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Abdominal and Genitourinary Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The peritoneal cavity contains solid organs (liver and spleen) and hollow viscera (distal oesophagus, stomach, duodenum, small bowel, caecum, colon, proximal rectum) and associated neurovascular structures. In penetrating trauma any of these structures may be injured in isolation, while in blunt traumatic injuries it is more common to see multiple injuries.9 For descriptive purposes the retroperitoneum is divided into three zones10: zone 1 in the mid-line above the aortic bifurcation contains the great vessels and their branches and tributaries, zone 2 on the left and right containing the kidneys, adrenals and ureters, and zone 3 below the bifurcation of the aorta, including the extra-peritoneal pelvis and iliac vessels. The pelvis contains the iliac vessels and their branches and tributaries and the extraperitoneal portion of the rectum along with the anal canal and pelvic floor.
Malignant Neoplasms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Progressive liver failure often results in malignant ascites, as well as jaundice. As it progresses due to increased fluid pressure in the liver, ascites distends the peritoneal cavity with an accumulation of fluid which often becomes increasingly uncomfortable for the patient. Shortness of breath can occur due to pressure of ascites on the diaphragm. In advanced cases, fluid can migrate across the diaphragm resulting in pleural effusion. Therapeutic paracentesis, when liters of fluid are removed with a large gauge needle, can help to relieve painful pressure. For patients with chronic malignant ascites, paracentesis can be done on a routine basis for palliation or a long-term drain (e.g. PleurX) may be surgically implanted for easier drainage. For refractory cases where surgery is a choice and a viable option, transjugular intrahepatic portosystemic shunts (TIPS) may be considered when severe symptoms are uncontrolled by other interventions.
Supported Lives
Published in Roger Cooter, John Pickstone, Medicine in the Twentieth Century, 2020
Another key innovation grew from peritoneal dialysis, a means of dialyzing in emergencies that had been tried with varying degrees of success from the 1920s. In this method, dialysis fluid is poured into the patient’s peritoneal cavity through a needle or tube in the abdomen; the membranes lining the cavity allow waste products in the bloodstream to pass through by osmosis, and the fluid is removed and replaced either continuously or intermittently. The weak point in this method was the insertion of a needle or tube bringing a high risk of peritonitis. As with the Scribner shunt, new materials changed the picture and in 1978 a Canadian team devised a permanent indwelling cannula, inserted in the wall of the abdomen below the navel, which allowed fairly safe repeated dialysis — ‘repeated’ here meaning every six hours. This process, known as Continuous Ambulatory Peritoneal Dialysis (CAPD) took off as a serious alternative to hemodialysis from about 1980. Some patients objected to having a tube protruding from their bellies, while others preferred this method because it allowed greater freedom of diet and fluid intake than hemodialysis. The varying extent of uptake of CAPD in different countries was largely, however, a matter of macro-policy. The US, with its generous funding for dialysis, retained a high level of hemodialysis; the UK, which had one of the lowest levels of provision in Western Europe in the 1970s, aimed to increase coverage while keeping costs down, and so used more CAPD than most other European countries.
Comparing the effect of adjunctive N-acetylcysteine plus low dose contraceptive with low dose contraceptive alone on recurrence of ovarian endometrioma and chronic pelvic pain after conservative laparoscopic surgery: a randomised clinical trial study
Published in Journal of Obstetrics and Gynaecology, 2022
Zahra Asgari, Ashraf Moini, Ali Montazeri, Zahra Tavoli, Ladan Hosseini, Reihaneh Hosseini, Afsaneh Tehranian, Rana Karimi
Endometriosis is a common benign disease characterised by the implants of endometrial tissue outside the uterine cavity, inducing an inflammatory response (Maia et al. 2012). It is a multifocal condition associated with chronic inflammation within the peritoneal cavity. oxidative stress is a component of this inflammatory process with the production of oxygen free radicals that favour disease persistence. A typical manifestation of endometriosis is chronic pelvic pain, dysmenorrhoea, dyspareunia and these symptoms have a negative impact on quality of life (Ray et al. 2015). Endometriomas are present in 17–55% of women with endometriosis and usually classified as advanced disease stage (Pittaluga et al. 2010). Surgical removal of ectopic lesions (stage 3, 4 of endometriosis) represents the first-line intervention but there is a relevant percentage of recurrence after surgery (Vercellini et al. 2009; Pittaluga et al. 2010). In addition, a variety of medical hormonal therapies, with the goal of reducing the levels of circulating oestrogens, are available (Rice 2002). However, these kinds of treatment modalities are often unsatisfactory and cannot be used for long periods due to their severe adverse effects. Therefore, new and improved therapeutic medication solutions with efficacy to reduce lesions and limited side effects are desirable. It had shown that N-acetylcysteine as an antioxidant agent with antioxidant properties could be effective in the control of endometriosis-associated pelvic pain and could reduce the recurrence rate of endometrioma in some researches and animal models of endometriosis (Porpora et al. 2013).
Absence of TNF Leads to Alternative Activation in Peritoneal Macrophages in Experimental Listeria Monocytogenes Infection
Published in Immunological Investigations, 2022
Xinying Li, Chen Chen, Lianjun Zhang, Xiaomin Cheng, Huiwu Geng, Qiang Ji, Chao Li, Huili Chen, Heinrich Körner, Xiaoying Liu
The peritoneal cavity is a specialized environment that encompasses a unique set of immune cells. TNF-deficient mice infected with L. monocytogenes results in rapidly progressing infections with fatal outcomes. While the recruitment of monocytic SPMs in B6.TNF-/- mice was comparable with wild-type mice at the beginning of the infection, this cell population was strongly reduced in the final phase of the infection. The absence of TNF leads to an increase of M2 macrophages (Schleicher et al. 2016). Interestingly, in our experimental setting the resident LPMs but not SPMs or monocytes showed a clear tendency to present with a significantly increased expression of Arg1. Subsequent in vitro experiments indicated that TNF was indeed responsible for the inhibition of M2 polarization observed in infected TNF-deficient mice. Moreover, we showed that the transcription factor PPARγ is a strong candidate for eliciting the M2 macrophages while counteracting the pro-inflammatory function of TNF.
Volumetric modulated arc therapy versus intensity-modulated proton therapy in the irradiation of infra diaphragmatic Hodgkin Lymphoma in female patients
Published in Acta Oncologica, 2022
Johannes Rosenbrock, Christian Baues, Andres Vasquez-Torres, Alessandro Clivio, Antonella Fogliata, Peter Borchmann, Simone Marnitz, Luca Cozzi
In the German Hodgkin Study Group (GHSG) HD17 trial, 1100 patients aged 18–60 years with unfavourable early-stage HL were enrolled. Following two cycles of etoposide, cyclophosphamide, doxorubicin, bleomycin, vincristine, procarbazine, prednisone (escalated BEACOPP) and two cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), they were randomised to receive either 30 Gy IFRT independent of PET or, in the experimental arm, 30 Gy INRT only if post-chemotherapy PET was positive [2]. For our in-silico planning study, we selected all the female GHSG HD17 patients with infra diaphragmatic HL who supplied us with both a CT scan before and post-chemotherapy. Table 1 summarises the disease involvement for the patients included in the study. We contoured the gross tumour volume (GTV) and the clinical target volume (CTV) according to the International Lymphoma Radiation Oncology Group (ILROG) guideline for ISRT [21]. For the clinical treatments and the photon planning, a margin of 7 mm was defined for the planning target volume (PTV). We used the ISRT definition instead of the INRT definition because ISRT has become the standard in daily practice. As OARs, we contoured bladder, bowel, femoral heads, kidneys, ovaries, rectum, spinal canal, and uterus. OARs were contoured according to the clinical standards. The bowel was defined as the entire peritoneal cavity.