Peritoneal Fluid Analysis Research Articles

Acute Renal Failure in a Calf

Acute Renal Failure in a Calf In this case report, hemotologic, biochemical, blood gases, urinalysis and peritoneal fluid analysis were evaluated in a four months old simmental calf which was referred to the internal medicine clinic. Creatinin and urea concentrations were increased in serum and peritoneal fluid analysis, dansity was decreased in urine analysis. A defect was detected compatible with ruptur in bladder. In the present case report, acute renal failure related with postrenal obstruction due to a suspected a urolith was discussed

Spiral colon impaction in juvenile alpacas: 12 cases (2006–2010)

To describe clinical signs and treatment outcomes for juvenile alpacas with spiral colon impaction (SCI). Retrospective case series. Animals-12 juvenile (< 6 months old) camelids with SCI. Crias with SCI were identified by searching the medical records database of the Cornell University Equine and Farm Animal Hospital. A keyword-based search method was used. Inclusion required confirmation of SCI on the basis of surgical or necropsy findings. History, signalment, examination findings, diagnostic test results, medical treatments, and surgical reports as well as short- and long-term outcomes were reviewed. Peritoneal fluid parameters were compared with those of age-matched comparison crias in which SCI was suspected but ruled out at necropsy or exploratory celiotomy. 12 crias with confirmed SCI were identified. Common clinical signs included lethargy and diarrhea. Abdominal distention was observed in 9 crias. In 3 crias, a mass in the region of the spiral colon was palpated. Seven crias underwent peritoneal fluid analysis; compared with age-matched comparison crias, SCI-affected crias had higher peritoneal fluid nucleated cell counts and nucleated cell count-to-total protein concentration ratios. A ventral midline celiotomy was performed in 9 crias; 7 underwent an enterotomy, and 2 underwent transmural infusion of saline (0.9% NaCl) solution with manual breakdown of ingesta; 3 of these crias survived for at least 6 months. Crias with SCI that were not resolved by medical management had a poor prognosis. During celiotomy, transmural infusion of saline solution with manual breakdown of ingesta provided a less invasive alternative to enterotomy.

Serum amyloid A and haptoglobin concentrations in serum and peritoneal fluid of healthy horses and horses with acute abdominal pain

Peritoneal fluid (PF) analysis is a valuable diagnostic tool in equine medicine. Markers such as serum amyloid A (SAA) and haptoglobin (Hp) could facilitate the diagnosis of inflammatory abdominal conditions. The objectives were to (1) establish reference intervals (RI) for SAA and Hp in serum and PF in healthy horses, (2) compare SAA and Hp concentrations between healthy horses and horses with colic, and (3) to assess the correlation between serum and PF concentrations. Serum amyloid A and Hp concentrations were determined by automated assays in prospectively enrolled healthy reference horses and horses with colic. RIs were calculated, group concentrations were compared by Student's t-test, and Pearson's correlation for serum and PF concentrations were determined. In healthy horses (n = 62) the measurements for SAA were below the detection limit (0.5 mg/L) in 94% of serum samples and 98% of PF samples. Horses with colic (n = 61) had statistically significantly increased SAA concentrations in serum (P < .0001) and PF (P = .0013). While PF Hp concentrations were increased in horses with colic the serum concentrations of Hp were decreased (P < .0001). There was a strong correlation between paired serum and PF SAA concentrations (n = 94, R = .72, P < .0001), whereas the correlation between paired serum and PF Hp was weak (n = 94, R = .22, P = .0382). Finally, horses with colic tended to have serum SAA and PF Hp concentrations above the RIs. With the apparent difference between healthy horses and horses with colic and the presently established RIs, serum SAA and PF Hp concentrations represent potential valuable diagnostic markers for inflammatory abdominal conditions in that species.

Chylous Ascites and Chylothorax as Presentation of a Systemic Progression of Discoid Lupus

We describe a patient with a history of discoid lupus erythematosus who presented with chylous ascites and chylothorax. Analysis of peritoneal and pleural fluid showed a high level of triglycerides and the presence of antinuclear antibody and anti-dsDNA antibody. Further study revealed other diagnostic criteria for systemic lupus erythematosus and serologic markers of disease activity. The patient was successfully treated with methylprednisolone pulse therapy and high doses of prednisone, followed by immunosuppressants.

Evaluation of the Fully Automated Hematological Analyzer Sysmex XE-5000 for Flow Cytometric Analysis of Peritoneal Fluid

Although microscopy still represents the gold standard for cytometric analysis of peritoneal fluids, automated flow cytometry may improve throughput and accuracy. We evaluated the performance of total nucleated cell (TNC), white blood cell (WBC), polymorphonuclear cell (PMN), and mononuclear cell (MONO) counts of Sysmex XE-5000 on peritoneal fluids. The imprecision was excellent, being always lower than 11%, whereas linearity studies yielded correlation coefficients of 1.00 for all parameters. The carryover was always lower than 0.2%. The comparison between XE-5000 and microscopic analysis of 117 ascitic fluids yielded correlation coefficients always greater than 0.96, with mean biases <11/µL. The diagnostic accuracy versus manual microscopy was greater than that of XE-2100, especially at thresholds for septic ascites (100 versus 98% for ≥500 WBC/µL; 98 versus 93% for ≥250 PMN/µL). The correlation with manual microscopy for macrophages and mesothelial cell count was also higher for XE-5000 than for XE-2100 (0.63 versus 0.55). The results of this evaluation show optimal performance of XE-5000 for routine analysis of ascitic fluids, which are combined with the advantages of automated analysis such as high throughout, shortened turnaround time, no need of sample preparation and trained staff, reduced sample volume, and less likelihood of transcriptional errors.

Eosinophilic Enteritis with Eosinophilic Ascites without Eosinophilia

Eosinophilic enteritis is an uncommon disease of unknown cause characterized by eosinophilic infiltration in various areas of the gastrointestinal tract with symptoms. It is generally classified according to the layer of the gastrointestinal tract involved. Eosinophilic infiltration of the serosa is the rarest form of presentation and may manifest eosinophilic ascites. We report a case of a 47-year-old man who experienced progressing abdominal pain. A diffuse erythematous change of the gastric mucosa was observed on gastrofibroscopy. An abdominal computed tomography and colonoscopy showed diffuse wall thickening of the small bowel and colon with a small amount of ascites. Eosinophilic infiltration was confirmed by multiple biopsies of the gastrointestinal tract and peritoneal fluid analysis. The patient was treated with corticosteroid and responded

INDICADORES BIOQUÍMICOS SÉRICOS E DO LÍQUIDO PERITONEAL DE EQUINOS SUBMETIDOS À OBSTRUÇÃO INTESTINAL

Twenty-four horses were distributed into four different groups, instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII) and large colon obstruction (GIV). Serum and peritoneal fluid analysis of aspartate aminotransferase, creatine kinase, lactate dehydrogenase, alkaline phosphatase, inorganic phosphorus and lactate were measured. Samples were collected one hour before the surgical procedure (T0); 3 hours after the obstruction (T3ob), 1, 3, 12, 24, 120 and 168 hours after the beginning of reperfusion/deobstruction. Duodenal (GII) and ileum (GIII) obstructions changed serum and peritoneal fluid biochemical analysis. However, only lactate, lactate dehydrogenase, creatine kinase and inorganic phosphorus concentrations were abnormal in peritoneal fluid three hours after the obstruction. The biochemical analysis of peritoneal fluid allowed a faster diagnostic of intestinal alterations than the serum analysis; hence it should be prioritized when pre-operatory colic assessment is carried out. KEYWORDS: biomarkers; colic; equine.

A Ruptured Hepatoma in a Non-cirrhotic Patient with Chronic Inactive Hepatitis B

Case Presentation: A 77-year-old male with no prior history of liver disease presented with an acute onset of diffuse abdominal pain. He had no history of illicit drug use, tobacco, or recent alcohol use. Laboratory studies were normal. A large liver mass with findings consistent of hemoperitonium was seen on CT scan. Peritoneal fluid analysis was negative for malignant cells. Hepatitis viral serologies showed positive Hepatitis B surface Antigen (HBsAg), negative Hepatitis B surface Antibody, positive Hepatitis B core antibody, negative Hepatitis B e-Antigen (HBeAg), positive Hepatitis B e-Antibody (HBeAb), and undetectable Hepatitis B virus DNA. Other serologies were negative. Serum alphafetoprotein was within normal limits. A partial hepatectomy was performed. Pathology confirmed hepatocellular cancer (HCC) in a background of a non-cirrhotic liver. Discussion: • Cirrhotic liver disease is the leading cause of primary HCC. • More than 20,000 new cases are diagnosed each year in the United States alone. • Worldwide 50% of patients diagnosed with HCC have chronic hepatitis B infection with 70-80% having underlying cirrhosis. •A direct correlation between HBV viral load and risk of developing HCC has been illustrated. •Patients with inactive or active chronic HBV have a higher incidence of HCC than the general population. •A positive HBsAG and HBeAg puts patients at higher risk when compared to patients positive for HBsAg with a negative HBeAg. • Patients with inactive HBV who consume alcohol habitually have been shown to have an increased risk of progression to HCC. • Later age of seroconversion from HBeAg to HBeAb has also been found to be directly correlated to an increased risk of developing HCC and related death. Conclusion: Though infrequent, the development of HCC in non-cirrhotic patients who are inactive carriers of HBV is still of concern. Several variables increase the risk of HCC in this patient population. Clinical follow-up with laboratory testing and radiographic studies is important, however, the frequency of surveillance in this population is not known.Figure: Abdominal MRI.

Analytical evaluation of Sysmex UF-1000i for flow cytometric analysis of peritoneal fluid

ObjectiveTo evaluate analytical performance of Sysmex UF-1000i for peritoneal fluid analysis. MethodsFunctional sensitivity, imprecision, linearity and comparison studies were performed on peritoneal fluids. ResultsTotal imprecision was 1.6–4.7%, functional sensitivity 27/μL for white blood cell (WBC) and 32/μL for total nucleated cell (TNC) count. Linearity was excellent up to 983cell/μL, carry-over <0.2%, correlation with manual microscopy always greater than 0.992. ConclusionThe instrument exhibited optimal performance at the conventional WBC diagnostic thresholds.

Oil Red O‐positive lipid in peritoneal fluid from a horse with a rectal tear

A 4-year-old Quarter Horse mare was presented to the Texas A&M University Veterinary Medical Teaching Hospital for evaluation of a rectal tear. On initial evaluation, rectal palpation and colonoscopy revealed a grade IIIb rectal tear. Analysis of peritoneal fluid revealed a modified transudate. Preliminary supportive care included fluid therapy and mineral oil administration via nasogastric tube. Approximately 48 hours after presentation, a second abdominocentesis was performed, and cytologic examination of the fluid revealed a marked suppurative exudate. Round clear nonrefractile material observed within neutrophils and macrophages and in the background stained bright pink to red with Oil Red O, confirming the material as lipid, likely from leakage of mineral oil through the rectal tear. The condition of the mare deteriorated and euthanasia was elected due to the poor prognosis. At necropsy, gross and histologic findings included peritoneal effusion and a full-thickness rectal tear with transmural necrotizing pyogranulomatous colitis and fibrinous peritonitis. To the authors' knowledge, this is the first reported case of Oil Red O-positive lipid vacuoles in the peritoneal fluid of a horse from presumed leakage of mineral oil through a transmural rectal perforation. The frequency of this occurrence in horses is unknown, but it is important for cytopathologists to be familiar with the appearance and significance of lipid-type droplets in phagocytic cells in cytologic fluid analysis specimens.

Effects of Aerobic and Anaerobic Fluid Collection on Biochemical Analysis of Peritoneal Fluid in Healthy Horses and Horses with Colic

To determine whether in healthy horses and those with colic, exposure of peritoneal fluid to room air affects values obtained on biochemical analysis. Prospective study. Adult horses with a primary complaint of acute abdominal pain (n=29) and 12 healthy horses. Peritoneal fluid was aseptically collected under aerobic and anaerobic conditions. After collection, pH, PCO(2) , PO(2) , HCO(3) (-) , Na(+) , ionized Ca(2+) , K(+) , lactate, and glucose were immediately measured using a commercial blood gas analyzer. Biochemical variables were compared between aerobically and anaerobically obtained samples using a paired t-test. In healthy horses, peritoneal fluid samples collected under anaerobic conditions had higher PCO(2) and ionized Ca(2+) and lower PO(2) , HCO(3) (-) , and pH compared with samples exposed to air. No differences were observed for K(+) , Na(+) , glucose, and lactate. In horses with colic, samples collected anaerobically had higher PCO(2) , ionized Ca(2+) , Na(+) , and glucose and lower PO(2) , HCO(3) (-) , and pH value compared with samples exposed to air. No differences were observed for K(+) and lactate. Exposure of peritoneal fluid to room air had a significant effect on pH, PCO(2) , PO(2) , and variables associated or dependent on changes in pH such as HCO(3) (-) and ionized Ca(2+) . Interpretation of biochemical analysis of peritoneal fluid may be influenced by sample collection method.

Proteomic analysis of peritoneal fluid of patients treated by peritoneal dialysis: effect of glucose concentration

Depending on both membrane composition and solute transport rate across the membrane, protein composition of the dialysate of patients receiving peritoneal dialysis (PD) has recently become of great interest. Unfortunately, thus far few studies have focused on dialysate characterization, and further investigations are required to better understand the biological mechanisms influencing PD efficiency. Different classical proteomic approaches were combined with advanced mass spectrometric (MS) techniques to analyse peritoneal fluid (PF) protein composition of adult patients receiving PD. Characterization was performed by using 1D gel electrophoresis combined with nano-RP-HPLC-ESI-MS/MS and shotgun proteomics, while comparative analyses were performed coupling 2D gel electrophoresis with MALDI-TOF MS. The study allowed the identification of 151 different proteins from PF, which are mainly of plasmatic origin. Comparison of PD effluents characterized by different glucose concentrations demonstrated four proteins (apolipoprotein A-IV, fibrinogen beta chain, transthyretin and alpha-1-antitrypsin) to be under-expressed in the highest osmolar solution having 4.25% compared to others having 1.5% and 2.5% glucose. All of them were found to be involved in the inflammatory processes. This study provides a possible platform for future diagnostic and therapeutic applications in the field of PD and allowed the identification of potential targets to be used in preventing inflammatory processes induced by the exposure to dialysis solutions.

Beta-2-Transferrin to Detect Cerebrospinal Fluid Ascites: A Case Report

Purpose: Abdominal ascites is a rare complication of ventriculoperitoneal shunts with few documented case reports. The diagnosis is one of exclusion and a formidable challenge. A 20 year old Caucasian female presented with new onset ascites. Her past medical history was significant for a pinealoblastoma diagnosed at age 5 which was treated successfully with chemotherapy and radiation. She had a ventriculoperitoneal shunt which had been functional for many years without any complications. Physical exam showed moderate ascites but no other signs of chronic liver disease. Initial labs showed normal Bilirubin, CBC, BUN, Creatinine, liver enzymes and prothrombin time. HIV and viral hepatitis serologies were negative. An abdominal US showed normal liver parenchyma. Peritoneal fluid analysis showed a WBC count of 4000 with 60% neutrophils and an albumin of 2.1 gm/dl with a serum ascites albumin gradient less than 1.1. Ascites and CSF fluid cultures including fungal and TB cultures were negative. CA-125 levels were elevated at 6815, but without any evidence of malignancy on CT scans of the chest, abdomen and pelvis, a whole body PET scan and peritoneal fluid cytology. An MRI of the abdomen and pelvis showed moderate ascites with layering of debris material within the fluid, multiple hepatic adenomas, as well as peritoneal and omental thickening. A CT guided omental biopsy showed severe acute inflammation without any evidence of malignancy. Neurosurgery evaluated the patient and deemed her shunt functional. The patient was discharged without a definite etiology for her ascites. Over the next few months she required multiple large volume paracentesis for control of ascites. Fluid analysis showed a gradual decline in WBC count. CA 125 levels also gradually decreased. A Beta-2-transferrin assay was sent on the peritoneal fluid and came back positive. This result along with unexplained refractory ascites pointed to the possibility of VP shunt-induced ascites. The patient underwent conversion to a ventriculo-atrial shunt with subsequent resolution of ascites. This case of recurrent ascites in the setting of a VP shunt demonstrates the use of beta 2 transferrin as a reliable marker for shunt-induced ascites. Beta 2 transferrin is a desialated isoform of the transferrin protein confined almost exclusively to the CSF with the exception of the perilymph of the cochlea and the vitreous humor of the eye. It has been widely studied as a sensitive and specific marker for suspected CSF leakage in the setting of rhinorrhea and otorrhea. For our patient, use of beta 2 transferrin earlier could have prevented extraneous testing and decreased overall hospital costs.

Diagnostic Accuracy of D-Dimer and Other Peritoneal Fluid Analysis Measurements in Dairy Cows with Peritonitis

Peritoneal fluid analysis in cattle traditionally includes the classic parameters despite the fact that they have only moderate diagnostic accuracy and often fail to identify the pathogenesis or etiological factors. Therefore additional parameters recently have been established to improve diagnostic precision. In a recent study, reference ranges for several of these parameters have been proposed in dairy cows. The aim of this observational study was to assess the diagnostic value of D-Dimer and other measurements of peritoneal fluid analysis in dairy cows with peritonitis. The study included 110 Holstein-Friesian cows grouped into cows with peritonitis (n = 47) and cows without peritonitis (n = 63). Peritoneal fluid was obtained by abdominocentesis. Total protein, albumin, glucose, cholesterol, fibrinogen, l-lactate, D-Dimer, lactate dehydrogenase (LDH), alkaline phosphatase, creatine phosphokinase, white blood cell, and red blood cell were determined in peritoneal fluid and venous blood. Serum-ascites albumin gradient (SAAG) and ratios of peritoneal fluid-venous blood were calculated. Sensitivity (SN) and specificity (SP) were calculated and receiver operating characteristic curve analysis performed. Peritoneal fluid D-Dimer was most accurate in diagnosing peritonitis in cows (SN and SP>95.0%). Total protein concentration, LDH and LDH ratio, and SAAG had sensitivities between 49.0 and 67.1%, and specificities between 88.4 and 95.5%. A low-peritoneal fluid glucose concentration was found to be highly indicative of septic peritonitis. Measurement of the recently introduced parameters may increase the diagnostic value of peritoneal fluid analysis and provide additional specific information. Therefore these measurements should be included in the routine procedure.

Peritoneal concentrations of transforming growth factor beta in horses with colic

In man, peritoneal transforming growth factor beta (TGF-beta) is associated with peritoneal diseases and subsequent adhesion formation. No studies on plasma and peritoneal TGF-beta concentrations in horses with colic are available. 1) To determine both plasma and peritoneal TGF-beta(1) and TGF-beta(3) concentrations in horses with different types of colic (not previously subjected to abdominal surgery); 2) to compare these concentrations according to the type of peritoneal fluid (transudate, modified transudate and exudate); and 3) to compare and correlate plasma and peritoneal concentrations of TGF-beta(1) and TGF-beta(3) and the types of peritoneal fluid according to the colic group and outcome. Peritoneal fluid and plasma samples from 78 horses with colic and 8 healthy horses were obtained. Patients were classified according to diagnosis (obstructions, enteritis, ischaemic disorders and peritonitis), peritoneal fluid analysis (transudate, modified transudate and exudate), and outcome (survivors and nonsurvivors). Plasma and peritoneal TGF-beta(1) and TGF-beta(3) concentrations were determined by ELISA. Data were analysed by parametric and nonparametric tests. P< or =0.05 was considered as statistically significant. Concentrations of peritoneal fluid TGF-beta(1) were significantly (P = 0.01) higher in horses with peritonitis in comparison with all other colic groups and controls. Horses with ischaemic lesions had significantly (P = 0.01) higher concentrations of peritoneal TGF-beta(1) in comparison with controls and the group of horses with obstructions. Peritoneal TGF-beta(1) concentration also was significantly (P = 0.01) higher in exudates in comparison with transudates. Peritoneal TGF-beta(1) and TGF-beta(3) concentrations and plasma TGF-beta(1) concentration were significantly increased in nonsurvivors compared to survivors (P = 0.001, P = 0.004 and P = 0.05, respectively). Peritoneal TGF-beta(1) concentration was higher in horses with severe gastrointestinal diseases (ischaemic intestinal lesions and peritonitis), in horses with an altered peritoneal fluid (exudate), and in nonsurvivors. Peritoneal TGF-beta concentration increases in horses with severe gastrointestinal disease as an anti-inflammatory response.

Prognostic significance of lipid peroxide and antioxidant levels in draft horses with peritonitis

To our knowledge, this is the first report describing the oxidant–antioxidant status in horses clinically affected with peritonitis. The present study was carried out to investigate the importance of oxidative stress markers and antioxidant parameters in the prediction of clinical outcomes of peritonitis in draft horses. Thirty-six draft horses were used in this study in the period between March 2006 and March 2009. Diagnosis of the clinical cases was based on the physical examination, clinical pathology, and necropsy. Our results showed that there was a significant increase (p < 0.05) in the level of malondialdehyde (MDA) of nonsurvivors in comparison with that of survivors. There was, however, a significant decrease (p < 0.05) in the activity of superoxide dismutase, catalase, reduced glutathione, vitamin C, and nitric oxide (NO). Analysis of receiver operating characteristic (ROC) indicated a high sensitivity (90%) and specificity (86.71%) of MDA level (p < 0.001) to predict the outcome of peritonitis. Results of peritoneal fluid analysis revealed an abnormal physical appearance with a significant increase (p < 0.05) in total leukocytic counts and total protein levels. In conclusion, our findings might indicate that lipid peroxide levels and antioxidant parameters could have a prognostic significance in draft horses showing peritonitis.

Leaks and endoscopic assessment of break of integrity after NOTES gastrotomy: the LEAKING study, a prospective, randomized, controlled trial

Gastric leak testing after natural orifice transluminal endoscopic surgery (NOTES) gastrotomy closure may help reduce the risk of leaks after transgastric procedures. To develop a novel endoscopy-based system to determine the presence of a leak after NOTES gastrotomy and to compare this system prospectively with radiographic leak testing. Prospective, randomized, controlled trial. Academic Medical Center laboratory. Fifty swine. During the pretrial phase, an endoscopic system for the measurement of intragastric pressure was developed. In the trial phase, swine with a NOTES gastrotomy were randomized to endoscopic versus radiographic leak testing. If a leak was demonstrated, the gastrotomy was reclosed by using a second-generation prototype T-anchor system. The primary outcome was leak detection after gastrotomy closure. The secondary outcome variables included necropsy findings, peritoneal fluid analysis, histologic examination, and clinical outcome. Fourteen swine were included in the pretrial phase and 36 in the randomized trial. Swine were survived for a mean of 9 days postoperatively. Endoscopic pressure monitoring demonstrated a reproducible change in intragastric pressure with insufflation; r = 0.735, P = .001 and r = 0.769, P < or = .000 for the total and maximum pressures, respectively. Post-peritoneoscopy, there was a detectable and significant decrease in the mean total and mean maximum pressures versus baseline (P = .006 and P = .009). There was no significant difference between the radiologic and endoscopic arms in leak detection rate (4/18 vs 3/18, respectively, P = .500). Clinical outcomes and mean weight gain were equivalent. There was 1 operative abdominal wall injury and no deaths. Animal study. Endoscopic pressure monitoring was reproducible, demonstrated the presence of gastric leak, and was as reliable as contrast-based radiographic leak testing.

Cytokine array analysis of peritoneal fluid between women with endometriosis of different stages and those without endometriosis

Cytokines are key mediators of intercellular communication and are likely to promote the development and progression of endometriosis. Previous studies provided evidence that endometriosis develops as a result of the pathogenetic factors in the peritoneal environment, especially the peritoneal fluid (PF). We determined different cytokine expression in peritoneal fluid between women with minimal/mild and moderate/severe endometriosis and those without endometriosis using the cytokine array. As a result, 78 cytokines were found to have a threefold change, including 74 increases and four decreases in endometriosis compared with the control group; 96 cytokines had a threefold change including 91 increases and five decreases in minimal and mild endometriosis compared with the control group; 83 cytokines had a threefold change including 14 increases and 69 decreases in moderate and severe endometriosis compared with minimal and mild endometriosis. The cytokine networks were produced by Pathway Studio software and revealed that most cytokines are involved in cell binding, interaction and protein synthesis and transportation regulation. Among them activin A, Smad7 and β-nerve growth factor are the most interesting as they may be involved in the pathogenesis of endometriosis. These results suggest that cytokines are very important factors in the development of endometriosis. The findings of differentially expressed cytokines improves our knowledge of the pathogenesis and development of endometriosis and these findings warrant further studies to develop potential targets for the diagnosis and treatment of endometriosis.

Natural orifice versus conventional laparoscopic distal pancreatectomy in a porcine model: a randomized, controlled trial

Natural orifice transluminal endoscopic surgery (NOTES) research has primarily involved case series reports of low-risk procedures. Distal pancreatectomy has significant postoperative morbidity and would permit rigorous examination in a controlled trial setting. To compare endoscopic transgastric distal pancreatectomy (ETDP) and laparoscopic distal pancreatectomy (LDP). Prospective, randomized, controlled trial. Academic hospital. Forty-one swine, 28 block randomized. LDP was performed with 3 trocars and stapled transection of the pancreas. ETDP was performed via a gastrotomy, with 1 trocar for visualization, by using endoloop placement, snare transection, and purse-string gastrotomy closure. Clinical examination, CT, serum chemistries, necropsy, peritoneal fluid analysis, and histologic examination. Swine were survived for 8 days. The procedure time for ETDP was significantly greater than for LDP (1:52 vs 0:33 [hours:minutes]; P = .00). Pancreatic specimen weight was similar (4.1 g vs 5.5 g; P = .108). Postoperatively, 26 of 28 animals thrived. In the LDP group, 1 death caused by pancreatic leak and renal failure occurred on day 1. In the ETDP group, 1 death caused by pneumothorax occurred intraoperatively. The necropsy, CT, and histologic examinations revealed focal resection-margin necrosis in 3 to 7 swine in the ETDP group with no proximal necrosis or pancreatitis. The groups were equivalent clinically, by survival, and by serum and peritoneal fluid analysis. The gastrotomy closure was associated with small serosal adhesions, but no gross abscess or necrosis. Animal study. In the largest controlled trial of NOTES orifice surgery to date, there was no clinical or survival difference between NOTES and laparoscopic approaches.

Peritoneald‐Dimer Concentration for Assessing Peritoneal Fibrinolytic Activity in Horses with Colic

Plasma D-dimer concentration is a useful marker to assess systemic coagulation and fibrinolytic activities in humans, dogs, and horses. Peritoneal fibrinolytic activity increases in horses with colic, especially in horses with endotoxin in the peritoneal fluid. Peritoneal D-dimer concentration can be used to assess peritoneal fibrinolytic activity in horses with severe gastrointestinal (GI) disorders and altered peritoneal fluid. Two hundred and twenty-one colic horses and 15 control horses. Prospective observational clinical study. Blood and peritoneal fluid were collected on admission. Horses were grouped according to diagnosis, peritoneal fluid analysis, and outcome. Peritoneal D-dimer concentration was determined, together with peritoneal tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) activities. Plasma D-dimer concentration also was measured. Peritoneal D-dimer concentration was significantly higher in all colic groups compared with controls, and in horses with enteritis, peritonitis, and ischemic disorders compared with horses with large intestinal obstructions. Peritoneal D-dimer concentration was significantly higher in horses with altered peritoneal fluid (modified transudate and exudate) compared with horses with normal peritoneal fluid analysis. Plasma D-dimer concentration also was significantly higher in the peritonitis group, and in horses with altered peritoneal fluid analysis. Peritoneal and plasma D-dimer concentrations also were significantly higher in nonsurvivors. Peritoneal d-dimer concentration was significantly correlated with decreased peritoneal t-PA activity and increased peritoneal PAI-1 activity. Peritoneal D-dimer concentration is markedly higher in severe GI disorders, and it can be used to assess peritoneal fibrinolytic activity in horses with colic.