Peritonea dialysis

O Primary peritonitis develops in up to 25% of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder appendicitis pancreatitis diverticulitis bowel infarction inflammatory bowel disease cholecystitis operative contamination of the peritoneum or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intraabdominal infection. In 1998, 278,000 appendectomies were performed in the United States for suspected appendicitis.5... 

The sterile peritoneal dialysis solutions are infused continuously into the abdominal cavity, bathing the peritoneum, and are then continuously withdrawn. The purpose of peritoneal dialysis is to remove toxic substances from the body or to aid and accelerate the excretion function normal to the kidneys. The process is employed to counteract some forms of drug or chemical toxicity as well as to treat acute renal insufficiency. Peritoneal dialysis solutions contain glucose and have an ionic content similar to normal extracellular fluid. Toxins and metabolites diffuse into the circulating dialysis... 

As an artificial dialyzer is not used in peritoneal dialysis, use of the term artificial kidney might not be appropriate in this case. In peritoneal dialysis,the dialysate solution is infused into the peritoneal cavity of the patient and later discharged. Uremic toxins in the blood are removed as the blood flows through the capillaries in the peritoneum to the dialysate by diffusion. Water is removed by adding glucose to the dialysate, thereby making the osmolarity of dialysate higher than that of the blood. 

In epithelium, cytosolic or non-receptor-mediated transport is inefficient and often leads to lysosomal degradation of the macromolecule [109], However, macromolecules, including IgG, are readily transported across the mesothelial surface of the peritoneum. The mesothelial lining cells are flat cells with pino-cytotic vesicles but no caveolae comparable to endothelial cells [193], Gap junctions separate interdigitated peritoneal mesothelial cells. IgG transport is known to be bi-directional and passive in rats [194-198] and also occurs in chronic peritoneal dialysis in humans [199],... 

Giant and atypical mesothelial cells can develop in the peritoneum in response to irritation caused by peritoneal dialysis solutions. Mesothelial hyperplasia without an increase in mesothelial cell size, cytological atypia in mesothelial cells, polynucleate cells with nucleoles, and enlarged mesothelial cells with a flat small nucleus and without evident nucleoles have all been described (5). These giant cells are not found unless there is peritonitis. During peritonitis mesothelial cells detach en masse from the basal lamina. 

The adverse effects of peritoneal dialysis fluids on the peritoneum have been succinctly summarized by authors arguing the case for a new, less toxic, and less acidic fluid for peritoneal dialysis (7). A low pH, high osmolality and lactate concentration, and the presence of several toxic contaminants may all contribute to impaired cellular function in the peritoneal membrane. In conventional peritoneal dialysis pH is dehberately lowered to 5.0-5.6... 

Copper levels in serum of CARD patients tend in general to be lower than those noted in the presence of a normal function. As for zinc however, its deficiency seems not to be due to the dialysis treatment itself. Here, loss of the element as the ceruloplasmin compound into the peritoneum has been suggested... 

Peritoneal dialysis (PD) is a type of dialysis in which dialysate is injected into the patient s peritoneal cavity with the peritoneum then employed as the dialysis membrane. It was first explored by Ganter in 1923 and initially showed poor results. The modern era of PD started in 1953, with intermittent... 

With peritoneal dialysis the peritoneum, which is well supplied with blood vessels, functions as a semipermeable membrane. Peritoneal dialysis solutions are sterile hyperosmotic solutions. These solutions withdraw water from the blood through the peritoneum. The transport of small ions takes place at the same time. 

The abdomen is surrounded by the peritoneum, an endothelial, single cellular layer that functions as dialysis membrane for water and small molecules. By using a hyperosmotic solution for peritoneal dialysis water and small molecules are withdrawn from the blood. After several hours the fluid is rinsed out and replaced with new CAPD solution. Solutions for peritoneal dialysis are made iso to hyper-osmotic with glucose to remove water from the body. 

NIR has been applied to prediction of the concentrations of glucose and lactic acid in peritoneal dialysis solution, which is a medical product and not a fermentation broth (22). The peritoneal dialysis solution is introduced into the peritoneal cavity of renal failure patients, and waste materials in the blood are dialyzed into the solution through the peritoneum. MLR was used to obtain calibration equations relating the NIR spectral data and the glucose and lactic acid concentrations of a calibration sample set obtained by enzymatic methods. A calibration equation for glucose in peritoneal dialysis solution was formulated with second-derivative NIR spectral data at 2270 nm, and the values of r and SEC were 0.996 and 2.03 g-l respectively. A calibration equation for lactic acid in peritoneal dialysis solution was formulated with the second-derivative NIR spectral data at 1688 and 1268 nm, and the values of R and SEC were 0.997 and 0.178 g-C respectively. In the validation results of the calibration equations, excellent agreement between the results of the enzymatic method and the NIR method was also observed for these constituents. The values of r for glucose and lactic acid in the peritoneal dialysis solution were 0.996 and 0.996, respectively. 

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