Identifying and sampling minimal amounts of liquid in the peritoneal cavity. Peritoneal paracentesis and the paracolico-iliac recess: a simple bedside method.
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Ascitic Fluid↗
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[Primary splenic abscess ruptured into the peritoneal cavity (peritonitis in 3 stages)].
The authors present a case with peritonitis following rupture of a splenic abscess in a female aged 18 years. Peritonitis developed in three stages. The diagnosis before surgery was of pelvic peritonitis. Bacteriologic examination revealed the presence of B. colli. Splenectomy was followed by complete recovery of the patient. The site of the primary infection could not be determined. The authors stress the usefulness of exploration of the splenic lodge in the so-called "primary" generalized peritonitis, in pelvic peritonitis or in all cases when the origin of the peritoneal infection is not known.
Abscess↗
Gamma interferon induces the appearance of a CD4-, major histocompatibility complex class II+ macrophage subpopulation in the rat peritoneal cavity.
Peritoneal cells from gamma interferon (IFN-gamma)-treated rats were phenotypically characterized by flow cytometry. Intraperitoneal inoculation of 3 x 10(4) units of IFN-gamma induced, within 24 h, the appearance of a CD4-, major histocompatibility complex (MHC) class II+ macrophage subpopulation not present in rats treated with phosphate-buffered saline. IFN-gamma induced an increased expression of MHC class II I-A molecules on both CD4- and CD4+ macrophages. Both cell types adhered to plastic and expressed high levels of the macrophage membrane molecules CD11b and OX41. Histological examination of sorted CD4- and CD4+ macrophages confirmed the macrophage morphology of both populations with less granula in the former. We conclude that the appearance of CD4- macrophages in the peritoneal cavity after inoculation with IFN-gamma most probably reflects a selective recruitment of these cells from blood or surrounding tissues. The function of these cells is still unknown, although strong expression of MHC class II I-A indicates competence as antigen-presenting cells.
Animals↗
Transfer of autologous haemoglobin from the peritoneal cavity during peritoneal dialysis.
Transfer of autologous haemoglobin from the peritoneal cavity was evaluated retrospectively in 14 patients who received this marker intraperitoneally (group 1) during routine continuous ambulatory peritoneal dialysis (CAPD). Five additional patients were studied during acute peritonitis (group 2). A model for balance of both dialysate volume and amount of haemoglobin is developed to assess movement of the compound into lymph or adjacent tissues. Under the conditions of the study the transfer was slow (8 +/- 10 ml/h) in patients without peritonitis (group 1), and significantly faster (25 +/- 22 ml/h) in those with peritonitis (group 2). These clearance values are the upper limits for lymph flow.
Adult↗
The absorption of iron dextran from the bovine peritoneal cavity in peritonitis. A preliminary report.
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Absorption↗
[Ultrasonography of the retroperitoneal space, pelvic cavity and peritoneal cavity].
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Ascitic Fluid↗
[Evaluation of loss of active heparin in the peritoneal cavity during intermittent peritoneal dialysis].
Our studies aimed at determining a loss of active heparin from the peritoneal cavity after its intraperitoneal administration (250 JU/l of dialysis fluid) in 16 patients treated because of the end-stage renal failure with intermittent peritoneal dialysis and at comparing heparin influx clearance with that of glucose. It has been shown that heparin used in this dose loses 60-70% of its activity after 20-minute equilibration of dialysis fluid in the peritoneal cavity. Heparin influx clearance is higher than that of glucose but it depends on utilization of heparin in peritoneal cavity rather than on its penetration to the blood circulation.
Adult↗
Pathways for fluid loss from the peritoneal cavity.
During peritoneal dialysis, fluid is transported out of the peritoneal cavity by lymphatic and nonlymphatic pathways, thereby decreasing net ultrafiltration by 40-50% and reducing small solute clearance by 15-20%. The direct lymphatic pathway consists of the diaphragmatic lymphatics, which directly connect the peritoneal cavity to the bloodstream. The interstitial lymphatic and direct blood entry pathways convey fluid that has been driven into the interstitial space of the tissue surrounding the peritoneal cavity by the increased intraperitoneal pressure, and return it to the bloodstream. Since flow through lymphatic pathways is only a portion of the flow through all pathways, total fluid loss is greater than lymph flow. The best technique for estimating lymph flow is direct measurement by cannulation of lymphatic vessels, a technique that is not clinically feasible. The tracer disappearance technique, which measures the rate at which macromolecules leave the peritoneal cavity, is an indirect measure of fluid loss. The tracer appearance technique, which measures the rate at which macromolecules reach the blood from the peritoneal cavity, slightly overestimates lymph flow because some tracer may enter the bloodstream directly from the tissues. Much of the previous controversy over the contribution of the lymphatic pathways to total fluid loss can be resolved by understanding the differences in what these techniques measure.
Ascitic Fluid↗
Environmental conditions favorable for tumor progression in peritoneal cavity induced by peritoneal cells without tumor selectivity.
The incidence of the lethal growth of 10(1) L1210 murine leukemia cells in mice was higher in intraperitoneal (i.p.) (97%) than in intradermal (i.d.) (17%) inoculation, and survival time of mice was shorter in i.p. than i.d. inoculation. It was supposed that resident peritoneal cells (PC) enhanced tumor progression. I.d. inoculation of 10(1) L1210 cells mixed with 10(6) PC induced a lethal tumor growth at higher incidence than that of 10(1) L1210 cells alone or the mixture of 10(1) L1210 cells and 10(4) peripheral blood mononuclear cells (PBM) did. Furthermore, co-inoculation of a tumorigenic number of L1210 cells (10(3] with 10(6) PC resulted in marked shortening of median survival time of mice. Similar growth enhancing effect of PC was observed in Meth 1 fibrosarcoma. Meth A fibrosarcoma and colon carcinoma 26 (C26). Further study showed that PC, intact or X-rayed, helped the in vitro tumor growth under the conditions in which L1210 alone did not grow at all, whereas PBM had no enhancing effect to L1210 growth. We characterized the cells involved in tumor growth enhancement by the in vivo and in vitro tests. Plastic dish adherent cells of PC which were Mac-1 positive, large in size and resistant to X-ray, enhanced L1210 growth, whereas non-adherent cells which were Mac-1 negative and small in size, did not. These data suggest that the cells responsible for enhancing activity of tumor progression in the peritoneal cavity were macrophages (M phi).
Animals↗
Host defense mechanisms in the peritoneal cavity of continuous ambulatory peritoneal dialysis patients. 2. Humoral defenses.
This is the second of a 2-part series reviewing host defense mechanisms of the peritoneal cavity of continuous ambulatory peritoneal dialysis (CAPD) patients. This article discusses humoral aspects of host defenses and accompanies the first article that focused upon cellular defenses. The purpose of this review is to provide a critical analysis of studies that have investigated the importance of peritoneal humoral immunity of CAPD patients in the pathogenesis of peritonitis. Specific attention is given to how CAPD alters normal humoral defenses of the peritoneal cavity and the clinical significance of such alterations.
Antibody Formation↗
The disappearance of macromolecules from the peritoneal cavity during continuous ambulatory peritoneal dialysis (CAPD) is not dependent on molecular size.
The transport of macromolecules from the circulation to the peritoneal cavity is a size-selective restricted process, while the transport of these solutes from the peritoneal cavity is probably mainly by lymphatic absorption. If so, it should be independent of molecular size. Therefore, we studied with a clearance technique the disappearance of intraperitoneally administered inulin and polydisperse dextran 70 in nine continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results with the simultaneously measured appearance clearance of serum proteins. Using gel permeation chromatography 18 dextran fractions with different molecular radii could be analyzed. Inulin clearance (2.94 mL/min) was higher than total dextran clearance (1.30 mL/min). The maximal dextran concentration in all dialysate samples was found in the 50.4 A fraction. The clearances of the dextran fractions were the same of different molecular sizes. All disappearance clearances were higher than the appearance clearances: the protein/dextran clearance ratio ranged from 0.15 for albumin/36 A to 0.04 for alpha 2-macroglobulin/91 A. This confirms that the appearance of a macromolecule, but not its disappearance is dependent on molecular size. It is concluded that the disappearance of macromolecules from the peritoneal cavity is mainly a size independent convective process, possibly by lymphatic uptake. This implies that total dextran 70 clearance can be used for measurement of lymphatic absorption in CAPD patients.
Adult↗
Cancer antigen 125 is locally produced in the peritoneal cavity during continuous ambulatory peritoneal dialysis.
The local production of cancer antigen (CA) 125 in the peritoneal cavity of 14 continuous ambulatory peritoneal dialysis patients was studied. In addition, the relationship between the concentration of mesothelial cells and CA 125 in the peritoneal dialysate effluent was examined. The median results and ranges were as follows: plasma CA 125 14 U/mL (range 10-23), dialysate CA 125 18 U/mL (range 5.2-76), dialysate/plasma ratio 1.9 (range 0.61-5.4), and number of mesothelial cells 400/mL (range 10-5000). Peritoneal concentrations of mesothelial cells and CA 125 were positively correlated (r = 0.50, p < 0.01). Using a monoclonal antibody, CA 125-positive cells were found in the cytospin preparations of the cells of dialysis effluents. All these CA 125 positive cells were also positive for cytokeratin used as a mesothelial cell marker. In vitro experiments using mesothelial cells in monolayers showed a linear increase in CA 125 concentration both in time and in relation to the number of mesothelial cells. From these experiments a production rate of 24 U/hour/10(6) cells could be calculated. It is therefore concluded that CA 125 is locally produced in the peritoneal cavity during CAPD and that the mesothelial cells are the major source of this CA 125.
Antigens, Tumor-Associated, Carbohydrate↗
Lymphatic versus nonlymphatic fluid absorption from the peritoneal cavity as related to the peritoneal ultrafiltration capacity and sieving properties.
In this article we discuss the role of capillary fluid absorption via Starling mechanisms (the transcapillary hydrostatic pressure gradient opposed by the colloid osmotic pressure gradient as multiplied by the capillary UF coefficient) vs. lymphatic fluid absorption as determinants of the total fluid loss from the peritoneal cavity during continuous ambulatory peritoneal dialysis (CAPD). We also mention that, under nonsteady state conditions, there is in addition some net absorption of fluid into the interstitium of tissues surrounding the peritoneal cavity. Support for the contention that nonlymphatic fluid absorption directly into the capillaries is the major mode of fluid transport from the peritoneal cavity to the blood is given by measurements of the peritoneal-to-blood clearance of tracer albumin (or other proteins). Such measurements yield clearance values of the order of 0.2-0.3 ml/min in CAPD. This represents only about 20% of the total peritoneal fluid loss rate (1.2-1.3 ml/min) in ordinary CAPD dwells. Indirect support for a relatively low lymph flow is also derived from capillary physiology. Like continuous capillary walls, the peritoneal membrane shows a bimodal selectivity towards molecules of graded molecular size. Thus, small solute transport can be described as occurring by diffusion through numerous 'small' (approximately 50 A radius) pores, whereas large solute transport is consistent with blood-peritoneal convection through smaller numbers of 'large' (radius approximately 250 A) pores. Furthermore, peritoneal sieving data are compatible with the notion that large crystalloid osmotic pressure gradients cause fluid flow through a water-exclusive ('ultra-small' pore) pathway. A three-pore model of peritoneal selectivity can explain why small solute sieving coefficients are only 0.5-0.6, even though small solute reflection coefficients are close to zero. Another important implication of the three-pore concept is that the peritoneal UF-coefficient is much higher than previously thought, emphasizing the role of capillary absorption in the fluid loss from the peritoneal cavity in CAPD. It is concluded that fluid loss from the peritoneal cavity is dominated by capillary fluid absorption. Hence, lymphatic absorption accounts for just a small fraction of the peritoneal-to-blood absorption of fluid in peritoneal dialysis.
Absorption↗
Lymph flow and lymphatic drainage of inflammatory cells from the peritoneal cavity in a casein-peritonitis model in sheep.
The purpose of this study was to characterize the cellular responses in the peritoneal cavity and draining lymph in a sterile peritonitis model in conscious sheep. Lymph was collected from lymphatics that drained the peritoneal space (caudal mediastinal and thoracic ducts) as well as from lymph vessels that drained peripheral tissues (prescapular). Casein was used as the inflammatory agent. Dialysis solution (Dianeal 4.25%) containing 1g% casein and 25 microCi 125I-human serum albumin was infused into the peritoneal cavity in 50 ml/kg volumes. Peritoneal volumes increased from a mean infused volume of 1572 +/- 51 ml to a maximum of 2119 +/- 77 ml at 3 hours. Over 6 hours, the number of macrophages and lymphocytes in the peritoneal cavity remained relatively constant but the number of neutrophils increased from 9.9 +/- 4.2 x 10(7) to 9.2 +/- 1.9 x 10(9) total cells. Caudal lymph which drains directly from the peritoneal cavity through diaphragmatic stomata, demonstrated a 5 fold increase in flow rate over 6 hours following the Dianeal-casein infusion. Thoracic duct and prescapular flows declined approximately 70% and 50% respectively in the same time period. the concentration of lymphocytes and the lymphocyte outputs (product of volume and concentration) declined in all lymph compartments. No elevations in neutrophil numbers in the thoracic and prescapular lymph compartments were observed but neutrophil output in the caudal lymph increased steadily from 3.1 +/- 1.5 x 10(6) to 4.6 +/- 1.3 x 10(7)/hr at the 6 hour mark. We conclude that the major route of removal of inflammatory cells and fluid from the peritoneal cavity is through diaphragmatic lymphatics.
Animals↗
Elimination patterns of Escherichia coli and bacteroides fragilis from the peritoneal cavity. Studies with experimental peritonitis in pigs.
An animal model for study of bacterial elimination from the peritoneal cavity is presented. Using Escherichia coli and Bacteroides fragilis as infecting agents, two elimination patterns emerged. The patterns were related to the surface properties of the micro-organisms. The concentration of both species was greatly reduced within 2 to 4 hours after peritoneal contamination with 10(10) CFU. The elimination of B. fragilis was contemporaneous with mobilization of granulocytes into the peritoneal cavity, and was probably attributable to bactericidal action of the granulocytes. Most of the E. coli inoculum, however, was cleared before the granulocyte mobilization. Cell-free peritoneal fluid was found to have a bactericidal effect against a rough strain of E. coli, but not against a smooth strain, as demonstrated in vitro. This effect was inhibited by pretreatment of the peritoneal fluid with EDTA, EGTA or heat, which suggested that the alternate pathway of the complement system was involved. In vivo the rough strain of E. coli was rapidly eliminated, while elimination of the smooth strain followed the B. fragilis pattern. It is concluded that bacterial surface properties are important in bacterial peritonitis.
Animals↗
Host defense mechanisms in the peritoneal cavity of continuous ambulatory peritoneal dialysis patients. 1.
This article provides a review of studies on peritoneal white blood cells (WBC) in CAPD patients. To some extent these studies support the concept that the peritoneal cavity of these patients contains adequate-functioning WBC that can provide effective antimicrobial defenses when they are studied in dialysate-free media. Commercially available dialysis solutions significantly impair WBC function. In some patients with high incidences of peritonitis, there appears to be reduced bactericidal capacity of their peritoneal macrophages. CAPD seems to contribute to a state of both macrophage and lymphocyte activation in the peritoneal cavity. The clinical consequences of this chronic activation are not known.
Cytokines↗
Vancomycin absorption from the peritoneal cavity during dialysis-related peritonitis.
The uptake of vancomycin from the peritoneal cavity during acute episodes of peritonitis was compared to noninfected patients in 14 patients, 7 of whom had dialysis-related peritonitis. Treatment consisted of 8 hourly dialysate exchanges, followed by 4-h dwells containing 37.5 mg/L of vancomycin. On day 4, serum vancomycin concentrations were 13.4 +/- 4.8 mg/L in the controls and 15.5 +/- 6.8 mg/L in the group with peritonitis. After 180 min in the peritoneal cavity, 61% +/- 13% of the infused vancomycin remained in controls and 30% +/- 15% in patients with peritonitis (p less than 0.05). Uptake of vancomycin from the peritoneal cavity is enhanced during episodes of peritonitis.
Absorption↗
The immunoglobulin allotype contributed by peritoneal cavity B cells dominates in SCID mice reconstituted with allotype-disparate mixtures of splenic and peritoneal cavity B cells.
We have studied potential regulatory interactions between mature B lymphocyte populations by analysis of C.B-17 severe combined immunodeficient (SCID) mice reconstituted simultaneously with immunoglobulin allotype-congenic mixtures of spleen (SP) and peritoneal cavity (PerC) B cells. We have previously shown that the independent transfer of B cells from these sources leads to the long-term survival of donor B cells and reconstitution of immunoglobulin levels in SCID mice (Riggs, J.E., D.L. Robertson, R.S. Stowers, and D.E. Mosier, manuscript submitted for publication). SP and PerC B cells differ in numerous respects, with the PerC having higher proportions of large, activated B cells that express the IgM greater than IgD phenotype and greater numbers of CD5 B cells. The injection of equal numbers of B cells from SP and PerC into SCID recipients (e.g., BALB/c SP + C.B-17 Per C----SCID) has led to the following observations: (a) serum IgM allotypes in B cell chimeras revealed strict dominance by the allotype contributed by the PerC B cells; (b) this dominance was not due to regulatory T cells; (c) B cells of the unexpressed (i.e., SP) allotype were present in the chimera in the spleen but not the peritoneal cavity; and (d) immunization with TI and TD antigens failed to elicit the SP IgM allotype, whereas secondary TD antigen immunization elicited low levels of the SP IgG2a allotype. Additional experiments demonstrated concurrent expression of IgM allotypes derived from both SP and PerC B cells in recipients that: (a) received a 10-fold excess of SP B cells; (b) received SP B cells before PerC B cell transfer; or (c) received SP B cells intravenously and PerC B cells intraperitoneally. We conclude that the establishment of IgM synthesis by PerC B cells leads to a feedback inhibition of subsequent IgM synthesis by SP B cells, and that the frequency of B cells that can lead to this effect is substantially higher in peritoneal cavity than in spleen. These data provide further confirmation of regulatory interactions between B cells in the absence of T lymphocytes, but confound the interpretation of experiments supporting the existence of a separate CD5+ B cell lineage.
Animals↗