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PubMed1998

Bedside peritoneoscopic peritoneal catheter placement of Tenckhoff and newer peritoneal catheters.

The success of Tenckhoff chronic peritoneal dialysis catheters depends more upon the skill of the physician in placing catheters and on the technique of placement than it does on the exact design of the peritoneal catheter. In this summary article, the existing types of peritoneal catheters are reviewed, including two recent alternative designs: Tenckhoff catheters with larger internal diameters, and the T-fluted catheter with grooved limbs adjacent to the parietal peritoneum. The three types of placement procedures for catheters (peritoneoscopy, surgical or dissective, and blind techniques) are described, and the complications of Tenckhoff catheters are compared according to placement technique.

Catheters, Indwelling↗

PubMed1998

[Diagnosis and surgical treatment of tuberculosis of mesentric lymph nodes].

OBJECTIVE: To evaluate the diagnosis, operative indication and therapeutic result of tuberculosis of mesentric lymph nodes. METHOD: Fifty-nine cases with tuberculosis of mesentric lymph nodes surgically treated at two hospitals from July 1976 to July 1997 were retrospectively analyzed. RESULT: Only 14 cases were correctly diagnosed before operation. Operative treatment for the tuberculosis of mesentric lymph nodes represented a safe, effective treatment with few complications and no operative death. CONCLUSION: Because patients with tuberculosis of mesentric lymph nodes show no characteristic manifestations, laboratory methods (e.g. polymerase chain reaction), peritoneoscopy, CT scanning and B mode ultrosound techniques should also be considered for diagnosis of the disease. The acute or chronic ileus, hemorrhage of digestive tract, intestinal perforation or fistula, intra-abdominal large tuberculous abscess and abdominal sinus caused by tuberculosis of mesentric lymph nodes should be surgically treated. The exploratory laparotomy also should be performed on the patients with abdominal mass or those whose diagnosis of neoplasm could not be ruled out. The postoperative antituberculosis chemotherapy should be continued to decrease the occurrence of complications.

Adolescent↗

PubMed1975

[Liver disease in polyvinyl chloride production workers - Clinical and peritoneoscopic aspects (author's transl)].

Peculiar clinical symptoms observed in polyvinyl chloride production workers of a nearby chemical plant arose the suspicion of liver and spleen disease in these workers before first reports on vinyl chloride-induced angiosarcoma of the liver became known. Starting at the end of 1972, 44 workers were followed up by biochemical investigations, peritoneoscopy and liver biopsy. As early as 1973 it could be ascertained, that advanced vinyl chloride-induced liver damage presents as hepatic fibrosis with splenomegaly, portal hypertension, and thrombocytopenia without conspicuous deterioration of hepatic parenchyma function. Similar symptoms have been observed after chronic intoxication by arsenic and thorium dioxide (thorotrast). The clinical and peritoneoscopic aspects of the disease are described.

Chemical Industry↗

PubMedDate not supplied

Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy.

BACKGROUND: Histopathological confirmation in abdominal tuberculosis is difficult due to suboptimal noninvasive access to the involved area. Peritoneoscopy and colonoscopy provide semi-invasive access to the peritoneum, large intestine and ileocecal area. Information on the diagnostic yield of these two investigation in abdominal tuberculosis is scarce. OBJECTIVE: To evaluate the role of laparoscopy and colonoscopy in the diagnosis of abdominal tuberculosis. PATIENTS AND METHODS: Between January 1998 and July 2001, 34 patients were diagnosed to have abdominal tuberculosis on the basis of laparoscopy or colonoscopy. The case records of these patients were retrospectively reviewed to assess the usefulness of laparoscopy and colonoscopy in the diagnosis of abdominal tuberculosis. RESULTS: Laparoscopy was performed in 23 patients. Peritoneal tuberculosis was diagnosed in 19 of them, characterized by presence of ascites, multiple whitish tubercles, fibrous bands and adhesions, hyperaemic edematous bowel loops or dense adhesions without ascites. Multiple jejunoileal hyperemic short segments with serosal neovascularization was noticed in three patients. One patient had cecal mass with pericecal inflammatory adhesions. In three patients, laparoscopy was converted to open laparotomy due to bowel injury, extensive adhesions, and difficulty in assessing lymph nodal mass in one patient each. Peritoneal biopsy confirmed the diagnosis in 10 of the 15 (67%) patients. In one patient pericecal tissue biopsy confirmed the diagnosis. The remaining patients received therapeutic trial with anti tuberculosis treatment. All patients showed good response. Thus laparoscopy provided positive diagnosis of tuberculosis in 20/23 (87%) and positive histology in 10 of the 15 (67%) patients with peritoneal lesions. Thirteen patients underwent colonoscopy. Mucosal lesions involving terminal ileum, cecum and colon was noted in 11 patients. Colonoscopic biopsy confirmed the diagnosis in six of the 11 patients (54%). Non of these patients had any complication related to colonoscopy. CONCLUSION: Laparoscopy was safe and helped in the diagnosis of peritoneal as well as intestinal tuberculosis in 87% of patients. Colonoscopy is useful for colonic and terminal ileal lesion with a positive diagnostic yield of 54%.

Adolescent↗

PubMed1975

Primary mesenteric venous occlusive disease.

Primary mesenteric venous occlusive disease is a highly lethal disease. The only way to improve survival is early diagnosis and immediate laparotomy. The disease occurs in the older age group with a higher incidence in women and should be considered in the differential diagnosis of serious abdominal distress. The most helpful diagnostic tests are paracentesis and peritoneoscopy, but above all, the most important diagnostic tool is a high index of suspicion on the part of the examining physician.

Adult↗

PubMed1992

Endoscopic approaches in the diagnosis of obstructive jaundice--with special reference to endoscopic retrograde cholangiopancreatography.

Duodenofiberscopy with endoscopic retrograde cholangiopancreatography (ERCP) was performed in 102 patients with obstructive jaundice. Peritoneoscopy and peritoneoscopic cholecystocholangiography were done in patients whose ERCP was inconclusive. The causes of obstructive jaundice were carcinoma of the pancreas in 14 cases, carcinoma of the papilla of Vater in 12 cases, choledocholithiasis in 37 cases, carcinoma of the common bile duct in seven cases, hepatocellular carcinoma (HCC) in seven cases, intrahepatic cholestasis in three cases and miscellaneous causes in eight cases. No final diagnosis was made in 14 patients. The duodenofiberscopic examination with biopsy revealed the cause of obstructive jaundice directly in eight cases, when carcinoma of the pancreas or papilla of Vater extended to the duodenal mucosal surface. In 34 of the 37 patients with choledocholithiasis, ERCP alone was successful in making the diagnosis. Percutaneous transhepatic cholangiography and ERCP were used together to reach a diagnosis in the remaining three patients. We propose a classification for HCC on ERCP which may be useful for the study of icteric type HCC.

Ampulla of Vater↗

PubMed1978

Lipoatrophic diabetes. Report of a case.

The female patient initially showed the acquired type of total lipoatrophy at about 8 years of age. At 12 years of age, the onset of diabetes mellitus was speculated from advanced pyodermia and dedentition. At 29 years of age, glucosuria was found, and she developed proteinuria, ascites, and pretibial edema. The physical examination revealed: hepatosplenomegaly, complete absence of subcutanous fat, cutaneous xanthomas, and emaciated facies with pronounced zygomatic arches. Diabetic retinopathy was revealed in the ophthalmological examination, and nephropathy was evident in renal biopsy specimens. She also had peripheral diabetic neuropathy. No adipose tissue was found in the mesenterium under peritoneoscopy. The hepatic biopsy specimen revealed advanced portal liver cirrhosis. Laboratory findings included: hyperlipidemia, elevation of BMR without evidence of hyperthyroidism, impaired renal function, and undetected anti-insulin antibodies and anti-insulin antibodies. Endocrinological examinations revealed normal value, except for an impaired hGH response in the arginine test. C-peptide immunoreactivity was high. Her condition was fairly well controlled by 140 units of insulin injection daily.

Adult↗

PubMed2004

Routine insertion of permanent peritoneal dialysis catheters in the nephrology ward. The sliding percutaneous technique.

AIM: A prerequisite to the technical success of peritoneal dialysis in its different modifications is a safe, reliable, correctly positioned, and functioning peritoneal catheter. The ideal method for insertion of permanent catheters (PC) remains debatable. The most commonly used technique is an open surgical approach, by minilaparatomy. Others have proposed a blind approach, using either a trocar method or a modified Seldinger technique or an insertion by means of peritoneoscopy. METHODS: We describe our 5-year experience (May 1997 - June 2002) with 68 percutaneous PC insertions in 63 consecutive patients. A modified technique of percutaneous PC insertion was used that here we call sliding percutaneous technique (SPT): 1) a midline incision is made 4 cm below the umbilicus; the peritoneum is punctured using a straight plastic catheter with a stylet. The catheter is pushed caudally towards the left iliac fossa; 2) a straight stiff 90 cm stylet is inserted through the temporary catheter, which is subsequently removed. The stylet has 2 tips, a blunt proximal one, which is pushed through the catheter into the iliac fossa, and the distal one; 3) having the stylet in situ, a double-cuffed curled-end PC is mounted at the distal tip of the stylet starting from the curl; then, the PC is gently slid down along the stylet as a train does along the rail-way. PC failure was defined as mechanical dysfunction, persistent dialysate leak and persistent peritonitis, or exit site/tunnel infection requiring PC removal. Furthermore, PC failure was defined as early, if occurring in the first 30 days after PC placement, or late, if occurring more than 30 days post-operation. Life-table estimates of PC survival were determined by Kaplan-Meier analysis. RESULTS: Early complications: in the 1st month on dialysis, obstruction to dialysate flow was the commonest cause leading to PC failure. The early actuarial survival (AS) was 90%. Late complications: peritonitis was the commonest cause of PC failure. The late AS, i.e. excluding the catheter failures occurring in the 1st month post-operation, was 82% at 3 years. Global AS, i.e. including both early and late PC failures, was excellent (74% at 3 years). CONCLUSIONS: Even though this study is retrospective and does not compare percutaneous with surgical PC placement techniques, it allows us to state that percutaneous PC insertion is a well-tolerated, rapidly performed, side-room procedure that gives excellent results, above all when using SPT.

Aged↗

PubMed1979

[Importance of laparoscopy to postoperative treatment of ovarian carcinoma (author's transl)].

Indications in favour of peritoneoscopy in postoperative after-treatment of ovarian carcinomas are proposed on the basis of the authors' own experience. Postoperative laparoscopy in combination with peritoneal cytology and histology appears to be justified in support of differentiated postoperative therapy, since it enables modification of empirical and rigid decions for high-continuity after-treatment of ovarian carcinomas.

Female↗

PubMed2006

Study of biochemical parameters of ascitic fluid in exudative ascites with special reference to tuberculous peritonitis.

In an attempt to differentiate between three important but clinically similar conditions of exudative ascites like tuberculous peritonitis, spontaneous bacterial peritonitis (SBP) and malignant ascites, we evaluated the biochemical parameters of ascitic fluid as a diagnostic aid. The serum ascitic albumin gradient (SAAG), lactate dehydrogenase (LDH), pH, adenosine deaminase(ADA), carcino-embryonic antigen (CEA) and carbohydrate antigen (CA-125) levels were measured in 36 patients with tuberculous peritonitis, 30 patients with SBP and 30 patients with ascites due to malignant disorders. The LDH level was significantly lower in tuberculous peritonitis patients than in malignant and SBP groups. A value of < 110 U/l gave the assay a sensitivity of 94% and a specificity of 93%, positive predictive value of 89% and negative predictive value of 96% for tuberculous peritonitis. The ADA activity was significantly higher in tuberculous peritonitis group than in the other two groups. A cut off value > 33 U/l gave the ADA test a sensitivity of 89%, specificity of 100%, positive predictive value of 100 % and a negative predictive value of 94% for tuberculosis. A pH value of <7.26 with high SAAG (>11 g/l) predicted SBP with reasonable accuracy. Elevated ascitic fluid CEA (>2 ng/ml) and CA - 125(> 35 U/l) was found exclusively in cases of malignant ascites with a single case of tuberculous peritonitis showing CA-125 value > 35 U/l. All these tests are rapid, non-invasive, and easily reproducible and offer good predictive accuracy which is comparable to that of more invasive procedures like peritoneoscopy and biopsy.

Adenosine Deaminase↗

PubMed1991

Ascitic fluid protein and cellular changes during diuretic therapy in cirrhosis of liver.

Thirty four patients with peritoneoscopy and/or biopsy proven uncomplicated cirrhosis of liver with ascites were studied for the effect of diuretic therapy on ascitic fluid protein and cell count. Renal function tests, liver function tests, ascitic fluid protein concentration and cell count were estimated prior to diuretic therapy and once every week till the end of therapy. There was no change in mean total serum protein (5.71 +/- 0.58 g/dl to 5.72 +/- 0.63 g/dl). The rise in mean ascitic fluid protein from 1.55 +/- 0.77 g/dl to 1.76 +/- 0.79 g/dl was not significant (P greater than 0.05). Twenty one patients (Group I) showed a rise in ascitic fluid protein concentration while 13 patients (Group II) did not show a rise or showed a fall in protein concentration during diuretic therapy. The rise in ascitic fluid protein concentration in Group I from 1.62 +/- 0.69 g/dl to 2.05 +/- 0.67 g/dl was statistically significant (P less than 0.05). Group I patients had a mean weight loss of 6.21 +/- 3.66 kg as compared to 3.15 +/- 2.00 kg in Group II patients (p less than 0.05). There was no other difference between Group I and Group II patients. Only 5 patients showed a rise in ascitic fluid cell count (more than 50 cell/mm3). It is concluded that diuretic therapy alters ascitic fluid protein concentration in a majority of patients but has no significant effect on cell count.

Adolescent↗

PubMed1976

[Hepatic schistosomiasis and sarcoidosis with voluminous subdiaphragmatic adenopathies].

The authors report a case of a West-Indian with sarcoidosis and peripheral, mediastinal and, above all, sub-diaphragmatic lymph nodes. The latter were very large and palpable through the abdomen, confirmed by lymphography and found to be due to S. Mansomi schistosomiasis. Liver biopsy carried out under peritoneoscopy, showed schistosomal granulomatosis with sarcoidosic granulomatosis. The authors consider that the rareness of this association is only apparent and does not correspond to the frequency of bilharziasis nor that of sarcoidosis in these subjects. They emphasize the mistakes which may result in interpretation of liver biopsy. They recall a few special characteristics of sarcoidosis in West-Indians, in particular, the possibility of failure of corticosteroid therapy as in their case, due to the onset of miliary lung disease under treatment, and show the lymphographic appearances of sarcoidosis.

Adult↗

PubMedDate not supplied

[Tuberculous peritonitis. Description of 2 cases associated with another infection and literature review].

The authors report two cases of peritoneal tuberculosis observed in Belgium: a 28-year-old black man, immigrant from Ghana and a 24-year-old caucasian woman. In both patients, tuberculosis was associated with another infection. The first patient had a retroperitoneal amoebic cyst and in the second patient Chlamydia trachomatis was found with Koch bacillus in the ascitic fluid. Both patients were successfully treated with appropriate antibiotics. Following the review of recent literature, it appears that the incidence of extrapulmonary tuberculosis is increasing in the industrialized part of the world, peritoneal tuberculosis now representing 0.5% of all cases of tuberculosis. Mortality approaches 7%. The diagnosis is difficult and should be evoked more often in order to be confirmed by appropriate means, such as ascitic fluid adenosine desaminase, bacteriology and peritoneoscopy.

Adult↗

PubMed1990

Primary liver cell carcinoma presenting as extrahepatic biliary obstruction.

Two cases of primary liver cell carcinoma simulating extra-hepatic biliary obstruction are presented. In order to avoid false diagnosis and preventable laparotomy, it is suggested that peritoneoscopy and target liver biopsy should be preferred to blind liver biopsy in the investigation of biliary obstruction.

Adult↗

PubMedDate not supplied

[Identification of a limited form of small cell lung cancer among 103 patients pre-selected for chemotherapy combined with surgery].

Between Nov. 1981 and Nov. 1987 103 patients preselected for chemotherapy combined with surgery, therefore with local extension within homolateral mediastinal lymph nodes, with no signs of remote metastases, PS greater than or equal to 70, with no contraindication for resectional surgery including pneumonectomy, no diabetes, no prior treatment underwent first staging. Staging included: case history, physical examination, full blood count, biochemical tests (alkaline phosphatase, SGOT, GGTP, LDH), CEA, X-ray assessment including CT scan of the chest, bronchoscopy, peritoneoscopy, liver scan (US was not routinely used at the beginning), bilateral bone marrow trephine biopsy, and bone scan. Staging was discontinued when secondaries were detected in one, the more so as in two organs or systems (25 pts), and/or bronchoscopic contraindication for thoracotomy (11 pts), and this group of patients was out of the study. To 67 patients chemotherapy was given and after 3 courses these patients were reevaluated. In 21 patients PD, NC or CR was found. Forty six patients with PR underwent supplementary staging procedures: CT of the brain, CT of the upper retroperitoneal space and liver. Metastatic sites were found in 7 patients. Limited disease was identified in 39 patients. Limited-stage disease can be determined only after exclusion of extensive disease on the ground of: case history, physical assessment, X-ray of the chest (PA + lateral) + CT chest scan, bronchoscopy with biopsy or cytology, and outside the chest: 1. bone marrow trephbine biopsy and bone scan--bone marrow and skeleton, 2. CT head scan--brain, 3. CT abdominal scan--upper retroperitoneal space and liver.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

[Extrapulmonary lesions of sarcoidosis].

Varieties of extrapulmonary sarcoidosis lesions have been detected in Japan, mostly in the past ten years, including heart, CNS, liver, spleen, bone marrow stomach, colon, esophagus, pancreas, gall bladder, abdominal lymph node, kidney, muscle, bone, joint and others. Most of these were detected mainly at onset with sarcoid changes on chest film. Hepatic lesions have frequently been found by peritoneoscopy and liver biopsy, irrespective of the age of patients or stage of sarcoid change on chest film. Therefore hepatic lesions are very important in the diagnosis and following the clinical course of sarcoidosis. Recent diagnostic procedures of extrapulmonary lesion include abdominal, cardiac and muscle echography; brain, chest, abdominal and muscle CT; cardiac and muscle MRI; gallium scan; thallium myocardial scan, cardiac pool scan and Holter ECG. Extrapulmonary sarcoidosis lesions causing disability were located in the heart, CNS, eye, liver, kidney, muscle and bone. These disabilities were found predominantly in cases older than 40 years old, and were mainly detected at onset in the past 10 years. The duration of some of these disabilities was more than 10 years.

Adolescent↗

PubMed1988

Primary liver cell carcinoma associated with infective liver disease.

Three patients, who had primary liver cell carcinoma combined with infective disorders (one each with pyogenic liver abscess, hepatic tuberculosis and amoebic liver abscess), are presented. The importance of further investigation, particularly liver biopsy and/or peritoneoscopy, in patients with liver diseases is highlighted.

Adult↗

PubMed1985

Cat scratch disease. Report of a case with hepatic lesions and a brief review of the literature.

An unusual case of cat scratch disease with large hepatic defects is presented. We describe a previously healthy 16-yr-old black man presenting with a neck mass, hepatosplenomegaly, and systemic symptoms. Pathology of the neck mass revealed a lymph node with chronic inflammation and focal necrosis. An abnormal computed tomography scan showed large hepatic defects which were confirmed at peritoneoscopy; biopsy specimens are described. Routine and special stains for bacteria and fungi were all negative. Serologic studies were unremarkable but a cat scratch skin test was positive. Follow-up examinations revealed resolution of all findings. Cat scratch disease should be considered in the differential diagnosis of diseases causing lymphadenopathy, systemic symptoms, and hepatic (and splenic) defects.

Adolescent↗