. The original blood, filtered blood, plasma supernate, effluent wash solution, and final washed packed red cells were cultured quantitatively in each experiment. The mean total number of E. coli retained in the final washed packed red cells was 1.4 X 10(5), 6.3 X 10(6), or 1.6 X 10(9) bacteria, or 23%, 13%, and 5% of each original inoculum. Additional washing with 10 L of saline did not remove significantly more bacteria (p greater than 0.20). Although emergency autotransfusion of blood contaminated with intestinal contents was lifesaving, we recommend caution since these results show that cell washing does not remove all bacteria. Further laboratory and clinical studies are needed to determine the levels of bacterial contamination of autotransfused blood that can be tolerated, and to determine adjunctive means of rendering contaminated or potentially contaminated blood safe for autotransfusion.

Blood↗

PubMedDate not supplied

Peritoneal washing cytology. Uses and diagnostic criteria in gynecologic neoplasms.

Review of a 20-month experience with 241 peritoneal washes performed on 191 patients showed that the use of these specimens has expanded greatly. Of the 19 patients with neoplastic cells in their peritoneal washing cytology specimens, 12 had primary ovarian neoplasms, 4 had primary uterine cervical neoplasms, 2 had primary endometrial neoplasms, and 1 had mammary carcinoma metastatic to the ovary. Gynecologic oncologists at this institution are now routinely obtaining peritoneal washing cytology specimens whenever there is intraabdominal surgery on patients known to have or suspected of having a pelvic neoplasm. The following criteria were found to be essential to the accurate evaluation of these specimens: (1) cells considered to be malignant should be present both singly and in groups and should be malignant by the usual cytologic criteria, (2) the patients must have or be known to have had a neoplasm whose cells are similar to those in the washing specimen, and (3) the cells considered to be neoplastic must be different from and not confused with reactive mesothelial cells. The last criterion is important because the peritoneal lavage traumatically removes mesothelium, which can appear atypical. These criteria make the cytologic interpretation of most peritoneal washing specimens straightforward; interesting diagnostic problems occur, however, including the evaluation of neoplasms of borderline malignancy, those "spilled" during surgery and second neoplasms found by peritoneal washing cytology.

Ascitic Fluid↗