Visceral Peritoneal Research Articles

Influence of 4% icodextrin solution on peritoneal tissue response and adhesion formation

BackgroundPostoperative peritoneal adhesion formation following abdominal surgery remains a relevant surgical problem. The application of soluble physico-chemical barriers like 4% icodextrin is one approach to protect the peritoneal surface from getting linked to adhesive scar. The aim of this study was to investigate the influence of 4% icodextrin on peritoneal tissue response both of visceral and parietal peritoneum, adhesion formation and wound healing.Methods40 rats were divided into two groups. After creation of an intraabdominal defect, either 4% icodextrin (Adept®) or sodium chloride was applied. Animals were sacrificed after 7 and 21 days. Adhesions were scored by an adhesion score. Furthermore, immunohistochemical investigations were conducted to determine the discrete influence of icodextrin on the parietal and visceral peritoneal tissue responses (CD68+ macrophages, CD3+ T-lymphocytes, vimentin for mesenchymal cells, HBME-1 for mesothelial cells, and as components of wound healing COX-2, C-myc, catenin).ResultsPostoperative peritoneal adhesions were predominantly present in the sodium chloride group as compared to the icodextrin group (14/19 (74%) vs. 9/19 (47%); p = 0.048). The adhesion score however did not reveal any significant differences, (p = 0.614). Furthermore, the expression of vimentin in both the parietal and visceral peritoneum after 21 days was significantly lower in the icodextrin group than in the sodium chloride group (p = 0.038 and p = 0.028, respectively). No significant differences were observed for macrophages, lymphocytes, reperitonealisation or the expression of COX-2, C-myc or Catenin.ConclusionsThe intraperitoneal application of 4% icodextrin reduces adhesion formation in comparison to sodium chloride. 4% icodextrin solution reduces the inflammatory and mesenchymal infiltrate in the wounded area, thus improving the ratio of mesothel cells to mesenchymal infiltrate. As demonstrated, icodextrin is able to ameliorate the local tissue response. Further experimental studies would be done to elaborate the impact on the early response of the adaptive immune system, which may then trigger the subsequent wound healing and tissue repair.

Multi‐system progressive angiomatosis in a dog resembling blue rubber bleb nevus syndrome in humans

A six-year-old, neutered, female golden retriever was presented with generalised, dark purple to black cutaneous nodules and gastrointestinal haemorrhage. Histopathologically, all cutaneous nodules were diagnosed as benign cavernous haemangiomas. Endoscopic analysis revealed similar nodules in the oesophagus, stomach and duodenum. At laparotomy, similar nodules were seen on the visceral peritoneal lining of abdominal organs. Metastatic haemangiosarcoma was ruled out based on histological features and lack of primary tumour in spleen, liver or heart ultrasonographically. Blood loss associated with gastrointestinal haemorrhage was managed with blood transfusion. To the authors' knowledge, this is the first canine case of multi-system progressive angiomatosis resembling blue rubber bleb nevus syndrome in humans.

Increased Lymphatic Vessels in Patients with Encapsulating Peritoneal Sclerosis

The angiogenic response is partly involved in the progression of encapsulating peritoneal sclerosis (EPS). However, the details of the angiogenic response, especially for lymphatic vessels in patients with EPS, remain unclear. In addition, because of technical limitations, morphology studies reported to date have examined only the parietal peritoneum. The morphologies of parietal and visceral lymphatic vessels in patients with EPS both need to be analyzed. We examined peritoneal samples from 18 patients with EPS who underwent enterolysis of the visceral peritoneum and compared them with samples from 17 autopsy cases (controls). To examine the angiogenic response, we performed immunohistochemistry for the endothelial markers CD34 (blood vessels) and podoplanin (lymphatic vessels) and for the cell proliferation marker Ki-67. Immunogold electron microscopy analysis for podoplanin was also performed. In 7 of 18 cases, we compared differences in the angiogenic response of the parietal and visceral peritoneal membranes. Angiogenic responses were more frequent in the compact zone than in regenerated layers. The number of capillaries positive for anti-CD34 and anti-podoplanin monoclonal antibodies per unit area of visceral peritoneal tissue was, respectively, 41.1 ± 29.3/mm(2) in EPS patients and 2.7 ± 4.4/mm(2) in controls (p ≤ 0.01) and 48.1 ± 43.9/mm(2) in EPS patients and 4.1 ± 5.4/mm(2) in controls (p ≤ 0.01). The percentage of capillaries positive for anti-Ki-67, CD34, and podoplanin was 4.6% in EPS patients (p ≤ 0.01) and 0.8% in controls (p = 0.09). The immunogold electron microscopy analysis revealed that podoplanin was localized to endothelial cells with anchoring filaments, a specific feature of lymphatic vessels. Furthermore, compared with parietal peritoneal membrane, visceral peritoneal membrane had a more prominent podoplanin-positive capillary profile, but not a prominent CD34-positive capillary profile. In addition, fibroblast-like cells double-positive for podoplanin and smooth muscle actin were markedly increased in the degenerated layer, as previously reported. Our study demonstrated that lymphatic vessels are increased in the visceral peritoneum of patients with EPS.

Impact of surgical and clinical factors on the pharmacology of intraperitoneal doxorubicin in 145 patients with peritoneal carcinomatosis

Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a combined treatment modality considered for selected patients with peritoneal carcinomatosis from colorectal and appendiceal cancer. Doxorubicin is a drug consistently used by our group in this clinical setting. The surgical and clinical factors that modify the pharmacokinetics of HIPEC may be important for the design of future perioperative chemotherapy regimens. Materials and methods The patients included were 145 who had colorectal or appendiceal carcinomatosis resected using CRS prior to treatment with HIPEC with doxorubicin as part of a multidrug regimen. The effect of clinical and surgical factors on drug distribution after a single intraperitoneal bolus administration with doxorubicin was determined. Results The pharmacokinetics of 145 patients treated with intraperitoneal doxorubicin showed a 78 times greater exposure to peritoneal surfaces as compared to plasma. At 90 min 12% of the drug remained in the chemotherapy solution and 88% was retained in the body. The extent of visceral resection and peritonectomy increased the clearance of doxorubicin from the peritoneal space. A major resection of visceral peritoneal surface, a contracted peritoneal space, and an incomplete cytoreduction reduced drug clearance. Conclusions Surgical and clinical factors may require modifications of chemotherapy administration. A large visceral resection and a contracted peritoneal space caused a reduced doxorubicin clearance. Total diffusion surface is an important determinant of doxorubicin pharmacokinetics.

The Effects of Interferon-α2b on Intestinal Flora in Peritoneal Fibrosis

Peritonitis is an important cause of the mortality and morbidity of peritoneal dialysis patients. The present study aims to investigate the effects of ýnterferon (IFN)-α2b on intestinal flora in peritoneal fibrosis. Twenty-four Wistar albino rats were divided into three groups. The control group received 0.9% saline (3 ml/d) intraperitoneally; the Chlorhexidine gluconate (CH) group received 3 ml daily injections of 0.1% CH intraperitoneally; the CH+IFN group received 3 ml daily injections of 0.1% CH intraperitoneally and pegylated IFN-α2b 1.5 μg/kg per week subcutaneously on days 0, 7, 14. On the twenty-first day rats were sacrificed and visseral peritoneum samples were obtained from the liver. Blood samples were obtained from the abdominal aorta and intestinal flora samples were obtained from distal small intestine and transverse colon. Histopathologic control of CH, CH+IFN groups peritoneal thickness were 6.04±2.32, 135.4±22.24, and 42.56±11.6 um, respectively. The decrease in thickness of parietal peritoneum in the CH+IFN group was statistically significant when compared to the CH group. Escherechia coli (E. Coli) had grown in cultures of the small intestine and colon samples of all the rats in the control group, whereas Proteus species (spp) had grown in one and Enterobacter spp. in seven cultures of the CH group. E. Coli had grown in four cultures, Proteus spp in three culture and Enterobacter spp. in one culture obtained from small intestine and transverse colon of the control group. The intestinal flora changed as the peritoneal thickness increased. The intestinal flora in the CH group completely changed compared with the control group (p<0.001). There was no correlation between visceral peritoneal thickness and intestinal flora change in the IFN group (p>0.05). IFN-α2b recovers the intestinal flora and the intestinal motility, thus reducing the experimental peritoneal fibrosis.

Physiological responses of Pacific halibut, Hippoglossus stenolepis, to intracoelomic implantation of electronic archival tags, with a review of tag implantation techniques employed in flatfishes

Management of Pacific halibut (Hippoglossus stenolepis), a long-lived flatfish, is complicated by possible ontogenic and sex-specific variation in migration. Archival tags promise the ability to help uncover long-term movement patterns at the individual level, if the tags can be retained and recovered from healthy fish. We examined fifteen individuals (69–90 cm fork length) for long-term physiological response to intracoelomic implantation of three types of archival tags: fully internal, internal with right angle protruding light stalk, and internal with straight protruding light stalk. Tags represented 0.05–0.16% of initial fish weights. Fish were reared at 10.8 ± 1.1°C for 59 weeks post-surgery. One fish died after 39 weeks from thermal stress unrelated to the surgical procedure. Temporal variation in behavior of tagged fish was indistinguishable from that of controls (n = 15 tagged, 5 controls). Treatment and control-group fish grew at similar rates. No tag expulsion or physiological response was evident in the individual that died at 39 weeks, but nine of eleven individuals dissected at the end of 59 weeks had developed internal responses. These responses ranged from deposition of fibrous protein and/or calcitic material on tag surfaces to partial or full tag encapsulation in either the visceral peritoneal layer (fully-internal tags) or the intestinal mesenteries (stalk-bearing tags). The responses were within the range reported for other pleuronectids implanted with tags of similar configuration and may have implications for design and interpretation of long-term tagging studies. Encapsulation may reduce the probability of tag recoveries even in the absence of tag expulsion, especially in species eviscerated at sea.

Changes induced by surgical and clinical factors in the pharmacology of intraperitoneal mitomycin C in 145 patients with peritoneal carcinomatosis

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are a combined treatment modality considered for selected patients with peritoneal carcinomatosis from colorectal and appendiceal cancer. Mitomycin C is a drug often used in this clinical setting. The surgical and clinical factors that may influence the pharmacokinetics of hyperthermic intraperitoneal chemotherapy should be further elucidated. The patients included were 145 who had colorectal or appendiceal carcinomatosis resected using cytoreductive surgery prior to treatment with hyperthermic intraperitoneal chemotherapy with mitomycin C as part of a multidrug regimen. The effect of clinical and surgical factors on drug distribution after single intraperitoneal bolus administration with mitomycin C was determined. The pharmacokinetics of 145 patients treated with intraperitoneal mitomycin C showed a 27 times greater exposure to peritoneal surfaces when compared to plasma. At 90min, 29% of the drug remained in the chemotherapy solution, 62% was retained in the body, and 9% was excreted in the urine. The extent of peritonectomy increased the clearance of mitomycin C from the peritoneal space (p=0.051). A major resection of visceral peritoneal surface and a contracted peritoneal space reduced drug clearance. A contracted peritoneal space significantly reduced (p=0.0001) drug concentrations in the plasma. Surgical and clinical factors may require modifications of drug dose or timing of chemotherapy administration. A large visceral resection and a contracted peritoneal space caused a reduced mitomycin C clearance. Total diffusion surface is an important determinant of mitomycin C pharmacokinetics.

Erratum to: ‘Does visceral peritoneal closure affect post-cesarean urinary symptoms? A randomized clinical trial’

The authors wish to point out that there were three errors in this article: In the legend below Fig. 1, commenting on Fig. 1b, the sentence: “Postpartum perineal ultrasound (48 h postpartum, sagittal view) showing the wider alpha angle in a case of visceral peritoneal non-closure (upper photo)...” should have read: “Postpartum perineal ultrasound (48 h postpartum, sagittal view) showing the narrower alpha angle in a case of visceral peritoneal non-closure (upper photo)...”. The authors would like to apologize for this error. The first sentence of the second paragraph of the Results section (p. 36), “After analysis of the data obtained by the UDI-6 questionnaire after puerperium, it was observed that significantly more closure group patients reported frequency of urination (p<0.001), urine leakage related to urgency (p<0.001) and physical activity (p=0.43, <0.05) compared to the non-closure group (Table 2)”, should have read “After analysis of the data obtained by the UDI-6 questionnaire after puerperium, it was observed that significantly more closure group patients reported frequency of urination (p<0.001), urine leakage related to urgency (p<0.001) and physical activity (p=≤0.05) compared to the non-closure group (Table 2).” The first sentence of the second paragraph on p. 37, “In our study, when the peritoneum was left open, the incidence and proportion of patients reporting (moderate/great) symptoms of postoperative frequency were significantly lower [11/285, 3.6%, vs. 48/297, 16.2%, p<0.001, and 7/ 285 (2.4) (1.3) vs. 30/297 (10.1%), p=0.0004, respectively] after 8 weeks of surgery, and the incidence dropped in both groups after 6 months [6/285, (2.1%) vs. 12/297, (4.0%), p=0.19]”, should have read “In our study, when the peritoneum was left open, the incidence and proportion of patients reporting (moderate/great) symptoms of postoperative frequency were significantly lower [11/285, 3.6%, vs. 48/297, 16.2%, p<0.001, and 7/285 (2.4) vs. 30/297 (10.1%), p= 0.0004, respectively] after 8 weeks of surgery, and the incidence dropped in both groups after 6 months [6/285, (2.1%) vs. 12/297, (4.0%), p=0.19]”. The corrections are underlined for clarity.

Signet Ring, High Grade, and Undifferentiated Colorectal Adenocarcinomas Differ

Studies with limited sample sizes have found colorectal signet ring carcinoma (SRC), to be prognostically similar to high grade adenocarcinoma (HGA); the relationship of these tumors to undifferentiated adenocarcinoma (UND) has not yet been fully elucidated. This study of Surveillance, Epidemiology, and End Results (SEER) program data compared the histotypes. Registered as having been diagnosed between 1988 and 2003 were 2,246 SRC, 32,999 HGA, and 920 UND. Analyses were performed to determine the presence or absence of differences in survival and extent at presentation. SRC, compared with HGA, was more likely to (1) be confined to an in situ stage or within a polyp, (2) have invaded visceral peritoneum, (3) have spread to contiguous organs, and (4) have metastasized. No differences between SRC and UND were seen, although this may have been due to small UND sample size. SRC was associated with a worse prognosis than HGA for patients with (1) T3 tumors, (2) contiguous organ spread, and (3) visceral peritoneal invasion. UND was associated with a worse prognosis than SRC among patients with metastases. These three histotypes of aggressive colorectal cancer are separate entities that should be regarded as such. Future study with respect to SRC should include further evaluation of T1 and T2 patients with appropriate sample size populations and the potential utility of peritoneal sampling and frozen section evaluation of non-mucosal margins.

Development of Encapsulating Peritoneal Sclerosis Following Bacterial Peritonitis in a Peritoneal Dialysis Patient

Encapsulating peritoneal sclerosis (EPS) isan uncommon and often fatal complication inpatients on peritoneal dialysis (PD) therapy. EPSis a clinical syndrome characterized by symp-toms of impaired intestinal motility, such asanorexia, nausea, vomiting, abdominal fullness,abdominalpain,absentbowelsounds,andconsti-pation.

Does visceral peritoneal closure affect post-cesarean urinary symptoms? A randomized clinical trial

We hypothesized that upward bladder traction by visceral peritoneal closure during cesarean sections may have an impact on postpartum urinary complaints. Based on a 90% power of the study and a 95% confidence interval, a sample size of 114 patients in each arm was needed to detect a 15% difference between both groups regarding postpartum urinary incontinence. To account for follow-up losses, we prospectively randomized 620 term primigravidas undergoing non-emergency cesareans into two groups (310 each): group 1, visceral peritoneal closure; group 2, non-closure. We compared perineal ultrasound findings 30 min before and 48 h after surgery. The UDI-6 questionnaire was used to assess urinary complaints. Group 1 showed significant widening of the posterior urethrovesical angle and alpha angle, more urethral descent 48 h postpartum and higher incidence of frequency, urge and stress incontinence 8 weeks postpartum. Symptoms disappeared almost completely after 6 months. Compared to visceral peritoneal non-closure, cesarean with visceral closure is associated with significant postpartum frequency of urination and/or incontinence that disappear without treatment almost completely within 6 months.

Assessment of postcesarean incontinence and perineal ultrasonographic changes following visceral peritoneal closure vs non-closure – a randomized trial

Assessment of postcesarean incontinence and perineal ultrasonographic changes following visceral peritoneal closure vs non-closure – a randomized trial

Effects of visceral peritoneal closure on scar formation at cesarean delivery

Objective To determine the effect of closure or non-closure of the visceral peritoneum at cesarean delivery on uterine scar formation assessed at repeat cesarean delivery. Methods Women undergoing initial cesarean delivery were allocated into 2 groups: group 1 underwent visceral peritoneal closure, while in group 2 the visceral peritoneum was not closed. At repeat cesarean delivery 4 specimens from the initial uterine scar were collected and assessed by light microscopy and scanning electron microscopy. Results In group 1, 57% of women had adhesions compared with 20.6% in group 2 ( P < 0.05). Light microscopy revealed reactive mesothelial hyperplasia (51.8% vs 13.7%), submesothelial fibrosis (48.1% vs 6.8%), and neoangiogenesis of mesothelial stroma (44.4% vs 12%) in group 1 and group 2 patients, respectively ( P < 0.05). Scanning electron microscopy showed more patients with pericytes on the surface of microvessels in group 1 compared with group 2 (26.3 ± 1.4 vs 11.5 ± 1.1 patients; P < 0.05). Conclusion Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions, evidenced by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis.

Peritoneal surface area: measurements of 40 structures covered by peritoneum: correlation between total peritoneal surface area and the surface calculated by formulas

We have not found studies that have measured the peritoneal surface area of each of the walls, organs, mesos, omenta, and peritoneal ligaments in a group of non-eviscerated human cadavers. The objectives of this study were to obtain in fixed non-eviscerated cadavers: (1) the surface values of walls, organs, mesos, omenta, and peritoneal ligaments of each one and all the areas mentioned in the anatomy bibliography and their contribution to supra- and infra-colic portions, visceral and parietal portions of the supra- and infra-colic portions and the total peritoneal surface area, and (2) the relationship between the peritoneal surface values by direct measurement and the values obtained applying the formulas usually used in clinical practice to obtain body surface area. The peritoneal surface area of ten female human bodies presenting no abdominal pathologies were measured. They were fixed in 5% formaldehyde solution without the use of perfusion pumps and non-eviscerated, thus maintaining all structures intact. Cellophane was placed directly in situ onto all organs, mesos, omenta, ligaments and parietal walls. Digital imaging was obtained by scanning the models. A length reference was included and the surface was determined by the Scion Image program for Windows. This paper provides for the first time data on each one and all the areas covered by the peritoneum. The total peritoneal surface area was (mean +/- SE) 14,323.62 +/- 824.37 cm(2). The two greater surfaces of peritoneum (39.21% of the total surface) correspond to the jejunum-ileum and its mesentery. The diaphragmatic peritoneum represented the greater area of parietal peritoneum. The supracolic surface was 4,487.46 +/- 196.21 cm(2) (31.79 +/- 1.50%) and the infracolic one of 9,836.16 +/- 732.67 cm(2) (68.21 +/- 1.50%). An interesting result of this work is that the surface of the parietal peritoneum in the supracolic abdomen (1,786.67 +/- 92.58 cm(2), 68.56%) is more than twice that of the infracolic region (756.62 +/- 55.91 cm(2), 31.44%). The visceral peritoneal surface (81.89 +/- 0.99% of the total) was much higher than that of the parietal peritoneum (18.11 +/- 0.99%). This difference is 12 times bigger in the infracolic abdomen. The peritoneal surface area measured in this study in non-eviscerated cadavers represents more than 96% of the one estimated by the above-mentioned formulas. The values shown in this paper would provide non-existing information for basic anatomy, and would contribute either to the study of pathologies involving the peritoneum or to their diagnosis and therapies.

Clinical Challenges and Images in GI

Question: A 63-year-old man with no significant medical history presented with obscure abdominal discomfort. He underwent computed tomography (Figure A), which revealed a mass in the pelvic cavity. The mass was a smooth-surfaced, egg-shaped lesion with a central low-density area. Magnetic resonance imaging was performed to confirm the finding (Figure B). T1-weighted images showed a low-intensity mass with a central high-intensity area. The mobile, hard mass was palpable by digital examination; however, colonoscopy revealed normal rectal mucosa and no submucosal tumor. Further physical examination and laboratory investigations showed normal findings. What is the diagnosis?View Large Image Figure ViewerDownload Hi-res image Download (PPT) Look on page 730 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pelvic CT scan showed a 45- × 40-mm mass and MRI demonstrated a low-intensity mass. In both investigations, the mass was found to show the same degree of intensity as the surrounding muscle tissue. A high-intensity area was observed in the center of the mass, identical to that seen in fatty tissues. The patient underwent laparoscopic surgery. We found a hard, white, egg-shaped peritoneal loose body that was completely free in the pelvic cavity (Figure C). The mass was laparoscopically removed using an endopouch. It was composed of many layers of laminated, fibrous tissues surrounding a central necrotic fatty lesion (Figure D). This mass was a “peritoneal loose body” as defined by the intraperitoneal separate body, which was mainly made from protein and calcium phosphate.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The general conception of peritoneal loose bodies is that they arise owing to torsion and separation of the appendices epiploicae, which are visceral peritoneal pouches filled with fat that exist along the antimesenteric tenia of the colon. It is important to differentiate peritoneal loose bodies from other lesions such as gastrointestinal stromal tumors (GIST), fibromas, desmoid tumors, teratomas, and urinary, gallbladder, and appendix stones. GIST is especially hard to distinguish from peritoneal loose bodies; however, the former exhibits a contrast-enhancing effect unlike peritoneal loose bodies, which require additional prone-positioned computed tomography examinations to monitor their mobility. A huge peritoneal loose body (∼10 cm) has been reported previously.1Mohri T. Kato T. Suzuki H. A giant peritoneal loose body: report of a case.Am Surg. 2007; 73: 895-896PubMed Google Scholar Such loose bodies rarely cause any symptoms if they are small (0.5–2.5 cm in diameter); however, “giant” peritoneal loose bodies (>5 cm in diameter) present with various symptoms.2Ghosh P. Strong C. Naugler W. et al.Peritoneal mice implicated in intestinal obstruction: report of a case and review of the literature.J Clin Gastroenterol. 2006; 40: 427-430Crossref PubMed Scopus (29) Google Scholar, 3Bhandarwar A.H. Desai V.V. Gajbhiye R.N. et al.Acute retention of urine due to a loose peritoneal body.Br J Urol. 1996; 78: 951-952Crossref PubMed Google Scholar If CT or MRI images reveal a huge peritoneal loose body, laparoscopic surgery is indicated, unlike cases that show small loose bodies.4Nomura H. Hata F. Yasoshima T. et al.Giant peritoneal loose body in the pelvic cavity: report of a case.Surg Today. 2003; 33: 791-793Crossref PubMed Scopus (25) Google Scholar In this case, abdominal discomfort disappeared spontaneously before operation. Therefore, we believe only symptomatic or cases that have significant findings should be treated surgically.

Vasoactive Components of Dialysis Solution

Conventional peritoneal dialysis (PD) solutions elicit vasodilation, which is implicated in the variable rate of solute transport during the dwell. The components causing such vasoactivity are still controversial. This study was conducted to define the vasoactive components of conventional and new PD solutions. Three visceral peritoneal microvascular levels were visualized by intravital video microscopy of the terminal ileum of anesthetized rats. Anesthesia-free decerebrate conscious rats served as control. Microvascular diameter and blood flow by Doppler measurements were conducted after topical peritoneal exposure to 4 clinical PD solutions and 6 prepared solutions designed to isolate potential vasoactive components of the PD solution. All clinically available PD solutions produced a rapid and generalized vasodilation at all intestinal microvascular levels, regardless of the osmotic solute. The pattern and magnitude of this dilation was not affected by anesthesia but was determined by arteriolar size, the osmotic solute, and the solution's buffer anion system. The greatest dilation occurred in the small precapillary arterioles and was elicited by conventional PD solution and heat re-sterilized solution containing low glucose degradation products (GDPs). Hypertonic mannitol solutions produced a dilation that was approximately 50% less than the dilation obtained with glucose solutions with identical osmolarity and buffer. Increasing a solution's osmolarity did not produce a parallel increase in the magnitude of dilation, suggesting a nonlinear relationship between the two variables. Lactate dissolved in an isotonic solution was completely non-vasoactive unless the solution's H(+) concentration was increased. At low pH, isotonic lactate produced a rapid but transient vasodilation. This vascular reactivity was similar in magnitude and pattern to that obtained with the isotonic 7.5% icodextrin solution (Extraneal; Baxter Healthcare, Deerfield, Illinois, USA). (1) Hyperosmolarity is the major vasoactive component of PD solution. (2) Hyperosmolarity and active intracellular glucose uptake account together for approximately 75% of PD solution-induced dilation, whereas GDPs contribute to approximately 25%. (3) Lactate is vasoactive only at low pH (high [H(+)]). (4) The magnitude of PD solution-mediated vasodilation is partially dependent on the nature of the osmotic solute, the GDP contents, and the [H(+)], which determine the vasoactivity of the lactate-buffer anion system. Studies are required to define the molecular mechanisms of PD-induced vasodilation and to determine the vasoactive properties of these solutions after chronic infusion.

Revision of the characters of Centrolenidae (Amphibia: Anura: Athesphatanura), with comments on its taxonomy and the description of new taxa of glassfrogs

Anurans of the family Centrolenidae are a diverse clade of arboreal frogs distributed across tropical America. Knowledge of their taxonomy, systematics, ecology, behavior, morphology, and other evolutionary aspects of their biology is deficient. Relationships among centrolenid species remain largely unresolved, with no satisfactory phylogenetic hypothesis, and none of the current genera has compelling evidence of monophyly. Further, understanding the phylogeny of glassfrogs is constrained by species-level taxonomic problems, including incorrect description of characters, incomplete analyses of intraspecific variation, and lack of appreciation of species diversity. Herein, we define and analyze the 23 characters that are useful, in combination, in diagnosing centrolenid species, and thereby provide a reference for the use of future workers. We propose revised classifications for the parietal and visceral peritoneal pigmentation, liver form and coloration of its associated hepatic peritoneum, nuptial excrescences, and hand ornamentation. We comment on the generic and species-level taxonomy of Centrolenidae, proposing the recognition of a new genus and describing a new species from Ecuador. We treat Hyla ocellifera Boulenger as a synonym of Centrolene prosoblepon (Boettger), Hyalinobatrachium cardiacalyptum McCranie &amp; Wilson as a synonym of Hyalinobatrachium chirripoi (Taylor), and Hyalinobatrachium crybetes McCranie and Wilson as a synonym of Hyalinobatrachium colymbiphyllum (Taylor). We also present an annotated list of the species of glassfrogs from the Republic of Ecuador with some distributional remarks.

Prenatal sonologic features of simple meconium peritonitis

Abstract A 25 yrs old female patient came to our department for routine antenatal ultrasound. Sonography revealed presence of a 24 week live intrauterine pregnancy. During routine screening for congenital anomalies, multiple highly echogenic foci were seen on the visceral peritoneal surface of liver and the parietal peritoneum. However no evidence of dilated bowel/ fetal ascites was detected. No other anomaly was detected.

Colon Cancer in Behçet's Disease

Behet's disease has rarely been reported in association with malignant diseases. In most cases the autoimmune nature of the disease itself or immunosuppressive drug use has been blamed for malignant transformation. Solid tumors in addition to lymphoid and hematological malignancies are also seen during the course of Behet's disease. We present here a case of colon cancer in a 40-year-old man with Behet's disease. A near total colectomy was performed and postoperative chemotherapy and radiotherapy was administered to treat visceral peritoneal invasion. Recurrent evidence was not found. We present the clinical details of this rare case of colon cancer with Behet's disease.

Peritoneal Closure at Primary Cesarean Delivery and Adhesions

Objective: To evaluate the effect of parietal peritoneal closure at cesarean delivery on adhesion formation. Methods: A prospective cohort study of women undergoing first repeat cesarean delivery was designed. All surgeons were asked immediately after surgery to score the severity and location of adhesions. Patient records were then abstracted to assess prior surgical technique, including parietal peritoneal closure, other attributes of first surgery, and patient characteristics. Exclusion criteria included adhesions, other surgery, or use of permanent suture at the first cesarean, unavailable first postoperative note and course, wound infection or breakdown following first surgery, intervening pelvic surgery, insulin-dependent diabetes mellitus, and steroid-dependent disease. The X 2 test and multivariable logistic regression were used for statistical comparison and analysis. A total of 128 patients was required to have 80% power to detect a 50% reduction in adhesions when the parietal peritoneum was left open. Results: One hundred seventy-three patients were enrolled. Prior parietal peritoneal closure was associated with significantly fewer dense and filmy adhesions (52% versus 73%, P =.006) and significantly fewer dense adhesions (30% versus 45%, P =.043). When controlling for potential confounding variables, including prior infection, visceral peritoneal closure, rectus muscle closure, payor status, ethnicity, maternal age, gestational diabetes, and labor, parietal peritoneal closure at primary cesarean delivery was 5-fold protective against all adhesions (odds ratio 0.20, 95% confidence interval 0.08-0.49), and 3-fold protective against dense adhesions (odds ratio 0.32, 95% confidence interval 0.13-0.79). Omental-fascial adhesions were decreased most consistently. Conclusion: Parietal peritoneal closure at primary cesarean delivery was associated with significantly fewer dense and filmy adhesions. The practice of nonclosure of the parietal peritoneum at cesarean delivery should be questioned.