Peritoneal lymphatics

Mactier, Robert; Khanna, Ramesh

doi:10.1007/978-94-017-3225-3_6

Cited by 4 publications

(6 citation statements)

References 132 publications

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“…Maximum expression of these changes in PD (i.e., peritoneal sclerosis) includes thickening of the bowel wall, mesentery, or parietal peritoneum (28). The peritoneal lymphatic and venous gradual dilation found in PD patients and hepatic ascites (27) support this hypothesis. In addition, the definitive diagnosis of PLE associated with lymphatic obstruction is established by finding dilatation in jejunal mucosal and submucosal lymphatic channels (24).…”

Section: Discussionmentioning

confidence: 62%

“…We believe that mainly acute and chronic PD, and possibly uremic GI pep-tide disorders, may induce motility disorders (4,25,26) and diminish peritoneal lymphatic and venous outflow, resulting in PLE. It has been demonstrated that chemical or infectious peritonitis induces a reversible lymphatic obstruction by fibrin or fibrosis, decreasing the absorption and outflow of lymph nodes (27). Two factors are known to control peritoneal lymphatic flow in PD: intraperitoneal pressure (hydrostatic) and intestinal peristalsis (27).…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that chemical or infectious peritonitis induces a reversible lymphatic obstruction by fibrin or fibrosis, decreasing the absorption and outflow of lymph nodes (27). Two factors are known to control peritoneal lymphatic flow in PD: intraperitoneal pressure (hydrostatic) and intestinal peristalsis (27).…”

Section: Discussionmentioning

confidence: 99%

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Protein-Losing Enteropathy is Associated with Peritoneal Functional Abnormalities in Peritoneal Dialysis Patients

Aguilera

Ma²,

Codoceo³

et al. 2000

Perit Dial Int

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Objective To evaluate the relationship between acquired peritoneal transport disorders and the presence of protein-losing enteropathy (PLE), and their contribution to the protein malnutrition in peritoneal dialysis (PD) patients. Patients and Methods We studied 31 clinically stable PD patients that received a fat overload diet for 3 days. We measured intestinal absorption of fecal fat (normal < 6 g/24-hour stool) and nitrogen (normal < 2 g/24-hr stool), intestinal protein permeability [fecal clearance of α1-antitrypsin (Cα1AT) (normal < 12 mL/24-hr stool)], and nutritional markers [normalized protein nitrogen appearance (nPNA), half-life medium-term proteins, and body mass index]. Peritoneal solute transport was measured by mass transfer coefficient (MTC), and water transport by peritoneal ultrafiltration (UF) capacity. To define protein maldigestion it was necessary to find high fecal nitrogen values with normal Cα1AT; PLE was defined when both values were elevated. Results High fecal nitrogen (mean 2.1 ± 1 g/24-hr stool) and fat (mean 5.8 ± 3.6 g/24-hr stool) were found in 15 patients; 6 patients had high Cα1AT levels (PLE). These 6 patients showed a worse nutritional status: lower albumin (3.57 ± 0.57 g/dL vs 3.98 ± 0.38 g/dL, p < 0.05) and transferrin (243 ± 70 mg/dL vs 272 ± 44.3 mg/dL, p < 0.05), as well as lower triglycerides (131.3 ± 31.7 mg/dL vs 187 ± 116 mg/dL, p < 0.05). Higher urea MTCs were found in 10 patients, normal in 7, and lower in 14. Higher creatinine MTCs were found in 8 patients, normal in 15, and lower in 8. Normal peritoneal UF capacity was found in 25 and lower in 6 patients. These 6 patients showed higher urea and creatinine MTCs and Cα1AT. A positive linear correlation between Cα1AT, urea MTC ( r = 0.56, p < 0.01), and creatinine MTC ( r = 0.46, p < 0.01) was found. A similar situation occurred between Cα1AT, fecal fat ( r = 0.45, p < 0.05), and fecal nitrogen ( r = 0.43, p < 0.05). Thirteen patients with previous history of peritonitis showed higher Cα1AT than those without peritonitis (10.2 ± 8 mL/24-hr stool vs 5.2 ± 4.4 mL/24-hr stool, p < 0.05). Conclusions We confirm that protein and fat malabsorption, maldigestion, and PLE are present in some PD patients. Higher fecal Cα1AT is associated with malnutrition and poorer showings of the viability markers of peritoneal membrane function.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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Protein-Losing Enteropathy is Associated with Peritoneal Functional Abnormalities in Peritoneal Dialysis Patients

Aguilera

Ma²,

Codoceo³

et al. 2000

Perit Dial Int

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“… 10 , 27 , 28 Under physiological conditions, the lymphatic drainage system plays an important role in the egress of fluid from the abdominal cavity via the lymphatic stomata in the diaphragmatic peritoneum. 29 – 31 The lymphatic vessels issuing from the posterior part of the diaphragm travel backward across the crura and directly connect with the origin of the thoracic duct or indirectly connect with the thoracic duct via intercalation of the upper para-aortic lymph node. 32 Recent studies have also demonstrated that the thoracic duct plays a specific role in lymphatic drainage from the abdominal cavity of quadrupeds.…”

Section: Discussionmentioning

confidence: 99%

Pathological Characterization of Ovarian Cancer Patients Who Underwent Debulking Surgery in Combination With Diaphragmatic Surgery

et al. 2015

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Despite exhaustive efforts to detect early-stage ovarian cancers, greater than two-thirds of patients are diagnosed at an advanced stage. Although diaphragmatic metastasis is not rare in advanced ovarian cancer patients and often precludes optimal cytoreductive surgery, little is known about the mechanisms and predictive factors of metastasis to the diaphragm. Thus, as an initial step toward investigating such factors, the present study was conducted to characterize the pathological status of ovarian cancer patients who underwent debulking surgery in combination with diaphragmatic surgery.This is a retrospective and cross-sectional study of patients who underwent debulking surgery in combination with diaphragmatic surgery at our institution between January 2005 and July 2015. Clinicopathological data were reviewed by board-certified gynecologists, pathologists, and cytopathologists. The rates of various pathological findings were investigated and compared by Fisher exact test between 2 groups: 1 group that was pathologically positive for diaphragmatic metastasis (group A) and another group that was pathologically negative for diaphragmatic metastasis (group B).Forty-six patients were included: 41 patients pathologically positive and 5 pathologically negative for diaphragmatic metastasis. The rates of metastasis to the lymph node (95.8% vs 20%, P = 0.001) and metastasis to the peritoneum except for the diaphragm (97.6% vs 60.0%, P = 0.028) were significantly increased in group A compared with group B. However, no significant differences between the 2 groups were found for rates of histological subtypes (high-grade serous or non-high-grade serous), the presence of ascites, the presence of malignant ascites, exposure of cancer cells on the ovarian surface, blood vascular invasion in the primary lesion, and lymphovascular invasion in the primary lesion.Our study demonstrated that metastasis to the lymph node and nondiaphragmatic metastasis to the peritoneum are significantly associated with metastasis to the diaphragmatic peritoneum, indicating that these factors may be pathological predictors of diaphragmatic metastasis in patients with ovarian cancer. However, as the data available are not sufficient to demonstrate the predictive power of these factors, a further comprehensive, large-scale study should be performed.

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“…The peritoneal cavity is a space that surrounds the internal organs, contains approximately 100 mL of fluid in healthy adults, and is lined by the peritoneum, a serous membrane (Figure , panel A). , The peritoneal cavity is utilized to perform peritoneal dialysis in patients with renal failure . Drugs such as antibiotics , and chemotherapeutics − are also delivered via the intraperitoneal (IP) route for the localized treatment of infections and intra-abdominal malignancies (i.e., gynecological and gastrointestinal cancers) .…”

Section: Introductionmentioning

confidence: 99%

Lymphatic Uptake of Liposomes after Intraperitoneal Administration Primarily Occurs via the Diaphragmatic Lymphatics and is Dependent on Liposome Surface Properties

et al. 2019

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Drugs are commonly administered via the intraperitoneal (IP) route to treat localized infections and cancers in patients and to test drug efficacy and toxicity in preclinical studies. Despite this, there remain large gaps in our understanding of drug absorption routes (lymph vs blood) and pharmacokinetics following IP administration. This is particularly true when drugs are administered in complex delivery systems such as liposomes which are the main marketed formulation for several drugs that are administered intraperitoneally. This study investigated the impact of liposome surface properties (charge and PEGylation) on absorption into lymph and blood, and lymphatic disposition patterns, following IP administration. To achieve this, stable 3H-dipalmitoyl-phosphatidylcholine (DPPC) and 14C-sucrose-radiolabeled liposomes of 100–150 nm diameter with negative, neutral, or positive surface charge, or a PEGylated surface, were prepared and administered intraperitoneally to rats. Radiolabel concentrations were measured in lymph, blood, and lymph nodes (LNs). Lymph was collected from the thoracic lymph duct at either the abdomen (ABD) or the jugular–subclavian junction (JSJ). The lymphatic recovery of the radiolabels was substantially lower after administration in positively charged compared to the neutral, negative, or PEGylated liposomes. Radiolabel recovery was substantially greater (up to 18-fold) in the thoracic lymph collected at the JSJ when compared to that at the ABD, suggesting that liposomes entered the lymphatics at the diaphragm. Consistent with this, the concentration of the liposome labels was substantially higher (up to seven-fold) in mediastinal than in mesenteric LNs. Overall, this study shows how the peritoneal absorption and lymphatic disposition of drugs administered intraperitoneally can be manipulated through a careful selection of the drug delivery system and may thus be optimized to treat localized conditions such as cancers, infections, inflammatory diseases, and acute and critical illness.

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Peritoneal lymphatics

Cited by 4 publications

References 132 publications

Protein-Losing Enteropathy is Associated with Peritoneal Functional Abnormalities in Peritoneal Dialysis Patients

Protein-Losing Enteropathy is Associated with Peritoneal Functional Abnormalities in Peritoneal Dialysis Patients

Pathological Characterization of Ovarian Cancer Patients Who Underwent Debulking Surgery in Combination With Diaphragmatic Surgery

Lymphatic Uptake of Liposomes after Intraperitoneal Administration Primarily Occurs via the Diaphragmatic Lymphatics and is Dependent on Liposome Surface Properties

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