Chronic Appendicitis Research Articles

0541: Ultrasound in the Digestive Tract

US is today an important imaging modality for evaluation of the digestive tract in children. It allows simultaneous non invasive anatomic and homodynamic study. It's of a diagnostic, prognosis, therapeutic and preventive value. It helps the physicians to confirm eventual antenatal diagnosed abnormalities and to treat children in several circumstances, exploring different congenital and acquired disorders. US exam must be carried out by high frequency convex and linear probes in all scan plans. The child is lying in supine position, in general. No premedication is needed and diet is not necessary. Doppler techniques, if available, are helpful. Normal aspect of digestive tract and variants are important to be known. Its main indications are acute and chronic abdominal pain, suspected intussusception or appendicitis, inflammatory bowel diseases, suspected hypertrophic pyloric stenosis or gastro-oesophageal reflux, blunt abdominal trauma mid gut volvulus, Schoenlein Henock purpura syndrome, mesenteric ischemia, and screening for abdominal congenital abnormalities. Checking all the intra abdominal organs must be the gold rule. The observation should include bowel wall thickness, bowel motility, bowel content, free fluid or collection in the abdomen, or any mass related to the bowel. US guided biopsy is very helpful, in particular when abdominal mass is suspected. US is needed during the follow up after medical or surgical treatment of several diseases: abscesses, ascitis, recurrencies of malignant tumors or intussusception.

Bowel Obstruction Following Appendectomy

Appendicitis is a common problem that is typically treated with an appendectomy. Following abdominal surgery, adhesions may form and may cause a subsequent small bowel obstruction (SBO). The purpose of our study was to determine the rate of post-appendectomy SBO in an adult population, and to observe any difference in SBO rates between open versus laparoscopic appendectomies. All patients who underwent an appendectomy at an adult hospital in the Calgary Health Region between 1999 and 2002 were identified by using the administrative discharge database. Pathology and operative technique (laparoscopic, McBurney incision, midline laparotomy) were reviewed. Using those regional health numbers, any further admissions with a diagnostic code for bowel obstruction were identified. Medical charts (n = 1777) were reviewed to confirm the rate of post-appendectomy SBO. A logistic regression was performed to identify risk factors of post-appendectomy SBO and expressed as odds ratios (95% confidence interval). The overall SBO rate was 2.8% over an average 4.1-year follow-up period. The risk factors for developing SBO following appendectomy for appendicitis included, perforated appendicitis (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 1.5-6.6), and midline incisions (OR = 5.4, 95% CI: 2.8-10.4). Those with pathology of cancer or chronic appendicitis conferred the greatest overall risk of SBO (OR = 7.4, 95% CI: 2.7-20.3). The rate of SBO following appendectomy in adults was 2.8%, or 0.0069 cases per person-year. The greatest risk factors for developing SBO were midline incision and nonappendicitis pathology. There is no statistically significant difference in SBO rates following laparoscopic appendectomy compared with open approaches.

Can Interval Appendectomy be Justified Following Conservative Treatment of Perforated Acute Appendicitis?

There continues to be controversy about the necessity of interval appendectomy for delayed presentation of acute appendicitis. While recent studies suggest that the risk of recurrent disease is small, the risk of interval appendectomy is also small and does provide histologic identification and usually definitive treatment of the right lower quadrant inflammatory process. A retrospective analysis of medical records gathered from 2002 to 2007 at a major teaching hospital of 986 adult patients over the age of 13 with appendicitis were analyzed. Forty-six patients (5%) were found to have right lower quadrant abscess or phlegmon, and were managed with intravenous antibiotics. Some patients also underwent percutaneous drainage. These patients were then readmitted 6 to 26 wk later for an elective laparoscopic interval appendectomy. There were 19 males and 27 females with an average age of 43 y. Ninety-four percent of the appendectomies were completed laparoscopically; 16% of patients were found to have a normal or obliterated appendix on pathologic evaluation and likely did not benefit from interval appendectomy. On the other hand, 84% of patients had persistent acute appendicitis, chronic appendicitis, evidence of inflammatory bowel disease, or neoplasm identified, and likely benefited from surgical appendectomy. Interval appendectomy provides diagnostic and therapeutic benefit to patients who present with a right lower quadrant abdominal inflammatory focus, and should be carefully considered in all adult patients.

The Impact of the Liberal Use of CT in the Work Up of Acute Appendicitis

Background: Acute appendicitis has historically been considered a clinical diagnosis, necessitating a CT scan only in the face of equivocal signs and symptoms. The purpose of this study is to determine whether or not the liberal use of CT in the work up of acute appendicitis results in a decreased negative appendectomy rate (NAR). Methods: The medical records of 940 consecutive patients who underwent emergency appendectomy between January 2002 and December 2006 were reviewed. Data collected included patient demographics, length of stay (LOS), results of contrast enhanced CT scans, emergency department (ED) work up time, and final pathology. Results: During the study period 940 patients (mean age 34.5±16.7 years, 53% males) underwent emergency appendec- tomy (64% laparoscopic). Eight hundred thirteen (86% patients, 50% males) underwent pre-operative CT scans. Final pathology was 76.1% acute appendicitis, 10% acute appendicitis with perforation, 7.7% gangrenous appendicitis, 1.2% acute appendicitis with abscess, 0.7% chronic appendicitis, and 4.3% negative for appendicitis. No difference was noted in the overall appendicitis rate by gender in the CT (Fishers exact test, p=0.96) or non-CT group (Fishers exact test, p=0.75). Similarly, no difference was noted by age (CT p=0.14, non-CT p=0.26). The NAR was lower for the CT group (3.4%) compared to the non-CT group (9.4%) (p=0.002). The NAR did not differ significantly by gender (Fishers exact test, p=0.491). Despite prolonging the ED work up time by 4.3 hours, the perforation rate did not differ between the CT (9.5%) and non-CT (12.6%) groups (p=0.30), nor did the LOS (3.67 vs. 3.63 days, p= 0.92). The sensitivity, specificity, negative predictive value, and positive predictive value of CT scans was 99%, 61%, 68%, and 99%, with an overall accu- racy of 98%. The positive and negative likelihood ratios were 2.52 and 0.02 respectively. The ROC for CT scans in pre- dicting appendicitis was 79.8% (95% CI: 76.9%, 82.5%). Conclusions: The use of CT in the work up of acute appendicitis is associated with a lower negative appendectomy rate independent of gender and age. The additional time spent obtaining a CT does not appear to increase the risk of perfora- tion nor increase the LOS.

115 example senior citizen acute appendicit is's ultrasound diagnosis

Objective Discusses the senior citizen acute appendicitis's ultrasound diagnosis significance.Method On clinical doubts to my hospital 115 examples has acute appendicitis's old age patient to carry on the ultrasound inspection. And after the Surgery the pathology carries on the check analysis. Results 115 example senior citizen appendi-citis ultrasound diagnosis coincidence rate 91.3%,To the suppurative and the gangrene appendicitis, the appendicular abscess coincidence rate, the sensitivity and the peculiar-ity reach 100%, the retinitis simplex and the chronic appendicitis exist leak examine the phenomenon. Conclusion The ultrasound inspection is the senior citizen appendicitis important auxiliary diagnosis method, may list as one of routine inspection projects Key words: Supersonic: Senior citizen; Appendicitis

Performance value of high risk factors in colorectal cancerscreening in China

To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China. We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy. The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for non-adenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality. The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.

Laparoscopic Removal of a Perforating Intrauterine Device Mimicking Chronic Appendicitis

The intrauterine contraceptive device (IUD) is a common form of reversible birth control. One of the rare, but serious, complications is uterine perforation. In this paper, we report a case of a patient who underwent laparoscopy for presumed chronic appendicitis. Intraoperatively, uterine perforation by the IUD was found. The IUD was removed laparoscopically. The postoperative course was uneventful.

Transumbilical endoscopic surgery: a preliminary clinical report

There has been great interest in natural orifice transluminal endoscopic surgery (NOTES) in recent years. We report another new approach--transumbilical endoscopic surgery (TUES)--which we have performed in 40 cases for liver cysts (3), bleeding ascites (1), chronic appendicitis (10), and gallbladder diseases (26). Transumbilical endoscopic liver cyst fenestration, abdominal cavity exploration, appendectomy, and cholecystectomy were performed in a total of 40 patients. All the operations were completed successfully except one case of intraoperative bleeding in TUES cholecystectomy which was converted to routine laparoscopic surgery. The operating times for TUES cholecystectomy, appendectomy, and liver cyst fenestration were 30-150 min,15-40 min, and 30-90 min, respectively. No postoperative bleeding or bile leakage occurred in this group of patients. Transumbilical endoscopic surgery is feasible, and would be another option for scarless abdominal surgery. TUES cholecystectomy is technically challenging. Careful selection of patients is important in the initial period of this technique.

Organizing Mucinous Ascitis Masquerading as Pseudomyxoma Peritonei: A Process Possibly Caused by Metaplasia But Not Neoplasia

Mucinous ascitis can be differentiated from the more ominous condition pseudomyxoma peritonei microscopically by the absence of epithelial cells amidst mucin pools in the former. Herein we communicate a brief report of organizing mucinous ascitis in a 34-year-old woman, with recurrent abdominal pain localized to right iliac fossa. Imaging studies were suggestive of mucocele. Conservative management, followed by appendicectomy and enbloc removal of the surrounding mucinous adhesions, was performed. Histopathology revealed chronic obliterative appendicitis, along with presence of mucin pools, mixed inflammatory cells and reactive mesothelial cells in the surrounding peri-appendiceal tissue. There was an absence of morphologically well-defined, neoplastic epithelial cells in the mucinous pool, thus excluding the diagnosis of pseudomyxoma peritonei. The problem of reactive mesothelial cells, which at places look like epithelial cells, was solved by a panel of immunohistochemistry. The localized mucinous ascitis possibly have originated from the mucinous metaplasia of the mesothelial lining cells of the peritoneum, secondary to recurrent attacks of appendicitis.

A Decade of Laparoscopic Appendectomy: Presentation of 1026 Patients with Suspected Appendicitis Treated in a Single Surgical Department

The laparoscopic approach for suspected appendicitis is increasingly gaining acceptance. Nevertheless, the discussion on its safety, efficacy, indications, and diagnostic accuracy remains open. During the decade 1993-2003, 1026 patients with suspected appendicitis were approached by laparoscopy. Sixty-three patients (6.1%) had chronic recurrent symptoms. Data were collected retrospectively and analyzed. There were 587 female and 439 male patients. Fertile women were compared to all other patients with respect to the diagnostic accuracy of laparoscopy. Conversion rate was 0.55%. Median operating time was 26 minutes. Overall complication rate was 5.7%, consisting mostly of minor complications. There were no major intraoperative complications. Wound infections and intra-abdominal abscesses were reviewed separately and were 1.1% and 0%, respectively. Diagnosis could be established via laparoscopy in 89% of all patients, 85.4% of fertile women, and 93.1% of patients except fertile women. A median of 4 minor analgesics and 2 narcotics were required after surgery. The median time until bowel movements, intake of solid food, and the median length of hospital stay were 24, 48, and 30 hours, respectively. Patients returned to normal activity after a median of 7 days. There was no mortality. There was 1 reoperation. Follow-up lasted 4 weeks. Laparoscopic appendectomy is a well-justified procedure in the treatment of acute and chronic appendicitis. If there is enough experience, patients can profit from a higher diagnostic accuracy, quicker return of bowel habits, less postoperative pain, shorter hospital stay, and a faster return to normal activities than is reported for the open procedure. Especially, fertile women can profit from these advantages. This abstract has been presented as a poster in the SAGES Conference 2004.

Ultrasound study of "acute appendicitis," an elective procedure or obligation in general surgery. A prospective study

576 patients admitted for suspected acute appendicitis were prospectively assessed by sonography following physical examination. The collective comprised - as proven by operation - 156 patients with acute appendicitis, 178 patients with chronic appendicitis or mesenteric lymphadenitis, as proven by observation, 186 patients suffering from gastroenteritis. 56 patients suffered from other diseases and 21 of them required urgent surgery. Based on clinical symptoms, correct diagnosis had been made in 433 patients (75%): gastroenteritis n = 186, chronic appendicitis or lymphadenitis n = 111 and acute appendicitis n = 136 (87%). In 123 patients the diagnosis was false positive, in 20 patients false negative. Based on sonographic assessment, 537 patients (93%) were correctly diagnosed; thus, in 129 patients (83%) an inflamed appendix was confirmed, in 56 patients; diagnosis of unrelated entities requiring urgent surgery correct in 21 cases. In 12 patients with mesenteric lymphadenitis - as proven by operation-a false positive, in another 27 patients with acute appendicitis a false negative diagnosis was made. The combination of clinical assessment and sonographic diagnosis yielded a correct diagnosis in 97% (560/576) comprising 414 true negative and 146 true positive results (94%) in respect of acute appendicitis.

Retroperitoneal Necrotizing Fasciitis Secondary to Ruptured Appendicitis-Two Cases Report

Appendicitis is a common disease of acute abdomen, and retroperitoneal necrotizing fasciitis (RNF) which means infection involved the retro peritoneal space is the relatively rare and fatal complications reported so far as we know. We present two cases affected by RNF due to perforated appendicitis and review the related literatures to identify the possible mechanism, risk factors and therapeutic strategies. The first patient was transferred to our hospital due to RNF after open appendectomy for acute ruptured appendicitis. The other case is a type 2 DM patient and has been bothered by obstinate abscess formation over right flank for a long period of time. Chronic appendicitis complicated with RNF was diagnosed finally although no abdominal symptoms were associated with it. Both of them received surgical and medical therapy, and has no recurrence after our treatment. In conclusion, immunocompromised status and intra-abdominal comorbidities are high risk factors. Both of the acute and chronic appendicitis may result in the lethal necrotizing fasciitis spreading along the retroperitoneal space similarly. Early and prompt wide debridement, broad-spectrum antibiotic therapy, constructive resuscitation, and prevention of nosocomial infection may improve the survival rate.

Der chronische Bauchschmerz aus Sicht des Chirurgen - Nur Konsiliarius für „Problemfälle”?

Patienten mit chronischen Bauchschmerzen stellen den Chirurgen oftmals vor eine große Herausforderung. Meist haben sie bereits eine lange Leidensgeschichte mit unzähligen Untersuchungen bei verschiedenen Fachärzten hinter sich, bevor sie dem Chirurgen vorgestellt werden. Mittels invasiver Verfahren soll nun die Diagnostik erweitert und je nach Möglichkeit eine Therapie angeboten werden. Zu den häufigsten Krankheitsbildern mit dem Leitsymptom der chronischen Bauchschmerzen gehören neben dem Morbus Crohn, der chronischen Pankreatitis oder der chronischen mesenterialen Ischämie auch kontrovers diskutierte Diagnosen wie Adhäsionsbeschwerden oder die chronische Appendizitis. Im Folgenden wollen wir einen kurzen Überblick über diese Krankheitsbilder und deren chirurgische Behandlungsmöglichkeiten geben.

Beyond acute inflammation: a review of appendicitis and infections of the appendix

Although the appendix is the most commonly resected and examined intra-abdominal organ, the pathogenesis and aetiology of acute non-specific appendicitis (the commonest diagnosis made in the appendix) remains enigmatic. This review encompasses the pathology and diagnosis of acute non-specific appendicitis, as well as controversial issues such as the diagnosis of chronic appendicitis, the implications of granulomatous appendicitis, and the significance of a morphologically unremarkable appendectomy specimen in the clinical context of appendicitis. The pathological features, pertinent diagnostic techniques, and clinical significance of several specific bacterial, viral, fungal, and parasitic infections affecting the appendix are presented, including adenovirus, cytomegalovirus, Yersinia species, Actinomyces, Mycobacteria species, Histoplasma, Enterobius vermicularis, schistosomiasis, and Stronyloides stercoralis.

Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic right lower-quadrant pain

It is questionable whether elective appendicectomy can effectively reduce persistent or recurrent right lower-quadrant abdominal pain due to chronic or recurrent appendicitis. This single-centre double-blind randomized clinical trial studied the effects of elective laparoscopic appendicectomy on pain 6 months after operation in patients with persistent or recurrent lower-quadrant pain. A secondary outcome evaluated was the relationship between clinical response and appendiceal histopathology. The analysis was performed on an intention-to-treat basis. Forty patients were randomized to laparoscopic appendicectomy (18) or laparoscopic inspection only (22). Postoperative pain scores differed significantly between the groups, favouring appendicectomy (P = 0.005). Relative risk calculations indicated that there was a 2.4 (95 per cent confidence interval (c.i.) 1.3 to 4.0) times greater chance of improvement in pain after laparoscopic appendicectomy. The number needed to treat was 2.2 (95 per cent c.i. 1.5 to 6.5). There was no association between postoperative pain scores and histopathology findings. Persistent or recurrent lower abdominal pain can be treated by elective appendicectomy with significant pain reduction in properly selected cases. Histopathology may not be abnormal. ISRCTN48831122 (http://www.controlled-trials.com).

Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths?

To examine the role of coprostasis and coproliths in recurrent appendicitis. We evaluated four hundred and twenty seven consecutive pathology reports of all appendectomy specimens from January 2003 to December 2004. Findings were categorised as showing acute appendicitis, acute recurrent appendicitis, subacute recurrent appendicitis, chronic appendicitis, or appendices without inflammation. All patients had presented with acute right lower quadrant pain. In 94 instances, there was a history of recurrent similar episodes in the past. Of the 427 histology reports, 294 were inter-preted as showing acute appendicitis, 56 acute recurrent appendicitis, 34 subacute recurrent appen-dicitis, 28 chronic appendicitis, and 15 non-inflamed appendices. Coprostasis was observed in 58 patients (13.58%) and the presence of coprolith in 6 (1.4%). Coprostasis, and age, were among the predictors in the final model. Coprostasis but not coproliths seems to be a contributing factor to acute exacerbations of chronic inflammatory appendicitis.

The Expression Patterns of Peritoneal Defensins

Local defense mechanisms are important for the integrity of the peritoneum, but few details are known about the expression patterns of antimicrobial proteins such as human defensin in normal and damaged peritoneum. Part A: The expression of different defensins in normal (n = 12), inflamed (n = 5), and metastatic peritoneum (n = 4) and in cultured human peritoneal mesothelial cells was analyzed using mRNA and immunohistochemistry. Part B: Using immunohistochemistry the expression of different defensins was analyzed in different subgroups: healthy controls (n = 25), patients with chronic appendicitis (n = 25) or acute appendicitis (n = 10), and end-stage renal disease patients (n = 25, with 15 on peritoneal dialysis). Part A: Human neutrophil peptides (HNP) 1 and 3 and human beta-defensins (HBD) 1 to 3 mRNA were detected in peritoneal specimens. In addition, HNP1,3, HBD1, HBD2, and HBD3 proteins were detected using immunohistochemistry. Part B: HBD1 showed a constitutive expression in mesothelium, while HBD2 and HNP1,3 were associated with inflammation. Decreased expressions of HNP1,3 were observed in end-stage renal disease patients and in patients on peritoneal dialysis. For the first time, the expression patterns of defensins in normal and damaged peritoneum have been described. The reduced expression of some defensins in end-stage renal disease is of potential clinical interest against the background of the frequent infective complications seen in peritoneal dialysis.

Laparoscope hepatectomy for hepatic hemangioma: a report of 18 cases

To evaluate the feasibility and practicality of laparoscopic hepatectomy for hepatic hemangioma. Candidate for laparoscopic liver resection were 18 cases of hepatic hemangioma from January 2002 to October 2006. The portal bloods stream was blocked by the laparoscope portal blood blocker. The Electric-cautery and ultracision were used for liver transection. Operative procedures included anatomical left hepatectomy in 2 cases, non-anatomical left hepatectomy 1 case, left lobectomy 5 cases, local liver resection 10 cases. Two cases of hepatic hemangioma associated with gallbladder stone were performed cholecystectomy synchronously, 1 case associated with chronic appendicitis were performed appendectomy synchronously. Laparoscopic left liver resection was successfully performed in all 18 cases. The operative duration was (185.4 +/- 55.7) min. The quantity of blood lost during the operation was (416.2 +/- 128.8) ml. The postoperative recovery was smooth and good. No critical complications occurred. The duration for hospitalization was (6.2 +/- 1.0) d. Laparoscope hepatectomy for hepatic hemangioma is safe and feasible.

Laparoscopic versus open appendectomy in patients with chronic appendicitis

To compare the advantages and disadvantages of laparoscopic versus open appendectomy in patients with chronic appendicitis. Two hundred twenty- four patients were divided into laparoscopic group (n=98) and open appendectomy group (n=126) according to individual willing. Prospective non- randomized study was performed to compare the operative time, operative bleeding, hospitalization time, the discovery and management concerned in operation. Abdominal pain in these chronic appendicitis cases was followed up. The operative time was (54.8+/-21.8) min in open group and (51.8+/-18.0) min in laparoscopic group (t=0.80,P > 0.05). The operative bleeding was (18.6+/-23.3) ml in open group and (9.8+/-4.7) ml in laparoscopic group (t=3.13, P < 0.05). The hospitalization time was (8.9+/-5.3) d in open group and (6.8+/-3.0) d in laparoscopic group (t=2.66,P < 0.05). Twenty- five cases had abdominal adhesion in laparoscopic group, including 9 cases of adhesion around appendix, 6 cases of adhesion between ileocecum and anterior or lateral abdominal wall, 4 cases of adhesion between epiploon and abdominal wall or intestines, 6 cases of adhesion around colon and others. All adhesion had been dissected. Fourteen cases adhesion around appendix had been discovered in 126 cases of open group and dissected (chi(2) =7.95,P < 0.05). In follow- up research, 24 cases still had chronic abdominal pain in 98 case of open group, and 9 cases had chronic abdominal pain in 87 of laparoscopic group, the difference was significant (chi(2)=6.29,P < 0.05). The laparoscopic appendectomy possesses more advantages in treating chronic appendicitis and can decrease the incidence of chronic abdominal pain after operation.

Peritoneal Mast Cells in Peritoneal Dialysis Patients, Particularly in Encapsulating Peritoneal Sclerosis Patients

We assumed that increased mast cell numbers contribute substantially to the fibrosis often seen in the peritoneum of peritoneal dialysis (PD) patients, particularly those with encapsulating peritoneal fibrosis (EPS). Therefore, we investigated mast cells in different pathological conditions of the peritoneum. One hundred fifteen tissue probes with different peritoneal pathological states were selected (normal, n = 20; chronic appendicitis, n = 25; herniotomy, n = 24; fibrosis, n = 11; PD, n = 26; and EPS, n = 9). For staining of mast cells, we used alpha-naphtol-AS-d-chloracetate-esterase and mast cell tryptase. Next, we counted numbers of mast cells per square millimeter. Tryptase was measured by using image analysis. Measurements by means of both methods correlated well (r = 0.812). Numbers of mast cells per square millimeter were as follows: normal, 26 +/- 16; chronic appendicitis, 241 +/- 217; herniotomy, 115 +/- 88; fibrosis, 99 +/- 66; PD, 81 +/- 64, and EPS, 24 +/- 23 (P = 0.00006). Amounts of tryptase present were 2.900 +/- 0.118, 2.871 +/- 0.150, 2.733 +/- 0.183, 3.041 +/- 0.176, 2.780 +/- 0.184, and 2.609 +/- 0.234, respectively (P = 0.00002). We found upregulation of mast cells in specimens of chronic inflammatory diseases of the peritoneum. This also was true for PD patients, with the exclusion of patients with EPS. Therefore, loss-of-control functions of mast cells may contribute to the ill-understood disease entity of EPS.