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Earthquakes and Medical Complications
Published in Ramesh P. Singh, Darius Bartlett, Natural Hazards, 2018
Scarlet Benson, Laura Ebbeling, Michael J. VanRooyen, Susan A. Bartels
For those who require renal replacement therapy, there are several dialysis options. Peritoneal dialysis does not require electricity or tap water but is difficult to use in patients with abdominal or chest injuries, requires relatively large quantities of sterile dialysate and may cause peritonitis when used under non-hygienic field conditions (Sever et al. 2006). With continuous renal replacement therapy, only one patient can be treated per machine, and experienced personnel, electricity and large volumes of substitute fluid are required (Sever et al. 2006). Some experts advocate for continuous arteriovenous haemofiltration (CAVH) in mass casualty situations located in rural areas because it is simple and does not require electricity, pumps or delivery systems (Better 1993). Intermittent haemodialysis offers the advantage of being able to treat several patients each day with the same dialysis machine and is also more efficient at removing potassium (Sever et al. 2006). The disadvantages of intermittent haemodialysis include the need for technical support, electricity and water supplies (Sever et al. 2006). Twice and even three times daily dialysis may be needed, and some patients may require more than one dialysis modality (Sever et al. 2002b). The average duration of dialysis for crush injury patients is 13–18 days (Sever et al. 2006).
Extracorporeal devices
Published in Ronald L. Fournier, Basic Transport Phenomena in Biomedical Engineering, 2017
CAPD is based on the addition to the peritoneal cavity of a sterile hypertonic solution of glucose and electrolytes. The peritoneal cavity is a closed space formed by the peritoneum, a membrane-like tissue that lines the abdominal cavity and covers the internal organs such as the liver and the intestines. The peritoneum has excellent mass transfer characteristics for a process like CAPD. The peritoneum has the appearance of a fairly transparent sheath that is smooth and quite strong. The surface area (S) of the peritoneum is about 1.75 m2. Its thickness ranges from 200 to over 1000 μm. The surface of the peritoneum presented to the CAPD dialysate solution consists of a single layer of mesothelial cells that is densely covered with microvilli or tiny hair-like projections. Beneath this layer of cells is the interstitium that has the characteristics of a gel-like material. Within the interstitium, there is a rich capillary network providing a total blood flow on the order of 50 mL min−1.
Asbestos exposure and mesothelioma
Published in Dorsett D. Smith, The Health Effects of Asbestos, 2015
Advances have been made in the treatment of peritoneal mesotheliomas, namely intraperitoneal chemotherapy, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy. Intraperitoneal chemotherapy, involving the administration of certain chemotherapeutic agents directly to the intraperitoneal cavity, was developed as a novel therapeutic strategy early in the 1950s. Intraperitoneal administration of chemotherapy results in higher intraperitoneal concentrations of the cytotoxic medications, particularly when heated, resulting in minimal systemic exposure compared with intravenous administration, which in turn may increase the efficacy of these agents with a substantial reduction in systemic toxicity. Intraperitoneal chemotherapy was used successfully in peritoneal surface malignancies, including malignant peritoneal mesothelioma, pseudomyxoma peritonei, malignant ascites, sarcomatosis, and peritoneal carcinomatosis from gastrointestinal and ovarian cancers. The advent of cytoreduction with hyperthermic intraperitoneal chemotherapy has dramatically improved survival outcomes, with wide median survival estimates of between 2.5 and 9 years. (Elias D, Goéré D, Dumont F et al. Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer 2014;50(2):332–40; Raza A, Huang WC, Takabe K. Advances in the management of peritoneal mesothelioma. World J Gastroenterol 2014;20(33):11700–12.)
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
Peritonitis is associated with significant morbidity and mortality. The treatment of peritonitis requires intra-peritoneal (IP) antibiotics such as vancomycin, second-generation cephalosporins, or aminoglycosides. IP antibiotics are needed for at least 2 weeks and if dialysate white cell count remains greater than 100/µL after day 5 of treatment, then catheter removal is indicated [16]. Catheter removal is generally needed for fungal peritonitis, as it has a high mortality risk [16]. Management of peritonitis is usually conducted in an outpatient setting, unless a patient is septic and/or needs catheter removal. About 20% of peritonitis cases require catheter removal, which is more commonly associated with S. aureus and gram-negative organisms. In one study, peritonitis was associated with a 95% increase in all-cause mortality [5,24]. This is more commonly associated with S. aureus, gram-negative organisms, and fungal peritonitis. Catheter removal also requires transfer to HD at least on a temporary basis, which may compromise a patient’s quality of life especially if they are elderly and comorbid. Peritonitis may also lead to decreased volume of fluid removal due to change in transport status of the peritoneal membrane [25]. This may be temporary or a permanent effect and may lead to significant fluid retention in patients, which has a high risk of mortality.
Decellularized inner body membranes for tissue engineering: A review
Published in Journal of Biomaterials Science, Polymer Edition, 2020
Ilyas Inci, Araz Norouz Dizaji, Ceren Ozel, Ugur Morali, Fatma Dogan Guzel, Huseyin Avci
Peritoneum is a complex serous membrane that covers the inner lining of the abdominal cavity and supports the internal organs within [154,155]. Peritoneum is composed of a basement membrane containing mesothelial cells and thin connective tissue carrying blood vessels, nerves, fat, lymphatics and fibers. Peritoneum consists of two layers: the outer and the inner layers, also known as parietal and visceral peritoneum. The former is the lining across the abdominal wall while the latter is the membrane, which covers the internal organs. Potential peritoneal space between these layers is called the peritoneal cavity and consists of mesothelial cells and a smooth serous fluid. Peritoneum has been shown to serve as a good candidate for the construction of skin, aorta and vascular grafts due to its biological characteristics (embryologically derived from the mesoderm) and its lower risk of thrombosis compared to artificial grafts [155].
Clinical effectiveness and versatility of a sealing hemostatic patch (HEMOPATCH) in multiple surgical specialties
Published in Expert Review of Medical Devices, 2018
Kevin M. Lewis, Shelly Ikeme, Tolu Olubunmi, Carl Erik Kuntze
Torres et al. [47] presented research abstract data derived from an observational study and noted that intestinal suture or bowel anastomosis reinforcement with HEMOPATCH might contribute to the reduction of surgical complications such as dehiscence, leaks, and fistula formation. The study included 12 peritoneal carcinomatosis patients who underwent complete cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (CRS-HIPEC using coliseum technique). In all subjects, HEMOPATCH was applied to cover up to 1 cm beyond the 5 colo-colonic, 3 ileorectal, and 4 jejunojejunal mechanical suture lines. Compared to an anastomotic dehiscence rate of 7.5% in series of 305 CRS-HIPEC patients, clinical and radiological examinations revealed no anastomotic leakage or dehiscence in any of the 12 patients treated with HEMOPATCH.