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Kumar, Rajneesh, Ankur Hastir, Lakshay Chopra, Sonali Jindal, R. P. S. Walia, and Subhash Goyal. "Role of drains in cases of peptic ulcer perforations: comparison between single drain versus no drain." International Surgery Journal 7, no. 2 (January 27, 2020): 404. http://dx.doi.org/10.18203/2349-2902.isj20200287.
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Background: Peptic ulcer perforation is one of the commonest causes of peritonitis and needs immediate surgical intervention after prompt resuscitation if mortality and morbidity are to be contained. Aims and objectives of the study was to compare role of Intra-abdominal drains prophylactically after plugging of these perforations single drain or no drain.Methods: In this study, we compared the relative safety and efficacy of putting single drain prophylactically near operation site or in natural abdominal fossae (hepato-renal pouch or sub hepatic) and no drain in cases of peritonitis due to peptic ulcer perforation. Study was done on 60 patients (one drain put in 30 patients Group A and no drain was put in other 30 patients of Group B). We handle the perforation after thorough peritoneal lavage with warm saline and metrogyl. All the perforation was closed by Grahm’s Patch.Results: No significant difference between drain and non-drain group as far age and sex concerned. Significant difference was seen in operative duration, hospital stay, wound dehiscence and post-operative fever, intraperitoneal collection or abscess formation. So use of drains are not effective in preventing post-operative infection rather there are chances of its blockage due to debris, intestine or omentum and tubes itself are source of infection as foreign body and there are chances of migration of bacteria from exterior to peritoneal cavity via these drains.Conclusions: Non drainage of peritoneal cavity after peptic ulcer perforation surgery is an effective method to reduce operative duration, hospital stay and wound dehiscence and post-operative pyrexia.
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Nguyen, Helen, and Carolyn Houska Lund. "Exploratory Laparotomy or Peritoneal Drain?" Journal of Perinatal & Neonatal Nursing 21, no. 1 (January 2007): 50–60. http://dx.doi.org/10.1097/00005237-200701000-00011.
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&NA;. "Exploratory Laparotomy or Peritoneal Drain?" Journal of Perinatal & Neonatal Nursing 21, no. 1 (January 2007): 61–62. http://dx.doi.org/10.1097/00005237-200701000-00012.
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Bhoir, Lata N., Nilesh Y. Jagne, and Divya Murali. "Is using peritoneal drains in bowel surgeries beneficial?" International Surgery Journal 4, no. 2 (January 25, 2017): 650. http://dx.doi.org/10.18203/2349-2902.isj20170208.
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Background: Surgical drains of various types have been used, with the best intentions, in different surgeries for many years. It is often open question whether they achieve their intended purpose despite many years of surgery. There is paucity of evidence for the benefit of many types of surgical drainage and many surgeons still ‘follow their usual practice’. The dictum ‘when in doubt, drain’ from Lawson Tait, is well known to surgeons’. But many studies we find routine placement of drain has been shown to be ineffective or potentially harmful in various abdominal surgical procedure. We thus performed a systematic review of the studies of outcomes of with or without peritoneal drain in abdominal surgeries.Methods: A comparable study was conducted in between two groups with and without drain in patient belonging to all age undergoing small and large bowel surgeries. A random patient selection was done. Pooled estimates of mortality, morbidity, wound infection, blockage, pain, anastomotic leak, re-intervention and length of hospital stay were calculated.Results: With drain; duration of stay is more than without drain with p value found to be 0.0087. Drain is ineffective due to blockage in 38% patient. Wound infection is more with drain with p (0.003). Pain is more with drain with p (0.0001). There is no difference in anastomotic leak, distension, re-intervention and mortality with or without drain.Conclusions: After a century of scientific investigation and research, all surgeons should recall the words of Halstead ‘no drainage at all is better than ignorant employment of it’ rather than the advice of Lawson Tait ‘when in doubt, drain.
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Sommer, Allan. "Open Drain in Cycling Peritoneal Dialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 6, no. 1 (January 1986): 41. http://dx.doi.org/10.1177/089686088600600112.
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Park, Min Sun, Hyon Ah Lee, Won Suk Chu, Dong Ho Yang, and Seung Duk Hwang. "Peritoneal Accumulation of Age and Peritoneal Membrane Permeability." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 20, no. 4 (July 2000): 452–60. http://dx.doi.org/10.1177/089686080002000413.
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Background In continuous ambulatory peritoneal dialysis (CAPD), the peritoneal membrane is continuously exposed to high-glucose-containing dialysis solutions. Abnormally high glucose concentration in the peritoneal cavity may enhance advanced glycosylation end-product (AGE) formation and accumulation in the peritoneum. Increased AGE accumulation in the peritoneum, decreased ultrafiltration volume, and increased peritoneal permeability in long-term dialysis patients have been reported. Aim The purpose of the study was to evaluate the relation between peritoneal membrane permeability and peritoneal accumulation of AGE. Methods Peritoneal membrane permeability was evaluated by peritoneal equilibration test (PET) using dialysis solutions containing 4.25% glucose. Serum, dialysate, and peritoneal tissue levels of AGE were measured by ELISA method using polyclonal anti-AGE antibody. Peritoneal biopsy was performed during peritoneal catheter insertion [new group (group N), n = 18] and removal [long-term group (group LT), n = 10]. Peritoneal catheters were removed due to exit-site infection not extended into the internal cuff ( n = 6) and ultrafiltration failure ( n = 4) after 51.6 ± 31.5 months (13 – 101 months) of dialysis. PET data obtained within 3 months after the initiation of CAPD or before catheter removal were included in this study. Ten patients in group N and 4 patients in group LT were diabetic. Patients in group LT were significantly younger (46.5 ± 11.1 years vs 57.5 ± 1.3 years) and experienced more episodes of peritonitis (3.5 ± 2.1 vs 0.2 ± 0.7) than group N. Results Peritoneal tissue AGE level in group LT was significantly higher than in group N, in both nondiabetic (0.187 ± 0.108 U/mg vs 0.093 ± 0.08 U/mg of hydroxyproline, p < 0.03) and diabetic patients (0.384 ± 0.035 U/mg vs 0.152 ± 0.082 U/mg of hydroxyproline, p < 0.03), while serum and dialysate levels did not differ between the groups in both nondiabetic and diabetic patients. Drain volume (2600 ± 237 mL vs 2766 ± 222 mL, p = 0.07) and D4/D0 glucose (0.229 ± 0.066 vs 0.298 ± 0.081, p < 0.009) were lower, and D4/P4 creatinine (0.807 ± 0.100 vs 0.653 ± 0.144, p < 0.0001) and D1/P1 sodium (0.886 ± 0.040 vs 0.822 ± 0.032, p < 0.0003) were significantly higher in group LT than in group N. On linear regression analysis, AGE level in the peritoneum was directly correlated with duration of CAPD ( r = 0.476, p = 0.012), number of peritonitis episodes ( r = 0.433, p = 0.0215), D4/P4 creatinine ( r = 0.546, p < 0.027), and D1/P1 sodium ( r = 0.422, p = 0.0254), and inversely correlated with drain volume ( r = 0.432, p = 0.022) and D4/D0 glucose ( r = 0.552, p < 0.0023). AGE level in the peritoneal tissue and dialysate were significantly higher in diabetics than in nondiabetics in group LT, while these differences were not found in group N. Serum AGE level did not differ between nondiabetics and diabetics in either group N or group LT. Drain volume and D4/D0 glucose were lower and D4/P4 creatinine and D1/P1 sodium higher in diabetics than in nondiabetics in both groups. Conclusion Peritoneal accumulation of AGE increased with time on CAPD and number of peritonitis episodes, and was directly related with peritoneal permeability. Peritoneal AGE accumulation and peritoneal permeability in diabetic patients were higher than in nondiabetic patients from the beginning of CAPD.
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Solass, Wiebke, Philipp Horvath, Florian Struller, Ingmar Königsrainer, Stefan Beckert, Alfred Königsrainer, Frank-Jürgen Weinreich, and Martin Schenk. "Functional vascular anatomy of the peritoneum in health and disease." Pleura and Peritoneum 1, no. 3 (April 24, 2019): 145–58. http://dx.doi.org/10.1515/pp-2016-0015.
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AbstractThe peritoneum consists of a layer of mesothelial cells on a connective tissue base which is perfused with circulatory and lymphatic vessels. Total effective blood flow to the human peritoneum is estimated between 60 and 100 mL/min, representing 1–2 % of the cardiac outflow. The parietal peritoneum accounts for about 30 % of the peritoneal surface (anterior abdominal wall 4 %) and is vascularized from the circumflex, iliac, lumbar, intercostal, and epigastric arteries, giving rise to a quadrangular network of large, parallel blood vessels and their perpendicular offshoots. Parietal vessels drain into the inferior vena cava. The visceral peritoneum accounts for 70 % of the peritoneal surface and derives its blood supply from the three major arteries that supply the splanchnic organs, celiac and superior and inferior mesenteric. These vessels give rise to smaller arteries that anastomose extensively. The visceral peritoneum drains into the portal vein. Drugs absorbed are subject to first-pass hepatic metabolism. Peritoneal inflammation and cancer invasion induce neoangiogenesis, leading to the development of an important microvascular network. Anatomy of neovessels is abnormal and characterized by large size, varying diameter, convolution and blood extravasation. Neovessels have a defective ultrastructure: formation of large “mother vessels” requires degradation of venular and capillary basement membranes. Mother vessels give birth to numerous “daughter vessels”. Diffuse neoangiogenesis can be observed before appearance of macroscopic peritoneal metastasis. Multiplication of the peritoneal capillary surface by neoangiogenesis surface increases the part of cardiac outflow directed to the peritoneum.
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Pourmoghadam, Kamal K., Stacey Kubovec, William M. DeCampli, Bertha Ben Khallouq, Kurt Piggott, Carlos Blanco, Harun Fakioglu, Alicia Kube, and Sukumar Suguna Narasimhulu. "Passive Peritoneal Drainage Impact on Fluid Balance and Inflammatory Mediators: A Randomized Pilot Study." World Journal for Pediatric and Congenital Heart Surgery 11, no. 2 (February 25, 2020): 150–58. http://dx.doi.org/10.1177/2150135119888143.
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Background: Infants after cardiopulmonary bypass are exposed to increasing inflammatory mediator release and are at risk of developing fluid overload. The aim of this pilot study was to evaluate the impact of passive peritoneal drainage on achieving negative fluid balance and its ability to dispose of inflammatory cytokines. Methods: From September 2014 to November 2016, infants undergoing STAT category 3, 4, and 5 operations were randomized to receive or not receive intraoperative prophylactic peritoneal drain. We analyzed time to negative fluid balance and perioperative variables for each group. Pro- and anti-inflammatory cytokines were measured from serum and peritoneal fluid in the passive peritoneal drainage group and serum in the control group postoperatively. Results: Infants were randomized to prophylactic passive peritoneal drain group (n = 13) and control (n = 12). The groups were not significantly different in pre- and postoperative peak lactate levels, postoperative length of stay, and mortality. Peritoneal drain patients reached time to negative fluid balance at a median of 1.42 days (interquartile range [IQR]: 1.00-2.91), whereas the control at 3.08 (IQR: 1.67-3.88; P = .043). Peritoneal drain patients had lower diuretic index at 72 hours, median of 2.86 (IQR: 1.21-4.94) versus 6.27 (IQR: 4.75-11.11; P = .006). Consistently, tumor necrosis factor-α, interleukin (IL)-4, IL-6, IL-8, IL-10, and interferon-γ were present at higher levels in peritoneal fluid than serum at 24 and 72 hours. However, serum cytokine levels in peritoneal drain and control group, at 24 and 72 hours postoperatively, did not differ significantly. Conclusions: The prophylactic passive peritoneal drain patients reached negative fluid balance earlier and used less diuretic in early postoperative period. The serum cytokine levels did not differ significantly between groups at 24 and 72 hours postoperatively. However, there was no significant difference in mortality and postoperative length of stay.
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Tzamaloukas, Antonios H., Deepak Malhotra, and Glen H. Murata. "Drain Volume Required for a Target Peritoneal Clearance." ASAIO Journal 44, no. 6 (November 1998): 828–34. http://dx.doi.org/10.1097/00002480-199811000-00012.
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Bernardini, Judith, Tracey Florio, Filitsa Bender, Linda Fried, and Beth Piraino. "Methods to Determine Drain Volume for Peritoneal Dialysis Clearances." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 24, no. 2 (March 2004): 182–85. http://dx.doi.org/10.1177/089686080402400210.
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Objective To compare the accuracy and convenience of 3 methods for measuring drain volume for peritoneal dialysis (PD) clearance studies. Design Prospective comparison of both automated PD (APD) and continuous ambulatory PD (CAPD) clearance study methods. Setting Adults ≥18 years old at 2 dialysis clinics. Patients 28 PD patients with 43 clearance studies, 15 on CAPD and 28 on APD. Interventions None. Main Outcome Measures Drain volume was determined by 3 methods for each study: ( 1 ) graduate-measured volume using a 2-L graduated cylinder; ( 2 ) weighed volume, with and without bag weight, using a digital floor scale or spring scale; ( 3 ) cycler-measured volume using the initial drain and ultrafiltration indicated by the cycler, plus the prescribed inflow volume without the last fill. Results There was no statistically significant difference in volumes using the 3 methods studied (all p > 0.89 for APD, all p > 0.97 for CAPD). Effluent volume was more accurate with the weight of the bag subtracted. Conclusion The most convenient and a precise method for APD is to determine the effluent drain volume using the prescription and total ultrafiltration and initial drain, as measured by the cycler. For CAPD, using the weight of drained bags is accurate but the weight of the empty bag must be subtracted. These approaches have the least risk of exposing staff to body fluids.
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Kim, Yong-Lim, Sung-Ho Kim, Jun-Hong Kim, Seog-Jae Kim, Chan-Duck Kim, Dong-Kyu ChO, Yong-Jin Kim, and James B. Moberly. "Effects of Peritoneal Rest on Peritoneal Transport and Peritoneal Membrane Thickening in Continuous Ambulatory Peritoneal Dialysis Rats." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 19, no. 2_suppl (February 1999): 384–87. http://dx.doi.org/10.1177/089686089901902s62.
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Objective To evaluate the effects of peritoneal rest on peritoneal transport and morphology in a rat model of peritoneal dialysis. Design Twenty-four rats (Sprague-Dawley, male, 250 300 g) were divided into three groups: group 1 (control, n = 6) without dialysis, group 2 (n = 9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n = 9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Both dialysis groups were dialyzed twice daily with an intraperitoneal instillation volume of 25 mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing the dialysis fluid with lipopolysaccharide (5 μg/mL) on days 8, 10, and 12 in both dialysis groups. Peritoneal equilibration tests were performed on each animal at baseline. The equilibration tests were repeated at the 4th and the 8th week of dialysis. Morphometric analyses of the peritoneal membrane were carried out in tissue specimens obtained at the time of sacrifice. Results The DIDo ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 was significantly lower than at baseline, indicating an increase in peritoneal permeability to glucose after 3 weeks of dialysis. DIDo in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drain volume in groups 2 and 3 at week 4 was significantly lower than at baseline; however, the drain volume in group 3 at week 8 was significantly higher than at week 4. The thickness of the parietal peritoneal membrane in group 3 was significantly greater than in group 1 and less than in group 2 (group 1, 11.4 ± 7.6 μm; group 2, 37.5 ± 18.4 μm; group 3,21.4 ± 12.1 μm). Conclusions Peritoneal rest improves ultrafiltration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal thickening. These data suggest that dialysis -induced changes in peritoneal transport and morphology are reversible under the conditions of peritoneal rest in this experimental model.
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Hutchison, Alastair J., Norma J. Ofsthun, Debbie Howarth, and Ram Gokal. "The Effect of Hemoglobin Concentration on Peritoneal Mass Transfer and Drain Volumes in Continuous Ambulatory Peritoneal Dialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 12, no. 2 (April 1992): 230–33. http://dx.doi.org/10.1177/089686089201200210.
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Objective To determine whether a correlation exists between hemoglobin levels and peritoneal mass transfer or drain volumes in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective study of two groups of CAPD patients, identified on the basis of their stable hemoglobin levels. Group A -hemoglobin less than 8.5 g/dL; Group B hemoglobin greater than 10.5 g/dL. Peritoneal mass transfer and drain volumes were measured for each patient, after which a subgroup of Group A was treated with rHuEPO (forming Group C) and measurements repeated once hemoglobin had risen by at least 2.0 g/dL. Setting Single renal unit of a university teaching hospital. Patients:Twenty-seven patients established on CAPD, selected according to their stable hemoglobin level. Group A -14 patients; Group B -13 patients; Group C (subgroup of A) -8 patients. Main outcome measures Difference between peritoneal mass transfer or drain volume in Group A versus Group B, and in Group C before and after rHuEPO therapy. Serum biochemical parameters in Group C before and after rHuEPO therapy. Results No statistically significant differences in any of the parameters measured were found between groups A and B, or before and after rHuEPO therapy in Group C. Conclusions Peritoneal transfer of small solutes and water is not influenced by hemoglobin level, and does not change following otherwise effective treatment with rHuEPO.
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Swartz, Richard, Joseph Messana, Leslie Rocher, Janice Reynolds, Barbara Starmann, and Patricia Lees. "The Curled Catheter: Dependable Device for Percutaneous Peritoneal Access." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 10, no. 3 (July 1990): 231–35. http://dx.doi.org/10.1177/089686089001000309.
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The curled peritoneal dialysis catheter is theoretically less prone to catheter migration and drainage failure. It also allows percutaneous placement, rather than surgical placement exclusively, whenever desired or necessary. Review of 213 curled-catheter placements, 134 (63%) percutaneous and 79 (37%) surgical, over the last 4 years, shows that the probability of continuing catheter function by life-table analysis was 88% at one year, 71% at 2 years, and 61% at three years, with no difference comparing percutaneous to surgical placement. Among the 213 total cases, nearly 50% of all catheters were still functioning at last follow up, and 38 catheters (17.8%) have been lost in total, attributed to infectious complications in 24 cases (tunnel-exit infection alone in 5, peritonitis alone in 11, combined infection in 8), refractory drain failure in 9 cases (early drain failure in 4, late drain failure in 5), recurrent late subcutaneous dialysate leaking in 3 cases, and peri-catheter hernia in 2 cases. Among other complications, the incidence of early drain failure (7.0%), and late drain failure (4.2%), compare favorably to reports describing other devices or other placement methods having comparable size of reported experience. Analyzing our own percutaneous and surgical placements separately, there were no differences in the respective frequencies of early drain failure, late drain failure, late subcutaneous dialysate leaking, outer cuff extrusion, required hernia repair, peritonitis or tunnel-exit infection. Only early external dialysate leaking was more frequent using percutaneous placement methods (21.6% vs. 10.1%; p < 0.05), although no catheters were lost due to early external leaking. In conclusion, the present experience suggests that the curled catheter is both amenable to safe and convenient percutaneous placement methods in the majority of cases, as well as dependable for long-term peritoneal dialysis in a large university program.
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TZAMALOUKAS, ANTONIOS H., GLEN H. MURATA, BETH PIRAINO, DEEPAK MALHOTRA, JUDITH BERNARDINI, PANDURANGA RAO, and DIMITRIOS G. OREOPOULOS. "The Relation Between Body Size and Normalized Small Solute Clearances in Continuous Ambulatory Peritoneal Dialysis." Journal of the American Society of Nephrology 10, no. 7 (July 1999): 1575–81. http://dx.doi.org/10.1681/asn.v1071575.
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Abstract. The normalized peritoneal clearances of small solutes depend on the ratio of their concentration in dialysate and plasma (D/P) and the drain volume (Dv) corrected for some measure of body size such as body water (V) or body surface area (BSA). The clearance formulas (D/P) × (Dv/V) and (D/P) × (Dv/BSA) can be used to examine why large individuals tend to be underdialyzed. Large people have low normalized drain volumes (Dv/V, Dv/BSA). It is not known whether size affects the D/P ratios. The purpose of this study was to examine the relationship between normalized peritoneal clearances (Kt/Vurea, CCr per 1.73 m2 BSA) and four size indicators (weight, height, V, BSA) in 301 patients on continuous ambulatory peritoneal dialysis (four daily exchanges with 2-L exchange volume) who underwent 613 clearance studies. Highly significant (P < 0.001) nonlinear relationships were found between Kt/Vurea and weight (r2 = 0.371), height (r2 = 0.289), BSA (r2 = 0.436), and V (r2 = 0.527); and between CCr and weight (r2 = 0.178), height (r2 = 0.115), BSA (r2 = 0.199), and V (r2 = 0.151). There were also significant negative correlations between the normalized drain volumes (Dv/V and Dv/BSA) and all four indicators of body size. Raw (not normalized) peritoneal clearances and drain volumes correlated positively with size. However, D/Purea or D/Pcreatinine did not vary with any size indicator except for a weak association between D/Pcreatinine and V (r = 0.089, P = 0.028). This association was not confirmed when V was used to stratify subjects into quartiles, and group differences for D/Pcreatinine were tested by one-way ANOVA. This study shows that the exclusive cause of the low normalized peritoneal clearances in large subjects on continuous ambulatory peritoneal dialysis is a low normalized drain volume. No evidence was found to indicate that body size influences the D/P ratio of small solutes. The portion of the variance in normalized clearance explained by size varies by size indicator and solute (urea versus creatinine).
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Pandey, Anand, Shailendra P. Singh, Vipin Gupta, and Rajesh Verma. "Conservative Management of Pneumoperitoneum in Necrotising Enterocolitis- Is it Possible?" Journal of Neonatal Surgery 5, no. 2 (March 13, 2016): 12. http://dx.doi.org/10.47338/jns.v5.279.
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Introduction: Necrotizing enterocolitis (NEC) is a common in neonatal intensive care unit (NICU) patients; especially in premature and low birth weight ones. Surgery is indicated when there is pneumoperitoneum. Other therapies include conservative observation or primary peritoneal drain (PPD). This study was conceived to evaluate peritoneal tapping, rather than primary peritoneal drain (PPD) as a treatment of NEC.Material and Methods- This prospective observational study conducted from December 2012 to December 2014 and including all patients of NEC having pneumoperitoneum on X-ray.Results- There were 12 patients of NEC. Seven patients responded to single peritoneal tapping. Three patients needed one more tapping. Laparotomy was required in remaining two patients. One patient, who underwent laparotomy, expired due to severe sepsis. The mean duration of follow up was 4.83 months (range 2 to 8).Conclusion- Peritoneal tapping in NEC who develops pneumoperitoneum appears to be a viable option. Further studies in this regard may substantiate this mode of therapy.
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Herbst, Claudia, Jan Dworschak, Gerald Schlager, Béatrice Kahl, and Daniel Zimpfer. "Prophylactic Peritoneal Catheter Placement in Congenital Cardiac Surgery." World Journal for Pediatric and Congenital Heart Surgery 13, no. 3 (April 21, 2022): 376–78. http://dx.doi.org/10.1177/21501351221084668.
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The use of a peritoneal catheter in selected patients, in relation to the congenital heart defect and surgical procedure, may improve postoperative fluid balance and recovery. The peritoneal catheter allows to either drain ascites passively out of the peritoneal cavity or utilize cycles of peritoneal dialysis. However, potential benefits contrast with risk. This article provides a step-by-step guide on how to implant a peritoneal catheter in the operating room after cardiac surgery, or insert it at the bedside in the ICU, to minimize the risk of complications such as bowel perforation, herniation or omental adhesions.
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James, Theodore, and Todd H. Baron. "902 PERITONEAL ENDOSONOGRAPHY FOR RESCUE OF A FRACTURED JACKSON-PRATT DRAIN." Gastrointestinal Endoscopy 89, no. 6 (June 2019): AB122. http://dx.doi.org/10.1016/j.gie.2019.04.136.
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Wani, Mumtaz Din, Ferkhand Mohi Ud Din, Aabid Rasool Bhat, Irshad Ahmad Kumar, Ashiq Hussain Raina, and Zubair Gul. "Role of biomarkers in predicting anastomotic leakage following colorectal surgeries." International Journal of Research in Medical Sciences 8, no. 7 (June 26, 2020): 2562. http://dx.doi.org/10.18203/2320-6012.ijrms20202896.
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Background: Recovery after surgery for patients with colorectal disease has improved with the advent of minimal access surgery and standardized recovery protocols. Despite these advances, anastomotic leakage remains one of the most dreaded complications following colorectal surgery, with rates of 3-27 per cent depending on specific risk factors. The aim of the study was to assess sensitivity and specificity of systemic and peritoneal drain-fluid bio-markers in early prediction of anastomotic leak; and to co-relate rise in levels of biomarkers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.Methods: The present study was a prospective observational study conducted on 60 patients in the Postgraduate Department of Surgery, Government Medical College, Srinagar after obtaining due ethical clearance over a period of two years.Results: The mean age was 54.87±11.901 years with 44 patients (73.3%) were males. Among systemic makers: the mean CRP level was 2.7800±0.500 mg/L, the mean total leukocyte count was 10.783±0.940 thousands and the mean serum procalcitonin level was 0.365±0.1385 ng/ml. Among peritoneal fluid drain bio-makers, the mean IL-6 level was 3551.066±1311.965 pg/ml, the mean IL-10 level was 628.533±460.358 pg/ml and the mean TNF-a level was 16.391±6.736 pg/ml. The anastomotic leak after colo-rectal surgery was noted in 16 patients (26.7%). In our study significant co-relation was noted between the rise in levels of peritoneal drain fluid biomarkers and severity of clinical symptoms but no significant co-relation was noted between the rise in levels of systemic markers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.Conclusions: Systemic biomarkers are poor predictors of anastomotic leak after colorectal surgery. But sensitivity and specificity of peritoneal fluid drain biomarkers in predicting anastomotic leak was significantly high.
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Churchill, D. N., K. E. Thorpe, K. D. Nolph, P. R. Keshaviah, D. G. Oreopoulos, and D. Pagé. "Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group." Journal of the American Society of Nephrology 9, no. 7 (July 1998): 1285–92. http://dx.doi.org/10.1681/asn.v971285.
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The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-yr patient survival probabilities were 91, 80, 72, and 71% for L, LA, HA, and H, respectively (P = 0.11). The 2-yr probabilities of both patient and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique failure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.33, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the mean 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and H, respectively (P < 0.001). The mean serum albumin values (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HA, and H, respectively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death. The decreased drain volume, increased albumin loss, and decreased serum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be considered in H and HA transporters.
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Pride, Eric T., Joan Gustafson, Angie Graham, Linda Spainhour, Vicki Mauck, Paige Brown, and John M. Burkart. "Comparison of a 2.5% and a 4.25% Dextrose Peritoneal Equilibration Test." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 22, no. 3 (May 2002): 365–70. http://dx.doi.org/10.1177/089686080202200311.
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Background Ultrafiltration (UF) failure develops over time in some patients on peritoneal dialysis. The workup of UF failure can be difficult and the 4.25% peritoneal equilibration test (PET) has been suggested to be more useful than the 2.5% PET for the workup of UF failure. It is unknown how a 4.25% PET compares to a 2.5% PET in individual patients. Objectives To assess the differences in drain volumes and sodium sieving using a 4.25% PET compared to a 2.5% PET, and to determine whether peritoneal transport rates, in terms of dialysate-to-plasma (D/P) ratios, are comparable between the two. Design Pilot study with each patient serving as his or her own control. Setting Outpatient dialysis facility of Wake Forest University Baptist Medical Center. Patients 47 patients, all of whom had a 2.5% PET and a 4.25% PET performed within 1 week of each other. Outcome Measures Dialysate-to-plasma ratios of urea and creatinine, dialysate total protein, and dialysate glucose compared to time zero (D/D0) at 0, 2, and 4 hours. Four-hour drain volumes and sodium sieving at 2 hours were also measured. Results There was reproducibility between the 2.5% and 4.25% PET for D/P ratios of urea and creatinine and for dialysate total protein. There were expected differences in drain volume, sodium sieving, and D/D0 glucose between the two methods. Conclusions The use of a 4.25% PET may be more useful for the workup of UF failure because of the accentuation of drain volume and sodium sieving, while remaining useful for prescription management.
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Tzamaloukas, Antonios H., Glen H. Murata, Deepak Malhotra, Lucy Fox, Richard S. Goldman, and Pratap S. Avasthi. "Dialysis Dose Required for a Minimal Acceptable Level." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 16, no. 1 (January 1996): 41–47. http://dx.doi.org/10.1177/089686089601600111.
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Objectives To identify the most advantageous formula for estimating creatinine clearance (CCr) and to establish a dose of dialysis that will ensure minimal acceptable levels of creatinine clearance in patients on continuous peritoneal dialysis (CPD). Design Analysis of all CCr studies performed in CPD patients over 40 months. Setting All four dialysis units following CPD patients in one city. One dialysis unit is government-owned, one is university-affiliated, and two are community-based. Participants One hundred and ninety-four patients representing almost the entire CPD population in Albuquerque. Interventions Creatinine and urea clearance studies were performed in 24-hour urine and drained dialysate samples. Creatinine clearance (peritoneal plus urinary) was normalized to either 1.73 m2 body surface area (CCr) or body water estimated by the Watson formulas (KT/V Cr). CCr and KT/Vcr were either corrected by averaging urinary creatinine and urea clearances or were not corrected. Two dialysis units were designated as the training set (92 patients, 143 clearance studies) and the other two units as the validation set (102 patients, 181 clearance studies). Main Outcome Measures Minimal acceptable creatinine clearance levels were determined in the training set by computing the creatinine clearance value corresponding to 1.70 weekly KTN urea by linear regression. Logistic regression models predicting low creatinine clearance were developed in the training set and were tested in the validation set. Results The following weekly creatinine clearance values corresponded to 1.70 KTN urea: corrected CCr 52.0 L/1. 73 m2, uncorrected CCr 54.4 L/1.73 m2, corrected KT/Vcr 1.46, uncorrected KT/Vcr 1.53. Logistic regression identified as predictors of low creatinine clearance low daily urine volume (UV) and low daily dialysate drain volume/body water (DV/V) for all four creatinine clearance formulas, plus low/low-average peritoneal solute transport (only for uncorrected CCr) and serum creatinine (for both KT/Vcr formulas). In the validation set, the predictive models produced an area under the receiver operating characteristic (ROC) curve between 0.835 and 0.919 indicating very good predictive accuracy. For corrected CCr and anuria, the regression model produced a minimal normalized drain volume (DV/V) value consistent with minimal acceptable CCr equal to 0.305 L/L per 24 hours. This DV/V cutoff detected low corrected CCr in validation set anuric subjects (n = 55) with a sensitivity of 85% and a specificity of 71 %. For uncorrected CCr and anuria, DV/V cutoffs were 0.273 L/L per 24 hours (high/ high-average peritoneal solute transport) and 0.420 L/L per 24 hours (low/low-average transport). Sensitivity and specificity of these cutoffs in validation set anuric subjects were 87% and 85%, plus 86% and 33%, respectively. Conclusions The uncorrected CCr appears to be the most advantageous creatinine clearance formula in CPD, because it allows the use of peritoneal solute transport type in the calculation of the minimal required normalized drain volume. The minimal acceptable uncorrected CCr is 54.4 L/1. 73 m2weekly. To achieve this uncorrected CCr in anuria, the required minimal normalized drain volume is 0.273 L per liter of body water daily if peritoneal solute transport is high or high-average and around 0.420 L per liter of body water daily if peritoneal solute transport is low or low-average. The required total daily drain volume is computed by multiplying the required normalized drain volume by body water.
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Čižman, Borut, Steve Lindo, Brian Bilionis, Ira Davis, Aaron Brown, Jennifer Miller, Gerald Phillips, Alex Kriukov, and James A. Sloand. "The Occurrence of Increased Intraperitoneal Volume Events in Automated Peritoneal Dialysis in the US: Role of Programming, Patient/User Actions and Ultrafiltration." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 34, no. 4 (June 2014): 434–42. http://dx.doi.org/10.1177/089686081403400401.
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Background, objectives and methods Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultra-filtration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively. Results Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed. Conclusions IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient's UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.
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Selby, Nicholas M., Sally Fonseca, Lisa Hulme, Richard J. Fluck, Maarten W. Taal, and Christopher W. McIntyre. "Automated Peritoneal Dialysis Has Significant Effects on Systemic Hemodynamics." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 26, no. 3 (May 2006): 328–35. http://dx.doi.org/10.1177/089686080602600309.
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Objectives Maintenance of residual renal function (RRF) is an important determinant of outcome in peritoneal dialysis patients. It remains contentious as to whether automated peritoneal dialysis (APD) leads to an increased rate of decline of RRF compared with continuous ambulatory peritoneal dialysis (CAPD). We studied whether APD was associated with significant systemic hemodynamic changes that may play a role in the accelerated loss of RRF. Methods As a follow-on from a previous study, 8 well-established CAPD patients underwent a 4-hour APD treatment consisting of 3 drain/fill cycles using 2 x 2.5 L 1.36% glucose and 1 x 3.86% glucose dialysate. Each dwell phase lasted 76 minutes. Blood pressure (BP) and a full range of hemodynamic variables, including pulse (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR), were measured noninvasively using continuous arterial pulse wave analysis. Results BP fell during 2 of the 3 drain/fill periods when dialysate was drained from the peritoneal cavity, but then rose upon instillation of dialysate fluid. The fall in BP was associated with a fall in TPR, matched by an inadequate rise in SV and CO. Over the entire study period, TPR progressively rose to +53.4% above baseline ( p = 0.032). Both SV and CO fell over the same period, to -21.1% ( p = 0.060) and -22.4% from baseline ( p = 0.037) respectively. This did not result in any significant difference between start and end BP. Conclusions This study demonstrates that APD is associated with significant systemic hemodynamic effects. The increased number of drain/fill cycles compared to CAPD, or the progressive rise in TPR and reduction in CO (possibly due to a cooling effect), may potentially be factors that adversely affect RRF in APD patients.
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Tzamaloukas, A. H., M. C. Saddler, G. H. Murata, D. Malhotra, P. Sena, D. Simon, K. L. Hawkins, K. Morgan, M. Nevarez, and B. Wood. "Symptomatic fluid retention in patients on continuous peritoneal dialysis." Journal of the American Society of Nephrology 6, no. 2 (August 1995): 198–206. http://dx.doi.org/10.1681/asn.v62198.
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The clinical features, pathogenesis, management, prognosis, and predictors of symptomatic fluid gain (SFR) were analyzed for 71 episodes occurring in 66 patients on continuous peritoneal dialysis, 94.4% on continuous ambulatory peritoneal dialysis (CAPD) and 5.6% on continuous cycling peritoneal dialysis. Compared with a control group of 149 CAPD patients, the SFR group had a higher percentage of diabetics (64 versus 46%) and a higher frequency of noncompliance with fluid restriction (76 versus 22%), salt restriction (74 versus 23%), and performance of dialysis (30 versus 7%) (all at P < or = 0.015). Peripheral edema (100%), pulmonary congestion (80%), pleural effusions (76%), and systolic (83%) and diastolic (66%) hypertension were the most common manifestations of SFR. The annual hospitalization rate for SFR was 4.1 +/- 5.8 days per patient. SFR resulted in the discontinuation of CAPD in 10 patients and death in 1 patient. Serum sodium concentration was not different between dry and maximal weight in the SFR group. Thirty-eight (58%) of SFR and 61 (41%) of control patients were evaluated by peritoneal equilibration tests (PET). SFR patients had lower PET drain volume (2.08 +/- 0.47 versus 2.54 +/- 0.23 L) and a higher frequency of high peritoneal solute transport (32.2 versus 2.4%). In this group, logistic regression identified dietary noncompliance, low PET drain volume, and young age as independent predictors of SFR. Response to management and preventive measures was inconsistent. The best results were obtained by the use of short dwell exchanges with hypertonic dialysate in compliant patients with high peritoneal solute transport. SFR has serious consequences in CAPD. (ABSTRACT TRUNCATED AT 250 WORDS)
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Ganatra, Vasant K., and Sunita Dinkar. "A comparative study of laparotomy closure in peritonitis with and without intraabdominal drainage." International Surgery Journal 9, no. 2 (January 29, 2022): 407. http://dx.doi.org/10.18203/2349-2902.isj20220332.
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Background: Purpose of this study was to investigate whether the use of abdominal drainage after laparotomy for peritonitis can prevent or significantly reduce post-operative complications such as intra-peritoneal abscess formation or wound infection.Methods: A prospective randomized study was done of one hundred and one (101) cases who underwent emergency laparotomy at General Hospital Palanpur and Sushrut Surgical Hospital, Palanpur. After completion of operation for peritonitis peritoneal cavity was either drained or not drained. Drained group of cases was termed as group A and non-drained group of cases was termed as group B. Parameters noted in group A were daily drain output, character and culture sensitivity of the fluid. Surgical outcomes in form of hospital stay and postoperative complications like wound infection, wound dehiscence, residual abscess within month of operation were compared between two groups.Results: Significant difference was observed between drained group and non-drained groups in terms of length of hospital stay, wound infection, wound dehiscence, residual abscess and overall postoperative complicationConclusions: From the present study we deduce that prophylactic abdominal drain in each case is unnecessary, as it stops functioning latest by 72 hours if not draining. On the contrary it invites infection from outside. This may delay convalescence. Drain should be kept when leak from suture line is anticipated or when there is lot of necrotic tissue within peritoneal cavity, and kept till it functions; otherwise it should be removed earliest.
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Dalton, Brian G. A., Kenneth C. Walters, and Melvin S. Dassinger. "Case Report: Delayed Perforation after Definitive Treatment of Focal Intestinal Perforation with a Peritoneal Drain." Case Reports in Surgery 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/316147.
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Focal intestinal perforation (FIP) has long been described in the pediatric literature. Peritoneal drainage (PD) is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP. The infant recovered well from this episode and was discharged home without known sequelae. Subsequently, the same patient presented 16 months later with peritonitis. A perforation was discovered at laparotomy without evidence of surrounding necrosis. Given this finding, we believe this second episode of perforation was at the same site as the initial episode of FIP. The finding of FIP has been described without findings of surrounding necrosis. However, we believe this to be the first report of delayed perforation greater than 1 year from initial presentation after FIP treated definitively with peritoneal drain.
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Karl, Zbylut J. Twardowski, O. Nolph Ramesh Khanna, Barbara F. Prowant Leonor, P. Ryan, Harold L. Moore, and Marc P. Nielsen. "Peritoneal Equilibration Test." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 7, no. 3 (July 1987): 138–48. http://dx.doi.org/10.1177/089686088700700306.
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Peritoneal transfer rates of urea, creatinine, glucose, protein potassium, and sodium as well as drain and residual volumes were measured during 103 equilibration tests performed in 18 diabetic and 68 nondiabetic patients. Equilibration test was performed over a 4-hour dwell exchange with 2 L of 2.5% Dianeal solution. Excellent reproducibility was seen after tests were standardized for length of preceding exchange, times of inflow and drainage, patient position, methods of obtaining and processing samples and laboratory assays. Diabetics did not have lower peritoneal solute transfers than nondiabetics. Wide variations were found in the study population. Measurements of creatinine, glucose and sodium transfer were particularly useful in predicting the patient's response to the standard CAPO. The patients with highaverage peritoneal solute transport did well on standard CAPO even after losing residual renal function. Patients with high peritoneal solute transfer rates were likely to have inadequate ultrafiltration on standard CAPO. These patients did much better on dialysis modalities with short dwell exchanges, i.e. nightly peritoneal dialysis (NPO) or daytime ambulatory peritoneal dialysis (OAPO). Patients with low average, and particularly low peritoneal transport rates were likely to develop symptoms and signs of inadequate dialysis as their residual renal function became negligible, particularly in individuals with high body surface area. Repeated tests were helpful in evaluating causes of insufficient ultrafiltration and/or inadequate dialysis.
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Zarour, Ahmad, Husham Abdulrahman, Kimball I. Maull, and Abdulwahab Almusleh. "Laparoscopic Rapid Totally Diverting Loop Colostomy: A New Twist on an Old Technique." American Surgeon 75, no. 7 (July 2009): 608–9. http://dx.doi.org/10.1177/000313480907500713.
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A minimally invasive variation of an established technique of colostomy is described. The method was originally published in 1977. In a setting where traditional celiotomy is not required, three ports are placed with the left lateral port used for the stoma. After initial peritoneal inspection, the colon segment and its mesentery are identified. A suture is passed forming a loop through the end of a soft latex drain, which is passed into the peritoneal cavity. Using the Goldfinger® instrument, the mesentery is breached and the loop end of the drain is snared and brought back through the mesenteric defect. This maneuver enables the colon to be retracted through the port site for completion of the colostomy. Inserting the finger along the loop provides proximal and distal visual confirmation. The colon is stapled but not divided. Maturation of the stoma may be done immediately or delayed depending on the clinical circumstances.
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Wang, Yi-Chao. "Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: A systematic review and meta-analysis." World Journal of Gastroenterology 21, no. 8 (2015): 2510. http://dx.doi.org/10.3748/wjg.v21.i8.2510.
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Vasudevan, V., Y. Zhuge, H. L. Neville, and J. E. Sola. "Peritoneal Drain versus Laparotomy for Very Low Birth Weight Neonates with Bowel Perforation." Journal of Surgical Research 158, no. 2 (February 2010): 277. http://dx.doi.org/10.1016/j.jss.2009.11.299.
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Craciunas, Laurentiu, Laura Stirbu, and Nikolaos Tsampras. "The use of a peritoneal gas drain following gynecological laparoscopy: a systematic review." European Journal of Obstetrics & Gynecology and Reproductive Biology 179 (August 2014): 224–28. http://dx.doi.org/10.1016/j.ejogrb.2014.04.012.
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Dann, Gregory C., Malcolm Hart Squires, Lauren McLendon Postlewait, David A. Kooby, George A. Poultsides, Sharon M. Weber, Mark Bloomston, et al. "Value of peritoneal drain placement after total gastrectomy for gastric adenocarcinoma: A multi-institutional analysis from the U.S. Gastric Cancer Collaborative." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 131. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.131.
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131 Background: A recent randomized trial of peritoneal drain (PD) placement after pancreaticoduodenectomy concluded that placement of PDs decreased the frequency and severity of complications. The role of PD placement after total gastrectomy for gastric adenocarcinoma (GAC) is not well-established. Methods: Patients who underwent total gastrectomy for GAC at 7 institutions from the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Univariate and multivariate analyses were performed to evaluate the association of PD placement with postoperative outcomes. Results: 344 patients were identified and anastomotic leak rate was 9%.253 (74%) patients received a PD. Those with PD placed had similar ASA class, tumor size, TNM stage, and need for additional organ resection when compared to their counterparts with no PD. No difference was observed in the rate of any complication (54% vs. 48%;p=0.45), major complication (25% vs. 24%;p=0.90), or 30-day mortality (7% vs. 4%;p=0.51) between the two groups. In addition, no difference in anastomotic leak (9% vs. 10%;p=0.90), need for secondary drainage (10% vs. 9%;p=0.92), or reoperation (13% vs. 8%;p=0.28) was identified. On multivariate analysis, PD placement was not associated with a decrease in frequency or severity of postoperative complications. Subset analysis of patients stratified by whether they underwent concomitant pancreatectomy similarly demonstrated no association of PD placement with reduced complications or mortality. In patients who experienced an anastomotic leak (n=31), placement of PD was similarly not associated with a decrease in complications, need for secondary drainage, or mortality. Conclusions: Peritoneal drain placement after total gastrectomy for adenocarcinoma, regardless of concomitant pancreatectomy, is not associated with a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, or decrease in the need for secondary drainage procedures or reoperation. Routine use of peritoneal drains is not warranted.
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Vonesh, Edward F., Kenneth O. Story, and William T. O'Neill. "A Multinational Clinical Validation Study of Pd Adequest 2.0." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 19, no. 6 (November 1999): 556–71. http://dx.doi.org/10.1177/089686089901900611.
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Objective To clinically validate the use of the newly released kinetic modeling program, PD ADEQUEST 2.0 for Windows (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), by assessing the level of agreement between measured and modeled values of urea and creatinine clearances (CCr), glucose absorption, total drain volumes, and net ultrafiltration for all forms of peritoneal dialysis. Design A nonrandomized, multinational, prospective longitudinal study. Patients The study involved 104 adult patients [41 on continuous ambulatory peritoneal dialysis (CAPD), 63 on automated peritoneal dialysis (APD)] from 16 centers in 7 countries. All patients underwent a 4-hour peritoneal equilibration test (PET) but with varying percentage dextrose concentrations (1.5% or 2.5% dextrose) and varying fill volumes (range 1.5 – 2.5 L). Patients with a residual renal function greater than 10 mL/min were excluded, as were patients who had peritonitis within 6 weeks prior to baseline. Main Outcome Measures Correlation coefficients and Bland–Altman limits of agreement were used to assess the level of agreement between measured and modeled values of weekly peritoneal urea Kt/V (pKt/V) and total Kt/V, weekly peritoneal creatinine clearance (pCCr, L/week/ 1.73 m2) and total CCr (L/week/1.73 m2), daily drain volume (L/day), net ultrafiltration (UF, L/day), daily peritoneal urea and creatinine mass removal (g/day), and daily peritoneal glucose absorption (g/day). Measured values were obtained from three repeat 24-hour urine and dialysate collections per patient, while modeled values were calculated using the Baxter PD ADEQUEST 2.0 program in conjunction with kinetic parameters estimated from a 4-hour PET and long-dwell exchange independent of the 24-hour collections. Results The results show there is excellent agreement between measured and modeled urea Kt/V and CCr with concordance correlation coefficients ranging from 0.83 to 0.97 among CAPD and APD patients. There was also excellent agreement between measured and modeled values of glucose absorption and total drain volumes (concordance correlations of 0.90 and 0.98, respectively). This level of agreement was further supported by a Bland– Altman analysis of individual differences, including differences between measured and modeled net UF (coefficient of clinical agreement ranged from 0.66 to 0.92). Conclusions Data from a carefully performed PET and overnight exchange can, in combination with a scientifically and clinically validated kinetic model, provide clinicians with a powerful mathematical tool for use in CAPD and APD prescription management. Although not intended to replace actual measurements, kinetic modeling can prove useful as a means for quickly estimating approximate levels of clearance for a wide variety of alternative prescriptions. This, in turn, should speed up the process by which a physician can optimize the dose of dialysis suitable for a given patient and his/her lifestyle.
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Cho, Jinbeom, Ilyoung Park, Dosang Lee, Kiyoung Sung, Jongmin Baek, and Junhyun Lee. "Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences." Digestive Surgery 32, no. 5 (2015): 375–81. http://dx.doi.org/10.1159/000438707.
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Background: Possible risk factors for postoperative intra-abdominal abscess (IAA) formation after laparoscopic appendectomy (LA) remain controversial. A perforated appendicitis, diabetes mellitus, peritoneal irrigation, obesity and age are considered to be possible risk factors for postoperative IAA, but the existing evidence is insufficient. This study aimed to identify the risk factors for IAA formation in patients receiving LA. Methods: Between January 2010 and December 2013, 1,817 patients who underwent 3-port LA were enrolled in this study. Patients were classified into 2 groups according to the development of postoperative IAA, and the differences between the groups were analyzed. Results: The incidence of IAA after LA was 1.5%, and the only identified risk factor for IAA was peritoneal irrigation. On logistic regression analysis of those patients who received peritoneal irrigation, suppurative appendicitis and non-placement of the peritoneal drain were found to be significant risk factors for the development of IAA. Conclusions: Peritoneal irrigation in a case of abdomen contamination was shown to be a risk factor for the development of postoperative IAA after LA. When peritoneal irrigation is performed, surgeons should consider using peritoneal drainage and postoperative antibiotics (including anti-anaerobic antibiotics) to prevent postoperative IAA formation.
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Szabo, Stephanie D., Kieri Jermyn, Jennifer Neel, and Kyle G. Mathews. "Evaluation of Postceliotomy Peritoneal Drain Fluid Volume, Cytology, and Blood-to-Peritoneal Fluid Lactate and Glucose Differences in Normal Dogs." Veterinary Surgery 40, no. 4 (April 5, 2011): 444–49. http://dx.doi.org/10.1111/j.1532-950x.2011.00799.x.
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Padmakumar, Smrithi, and Deepthy Menon. "Nanofibrous Polydioxanone Depots for Prolonged Intraperitoneal Paclitaxel Delivery." Current Drug Delivery 16, no. 7 (October 3, 2019): 654–62. http://dx.doi.org/10.2174/1567201816666190816102949.
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Background: Prolonged chemodrug delivery to the tumor site is a prerequisite to maintaining its localised therapeutic concentrations for effective treatment of malignant solid tumors. Objective: The current study aims to develop implantable polymeric depots through conventional electrospinning for sustained drug delivery, specifically to the peritoneum. Methods: Non-woven electrospun mats were fabricated by simple electrospinning of Polydioxanone solution loaded with the chemodrug, Paclitaxel. The implants were subjected to the analysis of morphology, mechanical properties, degradation and drug release in phosphate buffer and patient-derived peritoneal drain fluid samples. In vivo studies were conducted by surgical knotting of these implants to the peritoneal wall of healthy mice. Results: Non-woven electrospun mats with a thickness of 0.65±0.07 mm, weighing ~ 20 mg were fabricated by electrospinning 15 w/v% polymer loaded with 10 w/w% drug. These implants possessing good mechanical integrity showed a drug entrapment efficiency of 87.82±2.54 %. In vitro drug release studies in phosphate buffer showed a sustained profile for ~4 weeks with a burst of 10 % of total drug content, whereas this amounted to >60% in patient samples. Mice implanted with these depots remained healthy during the study period. The biphasic drug release profile obtained in vivo showed a slow trend, with peritoneal lavage and tissues retaining good drug concentrations for a sustained period. Conclusion: The results indicate that non-woven electrospun mats developed from biodegradable Polydioxanone polymer can serve as ideal candidates for easily implantable drug depots to address the challenges of peritoneal metastasis in ovarian cancer.
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Park, Sun-Hee, Eun-Gyui Lee, In-San Kim, Yong-Jin Kim, Dong-Kyu Cho, and Yong-Lim Kim. "Effect of Glucose Degradation Products on the Peritoneal Membrane in a Chronic Inflammatory Infusion Model of Peritoneal Dialysis in the Rat." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 24, no. 2 (March 2004): 115–22. http://dx.doi.org/10.1177/089686080402400202.
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Background Long-term use of the peritoneal membrane as a dialyzing membrane is hampered by its eventual deterioration. One of the contributing factors is glucose degradation products (GDPs) in the dialysis solution. In this study, we evaluated the effect of a low GDP solution on peritoneal permeability, the structural stability of the peritoneal membrane, and vascular endothelial growth factor (VEGF) production in a chronic inflammatory infusion model of peritoneal dialysis (PD) in the rat. Methods Male Sprague–Dawley rats were divided into 3 groups: a conventional solution group (group C, n = 12), a test solution group (group T, n = 12), and a normal control group (group NC, n = 8). Group T rats were infused with low GDP solution (2.3% glucose solution with two compartments), and group C rats with conventional dialysis solution (2.3% glucose solution), adjusted to pH 7.0 before each exchange. Animals were infused through a permanent catheter with 25 mL of dialysis solution. In both groups, peritoneal inflammation was induced by infusing dialysis solution supplemented with lipopolysaccharide on days 8, 9, and 10 after starting dialysate infusion. Peritoneal membrane function was assessed before and 6 weeks after initiating dialysis using the 1-hour peritoneal equilibration test (PET) employing 4.25% glucose solution. Both VEGF and transforming growth factor β1 (TGFβ1) in the dialysate effluent were measured by ELISA. The number of vessels in the omentum was counted after staining with anti-von Willebrand factor, and the thickness of submesothelial matrix of the trichrome-stained parietal peritoneum was measured. Peritoneal tissue was analyzed for VEGF protein using immunohistochemistry. Results At the end of 6 weeks, the rate of glucose transport (D/D0, where D is glucose concentration in the dialysate and D0 is glucose concentration in the dialysis solution before it is infused into the peritoneal cavity) was higher in group T ( p < 0.05) than in group C. Dialysate-to-plasma ratio (D/P) of protein was lower in group T ( p < 0.05) than in group C; D/Purea, D/Psodium, and drain volumes did not differ significantly between groups C and T. Dialysate VEGF and TGFβ levels were lower in group T ( p < 0.05) than in group C. Immunohistochemical studies also revealed less VEGF in the peritoneal membranes of group T. There were significantly more peritoneal blood vessels in group C ( p < 0.05) than in group T, but the thickness of submesothelial matrix of the parietal peritoneum was not different between the two groups. The VEGF levels in the dialysate effluent correlated positively with the number of blood vessels per field ( r = 0.622, p < 0.005). Conclusion Using a chronic inflammatory infusion model of PD in the rat, we show that dialysis with GDP-containing PD fluid is associated with increased VEGF production and peritoneal vascularization. Use of low GDP solutions may therefore be beneficial in maintaining the function and structure of the peritoneal membrane during long-term PD.
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Eddington, Helen, Helen Hurst, Marlina T. Ramli, Mary Speake, and Alastair J. Hutchison. "Calcium and Magnesium Flux in Automated Peritoneal Dialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 29, no. 5 (September 2009): 536–41. http://dx.doi.org/10.1177/089686080902900511.
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Background Calcium and magnesium balance in continuous ambulatory peritoneal dialysis (CAPD) has been extensively studied with several of the different formulations of fluid available. Calcium and magnesium balance in automated PD (APD) is less well studied and the effect on Ca and Mg flux is unknown. Data on glucose polymer solutions are also lacking. This prospective observational study was undertaken to examine mass transfer of Ca and Mg in APD patients. Methods 12 patients on APD were studied for two 24-hour periods using, alternately, 1.75 mmol/L and 1.25 mmol/L Ca (Dianeal PD1 and Dianeal PD4; Baxter Healthcare, Newbury, UK) 1.36% glucose-based dialysis fluid for the 9-hour overnight dialysis, followed by a 15-hour daytime dwell of glucose polymer-based fluid (icodextrin). Serum ionized Ca, serum Mg, and dialysate Ca and Mg concentrations were measured at the beginning and end of each period. Mass transfer was calculated as millimoles per exchange. Results During rapid overnight exchanges with Dianeal PD1 and PD4, mass transfer of Mg and Ca did not show significant correlations with serum levels when using PD1 fluid; however, mass transfer of Mg, but not Ca, was significantly correlated to serum levels when using PD4 fluid. During the long dwell with icodextrin, dialysate drain volume was the most significant factor determining the flux of both Ca and Mg. Conclusion Mass transfer of Ca and Mg in APD patients using conventional dialysis fluid was not related to drain volume in this study, which differs to studies in CAPD. Flux of Ca and Mg during icodextrin use was found to be dependent on ultrafiltration rate and not dialysate or serum concentration.
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Yadav, Priyanka, and Ankit Agarwal. "Meconium peritonitis in a preterm infant: a surgical emergency." International Journal of Contemporary Pediatrics 8, no. 4 (March 23, 2021): 753. http://dx.doi.org/10.18203/2349-3291.ijcp20211090.
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Meconium peritonitis is sterile chemical peritonitis that occurs after intestinal perforation resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The clinical presentations after birth can range from completely sealed-off peritonitis without any symptoms, to severe peritonitis requiring emergency surgical intervention. We describe a case of meconium peritonitis in a premature infant following intestinal perforation. In the immediate postnatal period, the patient was intubated and a peritoneal drain was placed. Laparotomy with bowel resection was performed the following day. The postoperative course was uneventful and the patient was discharged home in good clinical condition.
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Durand, Pierre Yves, Philippe Freida, Belkacem Issad, and Jacques Chanliau. "How to Reach Optimal Creatinine Clearances in Automated Peritoneal Dialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 16, no. 1_suppl (January 1996): 167–71. http://dx.doi.org/10.1177/089686089601601s31.
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This paper summarizes the basis of prescription for automated peritoneal dialysis (APD) established during a French national conference on APD. Clinical results and literature data show that peritoneal clearances are closely determined by peritoneal permeability and hourly dialysate flow rate, independently of dwell time or number of cycles. With APD, peritoneal creatinine clearance increases according to the hourly dialysate flow rate to a maximum (plateau), then decreases because of the multiplication of the drain-fill times. The hourly dialysate flow giving the maximum peritoneal creatinine clearance is defined as the “maximal effective dialysate flow” (MEDF). MEDF is higher for high peritoneal permeabilities: MEDF is 1.8 and 4.2 L/hr with nocturnal tidal peritoneal dialysis (TPD) for a 4-hr creatinine dialysate-to-plasma ratio (DIP) of 0.50 and 0.80, respectively. With nightly intermittent peritoneal dialysis (NIPD), MEDF is 1.6 and 2.3 Llhr for a DIP of 0.50 and 0.78, respectively. Under these conditions, tidal modalities can only be considered as a way to increase the MEDF. Using the MEDF concept for an identical APD session duration, the maximal weekly normalized peritoneal creatinine clearance can vary by 340% when 4hr DIP varies from 0.41 to 0.78. APD is not recommended when 4-hr creatinine DIP is lower than 0.50. However, the limits of this technique may be reached at higher peritoneal permeabilities in anurics because of the duration of sessions andlor the additional exchanges required by these patients.
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Fukuzaki, Haruna, Junichiro Nakata, Yuka Shirotani, Yuki Shimizu, Masayuki Maiguma, Nao Nohara, and Yusuke Suzuki. "An Unusual Case of Recurrent Migration of the Peritoneal Dialysis Catheter into the Inguinal Hernia Sac." Case Reports in Nephrology and Dialysis 11, no. 2 (June 28, 2021): 152–57. http://dx.doi.org/10.1159/000515566.
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We herein report the first case of a patient with recurrent migration of the peritoneal dialysis (PD) catheter into the inguinal hernia sac. A 58-year-old man suffered from end-stage renal disease due to polycystic kidney disease (PKD). A year before starting PD, a PD catheter was implanted with stepwise initiation of PD using the Moncrief-Popovich technique. He complained of drain failure and right inguinal swelling during the induction period and was diagnosed with right inguinal hernia. Further examination revealed that the PD catheter tip had migrated into the inguinal hernia sac. Although surgery was planned, the PD catheter tip spontaneously migrated back into the intra-peritoneal space. 14 months later, he noticed fill and drain failure again. Diagnosis was PD catheter dysfunction due to migration into the right inguinal hernia sac. PD was resumed without issues after repositioning of the PD catheter and repair of the inguinal hernia. Inguinal hernia is a frequent complication in PD patients, especially in those with PKD. Early diagnosis and treatment of hernia should be considered in PD patients.
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Drepper, Valérie Jotterand, Pierre-Yves Martin, Catherine Stoermann Chopard, and James A. Sloand. "Remote Patient Management in Automated Peritoneal Dialysis: A Promising New Tool." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 38, no. 1 (January 2018): 76–78. http://dx.doi.org/10.3747/pdi.2017.00054.
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Remote patient management (RPM) has the potential to help clinicians detect early issues, allowing intervention prior to development of more significant problems. A 23-year-old end-stage kidney disease patient required urgent start of renal replacement therapy. A newly available automated peritoneal dialysis (APD) RPM system with cloud-based connectivity was implemented in her care. Pre-defined RPM threshold parameters were set to identify clinically relevant issues. Red flag dashboard alerts heralded prolonged drain times leading to clinical evaluation with subsequent diagnosis of and surgical repositioning for catheter displacement, although it took several days for newly-RPM-exposed staff to recognize this issue. Post-PD catheter repositioning, drain times were again normal as indicated by disappearance of flag alerts and unremarkable cycle volume profiles. Identification of < 90% adherence to prescribed PD therapy was then documented with the RPM system, alerting the clinical staff to address this important issue given its association with significant negative clinical outcomes. Healthcare providers face a “learning curve” to effect optimal utilization of the RPM tool. Larger scale observational studies will determine the impact of RPM on APD technique survival and resource utilization.
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Benito, Alberto, Ramón Saiz-Mendiguren, Amaia García-Lallana, David Cano, Mariana Elorz, and José Ignacio Bilbao. "Iatrogenic Hepatic Puncture while Placing a Peritoneal Drain: Percutaneous Direct Embolization under Ultrasound Guidance." Journal of Vascular and Interventional Radiology 22, no. 4 (April 2011): 582–84. http://dx.doi.org/10.1016/j.jvir.2010.11.009.
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Kinashi, Hiroshi, Yasuhiko Ito, Ting Sun, Takayuki Katsuno, and Yoshifumi Takei. "Roles of the TGF-β–VEGF-C Pathway in Fibrosis-Related Lymphangiogenesis." International Journal of Molecular Sciences 19, no. 9 (August 23, 2018): 2487. http://dx.doi.org/10.3390/ijms19092487.
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Lymphatic vessels drain excess tissue fluids to maintain the interstitial environment. Lymphatic capillaries develop during the progression of tissue fibrosis in various clinical and pathological situations, such as chronic kidney disease, peritoneal injury during peritoneal dialysis, tissue inflammation, and tumor progression. The role of fibrosis-related lymphangiogenesis appears to vary based on organ specificity and etiology. Signaling via vascular endothelial growth factor (VEGF)-C, VEGF-D, and VEGF receptor (VEGFR)-3 is a central molecular mechanism for lymphangiogenesis. Transforming growth factor-β (TGF-β) is a key player in tissue fibrosis. TGF-β induces peritoneal fibrosis in association with peritoneal dialysis, and also induces peritoneal neoangiogenesis through interaction with VEGF-A. On the other hand, TGF-β has a direct inhibitory effect on lymphatic endothelial cell growth. We proposed a possible mechanism of the TGF-β–VEGF-C pathway in which TGF-β promotes VEGF-C production in tubular epithelial cells, macrophages, and mesothelial cells, leading to lymphangiogenesis in renal and peritoneal fibrosis. Connective tissue growth factor (CTGF) is also involved in fibrosis-associated renal lymphangiogenesis through interaction with VEGF-C, in part by mediating TGF-β signaling. Further clarification of the mechanism might lead to the development of new therapeutic strategies to treat fibrotic diseases.
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Johnson, David W., David W. Mudge, Sophie Blizzard, Mary Arndt, Amanda O'Shea, Rhonda Watt, Jan Hamilton, Sharon Cottingham, Nicole M. Isbel, and Carmel M. Hawley. "A Comparison of Peritoneal Equilibration Tests Performed 1 and 4 Weeks after PD Commencement." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 24, no. 5 (September 2004): 460–65. http://dx.doi.org/10.1177/089686080402400511.
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Objective The aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement. Design Prospective observational study of an incident PD cohort at a single center. Setting Tertiary-care institutional dialysis center. Participants The study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 ± 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD. Main Measurements Measurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0 glucose), and drain volumes at 4 hours. Results When paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 ± 0.07 vs 0.94 ± 0.07 respectively; p < 0.05), D/P creatinine (0.55 ± 0.12 vs 0.66 ± 0.11, p < 0.001), and D/D0 glucose (0.38 ± 0.08 vs 0.36 ± 0.10, p < 0.05). Using Bland–Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0 glucose (weighted κ 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement ( n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements. Conclusions Peritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0 glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.
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Vasilakis, Georgia M., and Dan Parrish. "Gastric outlet obstruction secondary to peritoneal drain placement for necrotizing enterocolitis in a premature infant." Journal of Pediatric Surgery Case Reports 72 (September 2021): 101962. http://dx.doi.org/10.1016/j.epsc.2021.101962.
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Ahle, Samantha, Faidah Badru, Rachelle Damle, Hector Osei, Armando Salim Munoz-Abraham, Adam Bajinting, Maria Estefania Barbian, et al. "Multicenter retrospective comparison of spontaneous intestinal perforation outcomes between primary peritoneal drain and primary laparotomy." Journal of Pediatric Surgery 55, no. 7 (July 2020): 1270–75. http://dx.doi.org/10.1016/j.jpedsurg.2019.07.007.
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Valappil, Mithun V., Sumit Gulati, Manish Chhabra, Ajay Mandal, Sanjay De Bakshi, Avik Bhattacharyya, and Supriyo Ghatak. "Drain in laparoscopic cholecystectomy in acute calculous cholecystitis: a randomised controlled study." Postgraduate Medical Journal 96, no. 1140 (December 23, 2019): 606–9. http://dx.doi.org/10.1136/postgradmedj-2019-136828.
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BackgroundThere is paucity of evidence regarding the role of drain in laparoscopic cholecystectomy (LC) in acute calculous cholecystitis (ACC), and surgeons have placed the drains based on their experiences, not on evidence-based guidelines. This study aims to assess the value of drain in LC for ACC in a randomised controlled prospective study.Patients and methodsAll patients with mild and moderate ACC undergoing LC were assessed. Preoperatively, patients with choledocholithiasis, Mirizzi syndrome and biliary stent were excluded. Intraoperatively or postoperatively, patients with complications, partial cholecystectomies and malignancies were excluded. Patients were randomised using computer-generated random numbers into two groups at the end of cholecystectomy before closure. Requirement of radiologically guided (ultrasonography () or CT) percutaneous aspiration/drainage of symptomatic intra-abdominal collection or reoperation; continuation of parenteral antibiotics beyond 24 hours or change in antibiotics empirically or based on peritoneal fluid culture sensitivity; requirement of postoperative USG or CT scan based on postoperative clinical course; wound infection rates; postoperative pain using numeric rating scale at 6 and 24 hours; and the duration of hospital stay in both groups were noted.ResultsForty-two out of 50 consecutive patients were randomised into two equal groups. Pain score at 6 and 24 hours was less in patients without drain. All other complication rates and duration of stay were similar in both groups.ConclusionsDrains should not be placed routinely after LC in ACC as it increases pain and does not help in detecting or decreasing complications.
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Ruano Cea, Elisa, Philippe Jouvet, Suzanne Vobecky, and Aicha Merouani. "Draining Fluids through a Peritoneal Catheter in Newborns after Cardiac Surgery Helps to Control Fluid Balance." Case Reports in Medicine 2010 (2010): 1–3. http://dx.doi.org/10.1155/2010/731865.
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Dialysis can be used in severe cases, but may not be well tolerated. In such patients, peritoneal drainage could be an alternative option for fluid removal. We report the case of a newborn with a truncus arteriosus who developed postoperatively a complicated clinical course with right ventricular dysfunction, prerenal condition as well as fluid overload despite diuretic therapy. Dialysis was indicated for fluid removal. Peritoneal dialysis was started using a surgically placed Tenckhoff catheter and stopped due to inefficacy and leaks and no other modalities of dialysis were used. However, the catheter was left in place over a period of two months for fluid drainage and removed because of unexplained fever. In order to determine the effect of peritoneal drainage, we selected a period of one week before and one week after the removal of the drain to compare daily clinical data, urine electrolytes and renal function and found a positive effect on fluid balance control. We conclude that the fluid removal by continuous peritoneal drainage is a simple and safe alternative that can be used to control fluid balance in infants after cardiac surgery.
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de Mooij, Cornelis Maarten, Martijn Maassen van den Brink, Audrey Merry, Thais Tweed, and Jan Stoot. "Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery." Journal of Clinical Medicine 8, no. 11 (November 17, 2019): 2005. http://dx.doi.org/10.3390/jcm8112005.
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Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.