Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit

Purpose  We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units. Methods  A retrospective observational study was conducted in a pediatric cardiac care unit in a tertiary care university hospital. The subjects were 40 patients with AKI requiring PD between 2003 and 2005, and controls matched by type of surgery and body weight. Acid-base variables, including blood gas data and electrolytes, were assessed. The Stewart-Figge variables, including strong ion difference apparent (SIDa), strong ion difference effective (SIDe), and strong ion gap (SIG), were calculated. Results  Blood gas analyses showed that the PD group was more acidemic, with a lower mean bicarbonate and a lower mean base excess, typical features of metabolic acidosis. The strong ion analyses revealed that the PD group had lower mean sodium and albumin concentrations. Based on the Stewart-Figge methodology, SIDa was smaller in the PD group than in the control group, but SIG was similar in the two groups. Receiver-operating characteristic curve analyses showed that serum albumin was the only prognostic factor associated with PCCU mortality, even after adjustment for PD treatment. Conclusion  Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.     

Staged laparoscopic adjuvant intraperitoneal chemohyperthermia after complete resection for locally advanced colorectal or gastric cancer: a preliminary experience

Background  Cytoreductive surgery followed by intraperitoneal chemohyperthermia (IPCH) is a promising treatment for patients with peritoneal carcinomatosis, a disease with dismal prognosis. Methods  We describe our preliminary experience with staged adjuvant laparoscopic IPCH after complete resection in patients with locally or regionally advanced colorectal or gastric cancer. Results  Twenty-one patients underwent resection for colorectal (N = 16) or gastric cancer (N = 5) followed by staged laparoscopic IPCH. No conversion to laparotomy was required. No major operative incident occurred. Mean duration of hospital stay was 12 days (range 9–23 days). No mortality occurred in the 30-day postoperative period. Four patients developed major complications (19%). One patient (5%) was reoperated. Mean follow-up period was 15.5 months (range 9–29 months). Three patients died, including two of cancer-related causes. No patient developed peritoneal carcinomatosis during the follow-up period. Conclusion  Staged laparoscopic adjuvant IPCH after open or laparoscopic resection in selected patients with colorectal or gastric cancer is feasible and reasonably safe. However, additional data are required to determine the effect on long-term survival.     

Two-port laparoscopic placement of a peritoneal dialysis catheter with abdominal wall fixation

We devised a new laparoscopic technique for peritoneal dialysis catheter (PDC) placement to overcome the common problem of malfunction or migration of the catheter. Between March 2005 and August 2006, 38 patients underwent laparoscopic catheter placement with lower abdominal wall fixation. Using an abdominal scout film, we checked for catheter tip migration regularly. There was no leak in the immediate postoperative period. After follow-up of 21.5 months (range 6–34), all catheters were working properly, although tip migrations were found in the iliac fossa in three patients and in the right upper quadrant in one patient. A port site hernia developed in one patient and peritonitis developed in two patients. Only one remote migration (2.6%) occurred during the study period. Thus, our method of laparoscopic catheter insertion might be a feasible option.     

腹膜原发性腺癌临床病理分析及鉴别诊断

目的 探讨腹膜原发性腺癌的临床病理特点和鉴别诊断.方法 回顾性分析8例腹膜原发性腺癌的临床病理资料,患者均为女性,平均年龄55.7岁,以腹胀、腹水为主要临床表现;其中浆液性乳头状腺癌7例,黏液腺痛1例.对肿瘤进行光镜观察,并做免疫绀化染色.结果 免疫组化染色显示肿瘤广谱CK、CK7、CK20、CA125、CEA、EMA、波形蛋白、钙网膜蛋白、P53 阳性比例分别为8/8、8/8、1/8、7/8、7/8、8/8、1/8、1/8、8/8.结论腹膜原发性腺癌被认为是起源于第二苗勒氏管系统的恶性肿瘤,起病隐匿、发病率低,与卵巢肿瘤相似有多种组织类型,因此容易误诊,免疫组化染色有助于鉴别诊断.     

尿毒清颗粒对维持性腹膜透析患者全身微炎症状态的影响

目的通过观察超敏C反应蛋白水平的变化,探讨尿毒清颗粒对维持性腹膜透析患者全身微炎症状态的影响。方法选取60例腹膜透析患者(透析时间3个月)为研究对象,10例健康志愿者为正常对照,研究对象于维持性腹膜透析(CAPD)的同时,予以尿毒清颗粒口服,分别于治疗0、3、6个月后检测患者血清超敏C反应蛋白(Hs-CRP)水平,并进行比较。结果与健康对照者比较,维持性腹膜透析患者存在全身微炎症状态,血清Hs-CRP水平明显升高,经过尿毒清颗粒治疗3个月后,Hs-CRP水平较治疗前明显下降(P0.05),随着治疗时间的延长下降更明显。结论尿毒清可以降低维持性腹膜透析患者的血清Hs-CRP,具有明显的抗炎症作用。     

Altered apoptosis of inflammatory neutrophils in MMP-9-deficient mice is due to lower expression and activity of caspase-3

Matrix metalloproteinase 9 (MMP-9) is a Zn²⁺-dependent endopeptidase that degrades some of the components of basement membranes and extracellular matrix and thus participates in leukocyte infiltration during inflammation. In a model of zymosan peritonitis, neutrophil infiltration in MMP-deficient (MMP-9^−/−) mice was significantly weaker at the time of their maximal influx in wild-type mice (6 h). However, during the late stages of peritonitis (24 h) an extended accumulation of neutrophils was observed in MMP-9^−/− versus the wild-type mice. Recently, we reported that the ratio of apoptosis of inflammatory leukocytes is impaired in MMP-9^−/− mice during late peritonitis and the process depends on COX-1-driven PGE₂. Here we scrutinized the alterations in apoptotic mechanisms by comparisons between MMP-9^−/− and the wild-type mice. Altered apoptosis occurred only during late (24 h) peritonitis and concerned only neutrophils, and not macrophages, mast cells or lymphocytes. Furthermore, expression and activity of caspases was altered in MMP-9^−/− animals, delayed for caspase-8 and -9, and decreased in the case of caspase-3. Also the expression of Bax/Bcl-2 proteins was changed in MMP-9^−/− mice. These changes, and in particular the impaired neutrophil apoptosis and weaker caspase-3 activity, were restored by the selective COX-1 inhibition. We conclude that in mice lacking MMP-9 the enhanced COX-1-PGE₂ decreases caspase-3 expression and activity leading to impaired apoptosis of inflammatory neutrophils resulting in abnormal accumulation of the cells at the inflammatory focus. The data also reinforce the notion that MMP-9 is a key enzyme in neutrophil biology.     

腹膜组织PPAR-γ、TLR4表达及STAT1信号活化与LPS诱导大鼠急性腹膜炎的相关性研究

h后p-STAT1表达明显升高,持续至24 h,与对照组相比,差异有统计学意义(P＜0.01).LPS作用4、8 h时大鼠腹水中IL-6浓度显著增高,与对照组相比差异均有统计学意义(P＜0.01,P＜0.05),12 h后其浓度接近对照组水平.壁层腹膜石蜡切片Masson染色可见LPS作用不同时间组腹膜组织明显水肿;各组间腹水白细胞计数差异无统计学意义.结论 腹膜组织PPAR-γ、TLR4的高表达及STAT1活化共同参与了LPS诱导的大鼠腹膜透析相关性急性腹膜炎症过程.     

Extrathoracic mesothelial proliferations and their mimics

Mesothelial proliferations, either reactive or neoplastic in nature, often pose difficult diagnostic dilemmas. Electron microscopy continues to be a gold standard in the identification of mesothelial differentiation. However, it is very common to apply long panels of antibodies for that purpose. In most cases, light microscopy and immunohistochemistry will solve the problem. However, the definitive, specific, and sensitive immunohistochemical marker is still lacking. This is particularly true in peritoneal and testicular mesothelial tumors, in which common embryologic origin with epithelial elements results in overlapping immunohistochemistry and morphology. The particularities of peritoneal and testicular mesothelial proliferations, and the main tumors that may mimic them in these sites, as well as the value and limitations of immunohistochemistry and electron microscopy in their differential diagnosis are the subject of this review.     

Tumour necrosis factor-alpha, interleukin-6 and interleukin-8 do not promote adhesion of human endometrial epithelial cells to mesothelial cells in a quantitative in vitro model

BACKGROUND: A key factor in the pathogenesis of endometriosis is the endometrial-peritoneal adhesion. To study the pathogenesis of endometriosis, a quantitative in vitro assay (QIVA) was developed to measure in vitro adhesion between human endometrial epithelial cells and mesothelial cells using commercially available cell lines. Using the QIVA, the hypothesis was tested that tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8) promote adhesion of endometrial epithelial cells to mesothelial cells. METHODS: Mesothelial cells were pre-treated with TNF-alpha, IL-6 or IL-8 in various concentrations (ranging from 0 to 1000 IU/ml) for 24 h. Confluent endometrial epithelial cells were labelled with [35S]methionine, added to the confluent mesothelial cells and incubated for 1 h. After incubation, non-adhering cells were removed and adherent cells were solubilized and their [35S]methionine radioactivity was counted to quantify the adherence of endometrial epithelial cells to mesothelial cells. RESULTS: The in vitro adhesion of human endometrial epithelial cells to human mesothelial cells was inhibited in a dose-dependent manner by TNF-alpha (P=0.0007), IL-6 (P<0.0001) and IL-8 (P=0.0004). CONCLUSIONS: Using a quantitative in vitro adhesion assay, we were unable to confirm our hypothesis that TNF-alpha, IL-6 and IL-8 promote the in vitro adhesion between endometrial epithelial cells and mesothelial cells.