Intraperitoneal Instillation Research Articles

Limited Epithelial Carcinoma of the Ovary Treated with Curative Intent by the Intraperitoneal Instillation of Radiocolloids

Limited Epithelial Carcinoma of the Ovary Treated with Curative Intent by the Intraperitoneal Instillation of Radiocolloids

Action of cytosine arabinoside on human tumor cells isolated from malignant effusions: in vitro phosphorylation and inhibition of DNA synthesis.

Tumor cells were isolated from malignant effusions of three patients with disseminated solid tumors of different origin. Intracellular accumulation of nondiffusible cytosine arabinoside (ara-C) nucleotides was used to measure phosphorylation. Mouse leukemia L 1210 and L 1210/CA, and ara-C-resistant subline, were used as reference cells. Phosphorylation activity was similar in the cells from all three solid tumors and showed a linear increase with drug concentrations of 0.1--100 micograms/ml. In contrast to activity in L 1210 cells, the in vitro activity was not saturable at drug levels up to 100 micrograms/ml. Ara-C inhibited the incorporation of thymidine into DNA 84%--90% in the solid tumor cells at a concentration of 10 micrograms/ml. Higher drug concentrations did not result in further inhibition. In one patient, DNA synthesis of tumor cells isolated before and after intraperitoneal instillation of 1,000 mg ara-C was measured. The in vivo inhibition was found to correspond to the in vitro data. Solid tumor cells isolated from malignant effusion have no greatly reduced capacity for cellular formation of ara-C/nucleotides, but higher drug levels than achieved with conventional therapy are necessary for sufficient ara-C nucleotide synthesis.

Limited epithelial carcinoma of the ovary treated with curative intent by the intraperitoneal instillation of radiocolloids

Limited epithelial carcinoma of the ovary treated with curative intent by the intraperitoneal instillation of radiocolloids

Septic induced acute gastric erosions: The role of cimetidine

A reproducible septic canine model closely akin to the clinical situation has been developed. Intraperitoneal instillation of four different bacteria plus canine gall bladder bile led to bacterial peritonitis, septicemia, and bleeding acute fundic gastric mucosal erosions. Intraperitoneal instillation of normal saline did not cause septicemia and acute gastric erosions did not develop. In this model oral cimetidine prevented the development of septic induced acute erosions, even though in these animals blood cultures were positive and bacterial peritonitis was present.

Hemodynamics of increased intra-abdominal pressure: Interaction with hypovolemia and halothane anesthesia.

The hemodynamic interaction of acute hypovolemia and halothane anesthesia in dogs with increased intra-abdominal pressure caused by intraperitoneal instillation of N2, N2O and CO2 was studied. During normovolemia and just basal pentobarbital anesthesia, the response to increase of intra-abdominal pressure to 40 torr consisted of a 35 per cent decrease in cardiac output, which was equal to the decrease in magnitude of inferior vena caval blood flow. During basal pentobarbital anesthesia, the addition of halothane anesthesia (1 MAC) in combination with hypovolemia (15 per cent blood volume loss) depressed the pre-inflation cardiac output more than addition of halothane anesthesia alone or induction of hypovolemia alone. During each of these conditions, superimposition of increased intra-abdominal pressure to 40 torr caused a further 26-43 per cent decrease in cardiac output compared with the pre-inflation value. Therefore, the greatest cardiovascular depression occurred when the animals were both hypovolemic and anesthetized with halothane. There was no difference in the responses to increased intra-abdominal pressure with the different inflating gases at any time. These findings indicate that in the presence of halothane anesthesia or hypovolemia, induction of pneumoperitoneum may cause severe cardiovascular depression.

Effect of noxythiolin on experimental peritonitis

The intraperitoneal instillation of noxythiolin in the treatment of peritonitis is widespread in clinical practice despite contradictory evidence as to its efficacy. In this light the value of noxythiolin was reappraised by studying its effect in guinea-pigs and mice with induced bacterial peritonitis. Treatment with a 1% solution of noxythiolin reduced the mortality rate of mice by 14% (P less than 0.1). The guinea-pig model proved unreliable giving inconsistent mortality rates throughout. Further studies are required to determine the optimum dose and concentration of noxythiolin while the search for more effective intraperitoneal antiseptics should continue.

Individualized treatment of ovarian cancer

During the years 1968 to 1974, 418 patients with Stage I and Stage II malignant epithelial tumors of the ovary entered a controlled clinical trial. The purpose was to compare the results of postoperative external irradiation with intraperitoneal instillation of radioactive colloidal gold (Au198). The Stage I series comprised 175 invasive carcinomas and 83 tumors of low potential malignancy. The Stage II series comprised 160 invasive carcinomas and five cases of potentially malignant tumors. No significant difference in the five-year survival rate was found for the patients with Stage I lesions. A lower number of cancer deaths among those treated with Au198 was outweighed by a higher number of deaths from complications. However, patients with Stage IA serous and mucinous tumors, Stage IB and IC tumors (all histologic types), and ruptured tumors did significantly better when treated with Au198. The five-year survival rate for patients with Stage II lesions treated with gold was 54.1 per cent as compared to 40.0 per cent for those receiving external irradiation. In agreement with these observations, a new treatment protocol is proposed which includes a randomized trial to study the value of adjuvant chemotherapy.

Antibiotic concentrations in ascitic fluid of patients with ascites and bacterial peritonitis.

Thirty-six paired specimens of serum and ascitic fluid from 21 patients with peritonitis and ascites, most with sponetaneous bacterial peritonitis and alcoholic cirrhosis, were assayed for antibiotic content. Antibiotics assayed and number of determinations were gentamicin, 14; tobramycin, 7; ampicillin, 5; clindamycin, 3; penicillin G, 2; cephalothin, 2; chloramphenico, 2; and cefazolin, 1. In 31 pared specimens the ascitic fluid antibiotic concentration was about one half or more of the simultaneous serum level and in 17 assays exceeded 90% of the serum level. All antibiotics studied penetrated ascitic fluid equally well. Clinical response to antibiotic therapy was good in 12 of 16 patients with culture-proven bacterial peritonitis. Antibiotic levels in ascitic fluid exceeded the minimal inhibitory concentration of the infecting organisms in all but one patient who responded. Direct intraperitoneal instillation of antibiotics does not appear to be necessary routinely; however, there may be an initial lag of several hours before antibiotic concentrations is ascites achieve therapeutic levels.

Serosal hypofibrinolysis: A cause of postoperative adhesions

1. 1. Fibrinolytic activator activity is present in canine and human gastrointestinal serosa and is decreased after trauma. 2. 2. Massive adhesion formation occurred when the serosal fibrinolytic activity was decreased at least 50 per cent. 3. 3. Intraperitoneal urokinase was effective in preventing adhesions in 80 per cent of the animals. 4. 4. No wound healing or anastomotic difficulties were encountered and there were no hemorrhagic complications from the intraperitoneal instillation of urokinase.

Use of 99m technetium-sulphur colloid scan prior to intraperitoneal instillation of radioisotopes for therapy purposes.

In recent articles, Ellis, Paine, Hall and Shearn (1968) and Ellis and Paine (1969) discussed the use of radioactive gold (198Au) colloid in the treatment of peritoneal metastases or prophylactically following the rupture of malignant ovarian cysts. Their technique employed the instillation of 200 ml. of carbon dioxide into the peritoneal cavity to assess the uniformity of distribution that could be expected. The gas, if free flowing, would indicate no obstruction to the subsequent instillation of 198Au colloid and it would be presumed that no abnormal loculation of the instilled radiopharmaceutical would occur. No confirmation of the uniformity of distribution was obtained post-instillation.

Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is now the gold standard technique for the treatment of gallstones disease. Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort during the first 24 to 72 postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following laparoscopic cholecystectomy. Fifty patients undergoing elective laparoscopic cholecystectomy were consecutively included in this study and sample was divided into two groups. Following removal of gallbladder, Group A received 20 ml of 0.25% bupivacaine instilled in the right sub diaphragmatic space and 20 ml of 0.25% bupivacaine in divided doses at the trocar sites. The evaluation of postoperative pain was done at fixed time interval according to the numerical verbal scale and the dosage of narcotic analgesics consumed was also recorded. Mean pain scores at 6 hours and at 12 hours after surgery were 6.02 and 4.72 respectively, in the bupivacaine group compared with 8.44 and 6.08 respectively in the control group (p= <0.001 and <0.001). However, pain scores at 24 hours and 48 hours postoperatively and incidence of shoulder tip pain did not differ significantly between the two groups. The mean total narcotic analgesics used in study group was 1.91 as compared to 2.50 in the control group respectively and was found to be statistically significant (p= <0.001). Infiltration of bupivacaine in to port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective laparoscopic cholecystectomy. DOI: 10.3329/medtoday.v22i1.5601 Medicine Today Vol.22(1) 2010. 24-28

Routine use of radiogold following operation for ovarian cancer

Seventy-four patients with malignant ovarian neoplasm have been treated at two Portland hospitals by the combined use of definitive surgery and intraperitoneal radioactive gold instillation over an 11 year period. Fifty-two of these patients have been followed from 3 to 11 years. The over-all survival rates are 43.9 per cent. A survival rate of 75 per cent was obtained in Class IIB, but in the presence of far-advanced lesions (Class IV) there were no survivors. Prevention or relief of ascites formation was accomplished in 84.3 per cent of patients who died. Complications from the use of gold in our hands have been mild and transient. While other methods of treatment, such as chemotherapy, have recently appeared, none seemed to have any great advantage over the combination of surgery and routine radiogold.

Continuous antibiotic irrigation in the treatment of infection.

Certain experimental and clinical observations indicate that the local use of antibiotics may be more effective in some situations than their systemic administration. Poth, for example, showed that when neomycin was added to a 10% suspension of human feces no bacteria could be cultured.¹Furthermore, if mice were inoculated intraperitoneally with 1 cc. of 10% human feces none survived, while in contrast, all survived if neomycin were given intraperitoneally within 1 hour of the fecal injection. Poth also demonstrated that the instillation of neomycin solution is effective in sterilizing the human intestinal tract within 30 minutes. Sterilization of peritoneal fluid has also been noted following intraperitoneal instillation of antibiotics in patients with acute bacterial peritonitis secondary to perforation of the gastrointestinal tract.² Because of these considerations antibiotics have been used intraperitoneally by us and our associates for several years in patients with peritoneal contamination and in patients undergoing

The effect of fibrinolysin and heparin on the formation of peritoneal adhesions.

T he problem of postoperative peritoneal adhesions is still unsolved, despite many advances in clinical surgery. In one postmortem study,s 90 per cent of patients with previous abdominal surgery were found to have peritoneal adhesions. Though most adhesions do not result in clinical morbidity, their role as a cause of small bowel obstruction (about 30 per cent)20 is well recognized. In those unfortunate patients who have multiple episodes of mechanical ileus and are subjected to repeated lyses of recurrent adhesions, surgery often seems to aggravate rather than alleviate the disease. Many methods of treatment based on varied concepts of the pathogenesis of adhesion formation have been investigated in experimental animals and in patients. Most have been directed at inhibiting or counteracting some phase in the organization of adhesions. These include the use of (1) membranes applied to abdominal viscera, (2) the intraperitoneal instillation of gases, lubricants, solutions of varying tonicity, and peptones, (3) methods to enhance intestinal peristalsis, (4) the instillation of enzymes such as pepsin, trypsin, and papain, and, finally, (5) amniotic fluid

Intraperitoneal neomycin as a cause of apnea.

Since the discovery of neomycin by Waksman in 1949,¹this antibiotic has been found useful in the prophylaxis and treatment of intra-abdominal infections. Poth²and others^3,4demonstrated the effectiveness and safety of neomycin sulfate used orally as an intestinal antiseptic prior to bowel surgery. More recently, intraperitoneal instillation has been advocated in the treatment of peritonitis.^5,6Neomycin has also been given as prophylaxis against the complications associated with soilage of the peritoneal cavity. Pridgen⁷in 1956 and Engel et al.⁸in 1957 each reported four cases of respiratory arrest associated with neomycin administered intraperitoneally. Another case is reported in the case section of the<i>American Society of Anesthesiologists' Newsletter.</i>⁹Ferrara et al.,¹⁰Webber,¹¹Middleton et al.,¹²and Doremus¹³reported six additional cases. At this time we are aware of 16 patients including the one presented in this paper who

Results of capillary fragilometry, and changes in blood coagulation after intraperitoneal instillation and marbadal

Results of capillary fragilometry, and changes in blood coagulation after intraperitoneal instillation and marbadal