Renal and Electrolytes
Kristen Davies, Shadaba Ahmed in Core Conditions for Medical and Surgical Finals, 2020
Dialysis describes the use of a semipermeable membrane that acts as a filter with a solution to regulate the fluid and electrolytes in the blood. There are three main forms: Haemodialysis: Uses an AV fistula (between radial artery and cephalic vein) with blood flowing from one side of a semipermeable membrane with dialysis solution flowing in the opposite direction. Requires multiple treatments per week. Complications include hypotension, infection, thrombosis (from AV fistula) and dialysis disequilibrium syndrome (cerebral oedema).Haemofiltration: Blood flows through a machine through a semipermeable membrane but no dialysis solution is used. Positive hydrostatic pressure pushes fluid across. Complications are similar to haemodialysis but haemofiltration causes less hypotension.Peritoneal dialysis: Uses the peritoneum as the semipermeable membrane with access gained via a Tenchkoff catheter through the anterior abdominal wall. Cheaper than haemodialysis/haemofiltration and more flexible for patients. Complications include peritonitis (most commonly due to Staphylococcus epidermidis). Contraindications include peritoneal adhesions, abdominal hernias and colostomy.
Upper GI Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
You proceed to order a CT that reveals a large amount of intraperitoneal air and fluid around the stomach, liver and spleen. What are the management options?This lady has a likely perforated stomach while on treatment for gastric lymphoma.This can occur due to the rapid response of the lymphoma to the chemotherapy with tumour necrosis and lysis causing a breach in the serosal layer.Conservative management is unlikely to be an option depending on the patient's other comorbidities. She should be considered for emergency laparotomy and gastric resection, with a sub-total or total gastrectomy.Complications would be significantly increased compared to the elective patient due to the presence of intraperitoneal contamination as well as patient factors including possible neutropenia while on chemotherapy. These include anastomotic leak, intra-abdominal abscess formation, duodenal leak as well as general complications including respiratory, cardiac and wound complications, in addition to sepsis.The patient should be appropriately counselled preoperatively about these risks and estimated mortality and morbidity probabilities calculated.
Colorectal peritoneal metastases
Tom Cecil, John Bunni, Akash Mehta in A Practical Guide to Peritoneal Malignancy, 2019
By 2000, a robust evidence base had been established supporting the role of intraperitoneal chemotherapy in the adjuvant treatment of colorectal cancers at high risk of peritoneal dissemination. Nevertheless, partly due to the Dutch randomised trial on CRS and HIPEC in the treatment of CPM, focus shifted away from adjuvant and prophylactic strategies [11,12]. It would be approximately a decade before a series of non-randomised, prospective studies were published regarding the value of adjuvant intraperitoneal chemotherapy in high-risk patients [39–41]. These studies showed that, in selected patients, intraperitoneal chemotherapy was associated with increased long-term survival and/or lower peritoneal recurrence rates, as compared to patients who did not receive intraperitoneal chemotherapy [42].
Immunogenic Cell Death (ICD) of Murine H22 Cells Induced by Lentinan
Published in Nutrition and Cancer, 2022
Wen Wang, Xin Yang, Chong Li, Yandong Li, Haibo Wang, Xue Han
Intraperitoneal injection was performed by a single researcher. Briefly, mice were restrained by firmly grasping the skin over the dorsal neck by using the thumb and forefinger of the handler’s nondominant hand, with the tail held between the palm and ring finger of the same hand. The mouse’s head was tilted downward and the needle inserted at an angle of approximately 30° to the abdominal wall, on the left of midline in the caudal left abdominal quadrant. A fresh 25-gauge, 3/4-in. needle was used for each mouse, and the needle was inserted no more than 0.5 cm into the abdomen (26). The injected volume was standardized at 0.2 mL and concentration of injected H22 cells was 1 × 106 cells/mL. About a week later, when the mouse's abdominal cavity was obviously raised, the ascites were collected to prepare H22 cell suspension.
A comparison between the mechanical properties of the hepatic round ligament and the portal vein: a clinical implication on surgical reconstruction of the portal and superior mesenteric veins
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Wentao Zhu, Rongqiang Song, Xuefeng Cao, Lei Zhou, Qiang Wei, Haibin Ji, Rongzhan Fu
Hepatic round ligament (HRL), also known as ligamentum teres, is the remnant of the embryonic umbilical vein, which degenerates after birth (Emre et al. 1993). It is located between the umbilicus and the left branch of the portal vein (PV), connecting the left hepatic vein or the inferior vena cava via the venous ligament. Anatomically, it can be divided into intraperitoneal and extraperitoneal segments. Structurally, it is organized into the inner, middle and outer layers and still retains the structural features of the blood vessel wall that is composed of collagen and elastic fibers, as well as smooth muscles. A distinct elastic muscle band enriched with smooth muscle, elastic and collagen fibers exist between the inner and middle layer. Blood supply to the HRL is sufficiently provided by the right hepatic artery and the umbilical vein. Clinically, narrowed or obstructed HRL can be widened to reconnect with the PV (Ikegami et al. 2008).
Intraperitoneal chemotherapy for peritoneal metastases: an expert opinion
Published in Expert Opinion on Drug Delivery, 2020
Wim Ceelen, Helena Braet, Gabrielle van Ramshorst, Wouter Willaert, Katrien Remaut
Intraperitoneal chemotherapy is currently administered using two different approaches. The first one is neoadjuvant (preoperative) or adjuvant (postoperative) cycles of IP chemotherapy using an indwelling Tenckhoff type catheter [55]. The second approach is HIPEC, during which the peritoneal cavity is perfused immediately after cytoreductive surgery (CRS) using a closed or open (coliseum) abdomen approach [56]. Some centers add early postoperative, IP catheter based chemotherapy to HIPEC during a period of 5 days [57]. A recent development in patients with unresectable peritoneal metastases is pressurized intraperitoneal aerosol chemotherapy or PIPAC (Figure 2). This novel concept of intraperitoneal drug delivery combines a diagnostic laparoscopy with locoregional administration of chemotherapy as an aerosol, which is generated by a patented nebulizer [58].
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