Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar.

AIM: The aim of this work is to analyze, by means of noninvasive monitoring, the clinical effects of high intraperitoneal pressure for enough time to insert the first trocar. METHODS: Sixty-seven patients without significant lung problems were randomly divided into groups P12 (n = 30, maximum intraperitoneal pressure 12 mmHg) and P20 (n = 37, maximum intraperitoneal pressure 20 mmHg). A Veress needle was inserted into the left hypochondrium for creation of pneumoperitoneum. The parameters evaluated were heart rate (HR, in bpm), arterial oxygen saturation (SaO(2), expressed as percentage of hemoglobin saturated with oxygen), end-tidal CO(2) (ETCO(2), in mmHg), mean arterial pressure (MAP, in mmHg), and intratracheal pressure (ITP, in cmH(2)O). Clinical parameters were evaluated in both groups at time point 0 (TP0, before CO(2) insufflation), time point 1 (TP1, when intraperitoneal pressure of 12 mmHg was reached in both groups), time point 2 (TP2, 5 min after reaching intraperitoneal pressure of 12 mmHg in group P12 and of 20 mmHg in group P20), and time point 3 (TP3, 10 min after reaching intraperitoneal pressure of 12 mmHg in group P12 and 10 min after TP1 in group P20, when intraperitoneal pressure decreased from 20 to 12 mmHg). Values outside of the normal range or occurrence of atypical phenomena suggestive of organic disease indicated clinical changes. RESULTS: Statistically significant differences were observed between the two groups regarding HR, MAP, ETCO(2), and ITP. No significant clinical changes were observed. CONCLUSIONS: Transitory, high intraperitoneal pressure (20 mmHg for 5 min) for insertion of the first trocar resulted in changes in HR, MAP, ETCO(2), and ITP that were within the normal range, and no adverse clinical effects were observed. Therefore, the use of transitory, high intraperitoneal pressure is recommended to prevent iatrogenic injury during blind insertion of the first trocar. Nevertheless, it is not clear that this method would be safe in patients with moderate to severe chronic obstructive pulmonary disease.

Anti-inflammatory properties of a heparin-like glycosaminoglycan with reduced anti-coagulant activity isolated from a marine shrimp.

The anti-inflammatory properties of a heparin-like compound from the shrimp Litopenaeus vannamei are related. Besides reducing significantly (p<0.001) the influx of inflammatory cells to injury site in a model of acute inflammation, shrimp heparin-like compound was able to reduce the matrix metalloproteinase (MMPs) activity in the peritoneal lavage of inflamed animals. Moreover, this compound also reduced almost 90% the activity of MMP-9 secreted by human activated leukocytes. Negligible anti-coagulant activities in aPPT assay and a poor bleeding potential make this compound a better alternative than mammalian heparin as a possible anti-inflammatory drug.

The ventriculoomental bursa shunt.

OBJECT: The aim of this study is to access the efficacy of the omental bursa (lesser sac) as a receptacle of cerebrospinal fluid (CSF) and to use it as an alternative to the ventriculoatrial or ventriculopleural shunts when the peritoneum reduces or loses its CSF absorption capacity. METHODS: Three patients with hydrocephalus presented with malfunctioning of ventriculoperitoneal shunts, secondary to peritoneal blockage caused by previous episodes of shunt infections in two and peritonitis in one patient. All patients underwent previous shunt revisions due to ventriculitis and shunt obstruction ranging from three to eight times. In order to keep the peritoneal cavity as the main receptacle of CSF absorption site, the distal catheter was inserted in the omental bursa, through the foramen of Winslow, jointly by a pediatric surgeon. We denominated this new technique of CSF diversion as ventriculoomental bursa (VOB) shunting. The children have been followed at least for 1 year (range 12 to 28 months) with no recurrence of shunt. CONCLUSIONS: VOB shunting may be considered an acceptable technique to CSF shunting when the anterior peritoneum loses or decreases its CSF absorption capacity.

Can the inflammation markers of patients with high peritoneal permeability on continuous ambulatory peritoneal dialysis be reduced on nocturnal intermittent peritoneal dialysis?

BACKGROUND: Patients with high peritoneal permeability have the greatest degree of inflammation on continuous ambulatory peritoneal dialysis (CAPD), which may be associated with their higher mortality. Nocturnal intermittent peritoneal dialysis (NIPD; "dry day") may decrease inflammation by reducing the contact between dialysate and peritoneum and/or providing better fluid overload control. Therefore, the aims of this study were to determine and compare serum and dialysate concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) of patients with high or high-average peritoneal transport on CAPD, changed to NIPD, and ultimately to continuous cyclic peritoneal dialysis (CCPD). METHODS: Crossover clinical trial in 11 randomly selected patients. All subjects had been on CAPD and were changed to NIPD, and ultimately to CCPD (6.4 +/- 3.1 months after initiation of study). All patients used glucose-based dialysate. Evaluations of clinical and biochemical parameters, dialysis adequacy, and serum and dialysis inflammation markers were performed at baseline on CAPD, 7 - 14 days after changing to NIPD, 7 - 14 days after switching to CCPD, and after 1 year of follow-up. All patients used only 1.5% glucose dialysate during evaluation days. CRP was determined by nephelometry, and IL-6 and TNF-alpha by ELISA. RESULTS: Seven patients were high transporters and 4 high average. Ultrafiltration increased (p < 0.05) when patients changed from CAPD [0.38 L (-0.3 - 1.1 L)] to NIPD [2.64 L (0.7 - 4.7 L)]; it then decreased on CCPD [0.88 L (0.4 - 1.3 L) and at the end of study [0.65 L (0.3 - 1.0 L)]. This better fluid overload control was accompanied by decreased weight and systolic and diastolic blood pressure when patients changed from CAPD (89 +/- 13 kg, 160 +/- 23 and 97 +/-9 mmHg, respectively) to NIPD (86 +/- 17 kg, 145 +/- 14 and 86 +/- 9 mmHg, respectively), and increased weight and systolic and diastolic blood pressure on CCPD (85 +/- 15 kg, 143 +/-23 and 88 +/- 14 mmHg, respectively) and at the end of follow-up (87 +/- 16 kg, 155 +/- 24 and 89 +/- 12 mmHg, respectively). Median serum CRP decreased (p = 0.03), from 3.8 (1.6 - 8.5) mg/L on CAPD to 1.0 (0.4 - 4.4) mg/L on NIPD, but increased on CCPD [1.8 (1.3 - 21) mg/L] and at the end of the study [3.2 (0.3 - 8.2) mg/L]. Dialysate CRP decreased nonsignificantly, from 0.10 (0 - 0.5) mg/L on CAPD to 0 (0 - 0.03) mg/L on NIPD, to 0.01 (0 - 0.08) mg/L on CCPD, and to 0 (0 - 0) mg/L at final evaluation. Serum TNF-alpha concentration decreased, from 0.14 (0.04 - 0.6) pg/mL on CAPD to 0.01 (0 - 0.08) pg/mL on NIPD, and then increased to 0.06 (0 - 0.4) pg/mL on CCPD and to 0.11 (0 - 0.2) pg/mL at the end of the study; whereas dialysate TNF-alpha decreased, from 0.08 (0.03 - 0.2) pg/mL on CAPD to 0.04 (0 - 0.2) pg/mL on NIPD, and to 0 (0 - 0) pg/mL and 0 (0 - 0.05) pg/mL on CCPD and final evaluation respectively. Serum IL-6 decreased (p = 0.07), from 2.5 (2.0 - 4.2) pg/mL on CAPD to 1.0 (0.7 - 2.0) pg/mL on NIPD, and to 1.0 (0.8 - 2.9) pg/mL on CCPD and 1.0 (0.5 - 9.8) pg/mL at the end of the study; whereas dialysate levels remained similar on CAPD [8.0 (3.7 - 13) pg/mL] and NIPD [7.8 (5.1 - 23) pg/mL], and increased on CCPD [11.2 (9.5 - 19) pg/mL] and at final evaluation [11.2 (8.3 - 15) pg/mL]. CONCLUSIONS: NIPD significantly decreased serum CRP and displayed a trend to decrease TNF-alpha and IL-6 serum concentrations compared with CAPD; whereas CCPD tended to reverse these effects. These results did not appear to be due to decreased local peritoneal inflammation, but they could be associated with better control of fluid overload on NIPD. Thus, NIPD, as Long as the residual renal function allows it, may be useful in reducing the systemic inflammation of patients with high peritoneal membrane permeability.

[Origin and development of B1 lymphocytes. A cell population involved in defence and autoimmunity]. / Origen y desarrollo de linfocitos B1 una población celular involucrada en defensa y autoinmunidad.

B1 lymphocytes are an anatomically, phenotypically, and functionally distinct subset of B cells producing the bulk of natural serum IgM in the absence of any apparent stimulation by specific antigens. These cells are a dominant population of B cells in peritoneal and pleural cavities and they have characteristics of activated cells and higher cell size and cytoplasmic complexity than conventional B cells. B1 cells spontaneously secrete antibodies and operate under a differentiation program that is unique and differs from the paradigm associated with Ig-secreting B-2 cells. The antibodies produced by B1 cells may participate in a variety of physiological activities since they are involve in immune regulation, clearance of senescent and apoptotic cells and resistance to infection. However, it has been suggested that they are also involved in autoimmunity. Many advances have been made to describe the origin, development and differentiation of B1 cells, which will be examined here.

Origen y desarrollo de linfocitos B1: una población celular involucrada en defensa y autoinmunidad / Origin and development of B1 lymphocytes: a cell population involved in defence and autoimmunity

Las células B1, responsables de la producción de IgM sérica en ausencia de aparente estimulaciónantigénica, son linfocitos B maduros con ubicación anatómica y características fenotípicas y funcionalesparticulares. Los linfocitos B1 se ubican mayoritariamente en cavidad peritoneal y pleural, presentancaracterísticas de células activadas y son de mayor tamaño y complejidad citoplasmática que las células B convencionales.Mientras que estos últimos deben diferenciarse a células plasmáticas para poder secretarinmunoglobulinas, los linfocitos B1 liberan espontáneamente anticuerpos al medio extracelular operando bajoun programa de diferenciación particular. Los anticuerpos producidos por los linfocitos B1 tendrían un rol protector,ya que están implicados en la remoción de células envejecidas y apoptóticas, en mecanismos deinmunomodulación y en resistencia a infecciones, sin embargo su participación en procesos autoinmunes tambiénha sido sugerida. Muchos estudios han aportado información sobre el origen, desarrollo y diferenciaciónde los linfocitos B1, los cuales son analizados en esta revisión.

B1 lymphocytes are an anatomically, phenotypically, and functionally distinct subset ofB cells producing the bulk of natural serum IgM in the absence of any apparent stimulation by specific antigens.These cells are a dominant population of B cells in peritoneal and pleural cavities and they have characteristicsof activated cells and higher cell size and cytoplasmic complexity than conventional B cells. B1 cells spontaneouslysecrete antibodies and operate under a differentiation program that is unique and differs from the paradigmassociated with Ig-secreting B-2 cells. The antibodies produced by B1 cells may participate in a variety ofphysiological activities since they are involve in immune regulation, clearance of senescent and apoptotic cellsand resistance to infection. However, it has been suggested that they are also involved in autoimmunity. Manyadvances have been made to describe the origin, development and differentiation of B1 cells, which will beexamined here.

Origen y desarrollo de linfocitos B1: una población celular involucrada en defensa y autoinmunidad / Origin and development of B1 lymphocytes: a cell population involved in defence and autoimmunity

Las células B1, responsables de la producción de IgM sérica en ausencia de aparente estimulaciónantigénica, son linfocitos B maduros con ubicación anatómica y características fenotípicas y funcionalesparticulares. Los linfocitos B1 se ubican mayoritariamente en cavidad peritoneal y pleural, presentancaracterísticas de células activadas y son de mayor tamaño y complejidad citoplasmática que las células B convencionales.Mientras que estos últimos deben diferenciarse a células plasmáticas para poder secretarinmunoglobulinas, los linfocitos B1 liberan espontáneamente anticuerpos al medio extracelular operando bajoun programa de diferenciación particular. Los anticuerpos producidos por los linfocitos B1 tendrían un rol protector,ya que están implicados en la remoción de células envejecidas y apoptóticas, en mecanismos deinmunomodulación y en resistencia a infecciones, sin embargo su participación en procesos autoinmunes tambiénha sido sugerida. Muchos estudios han aportado información sobre el origen, desarrollo y diferenciaciónde los linfocitos B1, los cuales son analizados en esta revisión. (AU)

B1 lymphocytes are an anatomically, phenotypically, and functionally distinct subset ofB cells producing the bulk of natural serum IgM in the absence of any apparent stimulation by specific antigens.These cells are a dominant population of B cells in peritoneal and pleural cavities and they have characteristicsof activated cells and higher cell size and cytoplasmic complexity than conventional B cells. B1 cells spontaneouslysecrete antibodies and operate under a differentiation program that is unique and differs from the paradigmassociated with Ig-secreting B-2 cells. The antibodies produced by B1 cells may participate in a variety ofphysiological activities since they are involve in immune regulation, clearance of senescent and apoptotic cellsand resistance to infection. However, it has been suggested that they are also involved in autoimmunity. Manyadvances have been made to describe the origin, development and differentiation of B1 cells, which will beexamined here. (AU)

Origen y desarrollo de linfocitos B1: una población celular involucrada en defensa y autoinmunidad / Origin and development of B1 lymphocytes: a cell population involved in defence and autoimmunity

Las células B1, responsables de la producción de IgM sérica en ausencia de aparente estimulaciónantigénica, son linfocitos B maduros con ubicación anatómica y características fenotípicas y funcionalesparticulares. Los linfocitos B1 se ubican mayoritariamente en cavidad peritoneal y pleural, presentancaracterísticas de células activadas y son de mayor tamaño y complejidad citoplasmática que las células B convencionales.Mientras que estos últimos deben diferenciarse a células plasmáticas para poder secretarinmunoglobulinas, los linfocitos B1 liberan espontáneamente anticuerpos al medio extracelular operando bajoun programa de diferenciación particular. Los anticuerpos producidos por los linfocitos B1 tendrían un rol protector,ya que están implicados en la remoción de células envejecidas y apoptóticas, en mecanismos deinmunomodulación y en resistencia a infecciones, sin embargo su participación en procesos autoinmunes tambiénha sido sugerida. Muchos estudios han aportado información sobre el origen, desarrollo y diferenciaciónde los linfocitos B1, los cuales son analizados en esta revisión. (AU)

B1 lymphocytes are an anatomically, phenotypically, and functionally distinct subset ofB cells producing the bulk of natural serum IgM in the absence of any apparent stimulation by specific antigens.These cells are a dominant population of B cells in peritoneal and pleural cavities and they have characteristicsof activated cells and higher cell size and cytoplasmic complexity than conventional B cells. B1 cells spontaneouslysecrete antibodies and operate under a differentiation program that is unique and differs from the paradigmassociated with Ig-secreting B-2 cells. The antibodies produced by B1 cells may participate in a variety ofphysiological activities since they are involve in immune regulation, clearance of senescent and apoptotic cellsand resistance to infection. However, it has been suggested that they are also involved in autoimmunity. Manyadvances have been made to describe the origin, development and differentiation of B1 cells, which will beexamined here. (AU)

Leukocyte recruitment to peritoneal cavity of rats following formalin injection: role of tachykinin receptors.

The aim of this work was to verify whether formalin would induce leukocyte recruitment following intraperitoneal (i.p.) injection in rats. Formalin (1.25 - 2.5%) induced cell recruitment, which was concentration- and time-dependent (0 - 24 h). Two peaks of leukocyte recruitment were observed. The first peak (from 2 to 4 h) was characterized by a mixed polymorphonuclear and lymphocyte cell population (representing an increase of 100 - 220% and 55 - 60%, respectively), whereas the second peak was characterized by a marked increase in lymphocytes at 24 h (representing an increase of 230%). Pretreatment of animals with specific antagonists for neurokinin NK(1), NK(2), and NK(3) receptors (SR140333, SR48968, and SR142801 compounds, respectively) reduced the early leukocyte increase (representing a significant reduction of 65%, 51%, and 46%, respectively), whereas only the treatment with NK(2)-specific antagonist reduced the late cell increase induced by formalin injection (amounting to a significant reduction of 48%). These results suggested that substance P, neurokinin A, and neurokinin B release accounted for formalin-induced cell migratory activity. The anti-inflammatory drug dexamethasone also reduced cell recruitment, which was mainly related to a reduction in 79% of the neutrophils at 4 h following 1.25% formalin injection, suggesting also a release of lipid mediators (eicosanoids and/or platelet-activating factor) and/or cytokines/chemokines by the formalin injection.

Neutrophil migration induced by staphylococcal enterotoxin type A in mice: a pharmacological analysis.

Staphylococcal enterotoxin type A induced marked neutrophil migration into the mouse peritoneal cavity and was dependent on the number of resident macrophages. This migratory response was dose- (16-64 microg of staphylococcal enterotoxin type A/cavity) and time-dependent, peaking at 12 h and disappearing after 72 h. Dexamethasone (0.5 mg/kg) inhibited the neutrophil migration induced by staphylococcal enterotoxin type A (32 microg; 42% inhibition). A similar response was observed with the platelet-activating factor-acether receptor antagonist, BN 52021 (ginkgolide B, 3-(1,1-dimethylethyl)-hexahydro-1,4-7b-trihydroxy-8-methyl-9H-1,7alph a (epoxymethano-1H,6alphaH-cyclopenta (c) furo (2,3-b) furo (3', 2': 3,4) cyclopenta (1,2-d) furan-5, 9, 12 (4H)-trione); 10 mg/kg; 57% inhibition), the histamine H2 receptor antagonist, cimetidine (2 mg/kg; 31% inhibition), the lipoxygenase inhibitor, BWA4C (N-(3-phenoxycinnamyl) acetohydroxamic acid); 10 mg/kg; 73% inhibition), and capsaicin (trans-8-methyl-N-vanillyl-6-nonamide), a sensory C-fiber neuropeptide depletor. In contrast, indomethacin (5 mg/kg) had no effect on staphylococcal enterotoxin type A-induced chemotaxis. We conclude that the peritonitis induced by staphylococcal enterotoxin type A in mice is macrophage-dependent. The mechanism whereby staphylococcal enterotoxin type A stimulates macrophages to induce neutrophil recruitment remains to be elucidated.

Respiratory mechanics and morphometry after progressive intraperitoneal effusion.

Respiratory mechanics and thoraco-abdominal morphometry were evaluated in anesthetized, paralyzed, mechanically ventilated rats before and after controlled intraperitoneal injection of warm (37 degrees C) saline. Respiratory system resistances and static elastance were determined in 9 animals using the end inflation occlusion method. Chest wall configuration at both functional residual capacity (FRC) and end inspiration (FRC + VT) was evaluated in: (a) 6 rats by measurements of lateral and anteroposterior diameters, and circumferences at four levels: 3rd intercostal space, xiphoid, subcostal plane and crista iliaca; and (b) 8 rats by measurements of thoracic cephalo-caudal diameter. In addition, FRC changes were measured in 6 rats. Resistances were not altered but static elastance increased progressively. Morphometric changes were similar at both FRC and FRC + VT: cephalo-caudal diameter diminished whereas all other diameters augmented; FRC decreased. In conclusion, intraperitoneal infusion of saline in rats augments elastance, and this is related to a cephalad deviation of the diaphragm plus an increase of the circumferences and diameters of the lower thorax.