Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a ten year period, four patients with inflammation or perforation of non-Meckelian, small intestinal diverticula were treated on the surgical services of Bellevue Hospital. This entity remains uncommon but may be increasing in incidence. The patients presented with a short history of severe abdominal pain, usually accompanied by nausea and vomiting. Each patient also gave a longer preceding history of less well defined abdominal symptoms. The pathogenesis of the small intestinal diverticula is uncertain but may be related to disturbed muscular peristalsis in the small bowel analogous to the changes implicated in esophageal and colonic diverticular disease. The diverticulum may be difficult to demonstrate at operation, and careful exploration for this possibility should be carried out at the time of operation for peritonitis of obscure origin. Segmental resection and end-to-end anastomosis is the treatment of choice.
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PMID:Perforated diverticula of the jejunum and lleum. 82 70

Isolated, small bowel metastases from lung carcinoma are extremely rare; only 34 cases have been previously reported. Rarer still is the presentation of lung carcinoma with a lesion metastatic to the small bowel. These 34 cases and 3 recent ones from Easton Hospital (Easton, PA) were analyzed to clarify the clinical and pathologic features of the disease. The majority of patients had a history of abdominal pain (86%), melena (23%), or nausea and vomiting (26%). Few had weight loss (16%). Twenty-one patients (57%) came to the hospital with perforation and peritonitis, including 9 in whom lung carcinoma was undiagnosed before laparotomy. Thirteen patients (34%) underwent laparotomy because of small bowel obstruction, 2 (6%) for bleeding and 1 (3%) for a mass found during work-up. Squamous cell (49%) and large cell (22%) were the most common cell types, and the jejunum was the most common site of the metastases (79%). Survival time was dismal (mean 51 days) and was unaffected by therapy to the primary site of the cancer or its metastases. The authors conclude that small bowel metastases from lung carcinoma are not uncommon and may be seen more frequently as patients live longer after their diagnosis of cancer. Small bowel metastases must be considered in any patient with both lung carcinoma and abdominal pain, and should be expected in patients with both lung carcinoma and an acute abdomen.
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PMID:Small bowel metastases from primary lung carcinoma: a rarity waiting to be found? 148 99

Intraperitoneal (i.p.) 5-fluoro-2'-deoxyuridine (Floxuridine, FUdR, FdUrd) was evaluated in a phase I study at a starting level of 500 mg given on 1 day in 2 I 1.5% dialysate. Escalations within patients were allowed every other cycle. A total of 23 patients (age, 32-78 years) received 108 treatment courses. Local tolerance at all dose levels was excellent, with no cases of drug-related peritonitis being observed. Nausea and vomiting increased in severity in relation to dose and was universal at greater than 3,000 mg x 3 days. One patient each developed grade 1 mucositis as well as diarrhea at a dose of 3,000 mg x 3 days and leukopenia and thrombocytopenia at 5,000 mg x 3 days. Peritoneal fluid (PF) and plasma (PL) FdUrd profiles were monitored by an HPLC method in 13 subjects, with 7 being studied serially at 2-4 increment doses for up to 6 h. Profiles that exhibited apparent linear pharmacokinetics gave PF drug levels 2-4 logs higher than the PL counterparts, with the latter essentially declining in parallel to the former, indicating that the disposition of FdUrd from the peritoneal compartment is rate-determining. The mean terminal half-life for PF FdUrd was found to be 115 min and mean peritoneal clearance was 25 ml/min. The vast differences in drug levels and AUC found between the PF and the PL profiles suggests a high systemic clearance of FdUrd, which was confirmed in two patients receiving 2 g FdUrd by short i.v. infusion. A disproportionate increase in the plasma FdUrd levels and the corresponding AUC values was found with increasing dose, suggesting a disproportionate increase in the systemic partitioning of FdUrd when doses were escalated within a patient. Substantial levels of peritoneal 5-fluorouracil (FUra) were also detected in most of the subjects. Thus, FdUrd was found to have several desirable properties for i.p. administration: (1) a 2- to 4-log pharmacologic advantage. (2) the absence of local toxicities, and (3) a favorable antitumor spectrum and some evidence of antitumor effects in this phase I and pharmacology study. A 3,000-mg dose given in 2 1 1.5% dialysate for 3 consecutive days exhibited antitumor activity and produced no systemic toxicity except nausea and vomiting, which was controlled by antiemetics. This dose schedule is therefore recommended for phase II trials directed against small-volume disease in the peritoneal cavity, such as may be found in some stages of ovarian and gastrointestinal cancers.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Phase I and pharmacologic evaluation of intraperitoneal 5-fluoro-2'-deoxyuridine. 183 36

We reviewed the cases of 15 patients with intestinal perforation following blunt abdominal trauma, which occurred between 1971 and 1988. Twelve patients were treated at The Mary Imogene Bassett Hospital (Cooperstown, NY); three other patients were treated at surrounding area hospitals. These injuries included 11 motor vehicle accidents, three low-velocity impact injuries, and one blast injury. There were four duodenal, ten jejunal, and two ileal injuries. Five patients who were operated on within 12 hours had classic signs of peritonitis or gross blood on diagnostic peritoneal lavage. Four patients were operated on after 12 hours, and six after 24 hours; physical signs were subtle in this group. Pain was a universal finding but was usually moderate; nausea and vomiting were frequent early findings in the ten patients with late recognition. An altered sensorium due to intoxication or head injury was present in three of ten patients operated on after 12 hours. Laboratory determinations, including a white blood cell count and amylase analysis, as well as abdominal radiographs, were often not helpful. Diagnostic peritoneal lavage is an important test, but when it is performed within four hours post-injury, it may yield false negative findings in up to 50% of patients and may need to be repeated. Computer tomographic scanning should employ oral and intravenous contrast to increase accuracy; perforation of a hollow viscus may not be immediately recognized. Four of the five patients operated on within 12 hours had an uncomplicated course. Complications occurred in all six patients operated on beyond 24 hours and included intraabdominal abscesses in five, and death for one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Small bowel injuries following blunt abdominal trauma. Early recognition and management. 229 18

Of the 257 typhoid enteric perforations analysed at the Departments of General and Paediatric Surgery, Ankara University Hospital, through the years 1979-1986, 74.9% were males, while the patients mean age was 35.8 years. The early signs and symptoms averaged 5.9 days. The corresponding percentages for the occurrence of abdominal pain, fever, nausea and vomiting and central nervous system disorders which constituted the clinical findings were 97.27, 51, 61.2 and 18 respectively. While the mean value for the white blood count ranged around 6600, only 61.9% of the cases had diagnostic findings in their erect abdominal roentgenograms. The standard method for the treatment of typhoid enteric perforations is still presently primary suturing of the perforated viscus and peritoneal drainage. Despite the use and misuse of a large variety of antibiotics, typhoid perforations still have a high morbidity of 74.1% and a mortality of 31.4%. Generalized peritonitis (78.4%), is considered to be to the most important cause in both situations.
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PMID:A contemporary evaluation of enteric perforations in typhoid fever: analysis of 257 cases. 237 98

A randomized prospective study was undertaken in patients on continuous ambulatory peritoneal dialysis (CAPD) to evaluate the efficacy of three different antibiotic regimens for the treatment of peritonitis. There were 39 episodes in each treatment group. Patients were treated with intraperitoneal (IP) cephalothin (250 mg/L) and tobramycin (8 mg/L) in group 1, oral ofloxacin (400 mg loading followed by 300 mg daily) in group 2, and a combination of ofloxacin (400 mg followed by 300 mg daily) and rifampicin (300 mg daily). Treatment duration was 10 days. The average culture-positive rate was 75%. The overall cure rate was 80.6% with IP antibiotics, 78.4% with oral ofloxacin, and 81.1% with ofloxacin and rifampicin. After the exclusion of tunnel infections and episodes of peritonitis due to Pseudomonas and resistant organisms, the corresponding figures were 100%, 90.6%, and 93.7%, respectively. Side effects were minimal with IP treatment and with oral ofloxacin, but severe nausea and vomiting occurred in some cases with the combination of ofloxacin and rifampicin. It was concluded that oral ofloxacin is an acceptable first-line therapy for peritonitis in CAPD patients.
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PMID:A randomized prospective trial of three different regimens of treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis. 240 53

A phase I and II clinical trial of intraperitoneally administered liposome-encapsulated doxorubicin in patients with advanced ovarian cancer is being evaluated. Doxyrubicin liposomes were prepared with cardiolipin, phosphatidyl choline, cholesterol, and sterarylamine and sized by flow cytometry before administration. Fifteen patients have been treated with 42 cycles of intraperitoneal liposome-encapsulated doxrubicin. Liposome-encapsulated doxorubicin in 2 L of normal saline solution was infused over 1 hour through an infusaport into the peritoneal cavity with a dwell time of 4 hours every 21 days. Liposome-encapsulated doxorubicin has been administered at escalating doses up to 100 mg/2 L and has been well tolerated. Increased bowel motility with mild-to-moderate abdominal distress has been encountered during the first 24 hours after administration. There has been one patient with presumed chemically induced peritonitis after a temperature elevation to 39.5 degrees C. There has been no myelosuppression, abnormalities of liver function tests, or alopecia. Nausea and vomiting were minimal. Liposome-encapsulated doxorubicin was extravasated in two patients without sequelae. Drug levels were measured after completion of infusion. At a dose of 70 mg, the peak intraperitoneal concentration was 28.6 micrograms/microliter, which was reduced to 23.6 micrograms/microliter by 2 hours. Concurrent plasma levels were in the range of 0.2 to 0.5 micrograms/microliter. A similar pattern was observed at other doses. The maximum tolerable dose has not yet been obtained. There were three responders in the 10 evaluable patients. The preliminary experience with intraperitoneal liposome-encapsulated doxorubicin is encouraging.
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PMID:A phase I/II study of intraperitoneally administered doxorubicin entrapped in cardiolipin liposomes in patients with ovarian cancer. 271 14

Two-route chemotherapy of cisdiamminedichloroplatinum (CDDP) and sodium thiosulfate (STS) was performed in 32 patients with peritonitis carcinomatosa, originated from 21 gastric cancers, 4 colorectal cancers, 3 pancreatic cancers, 2 leiomyosarcomas of small intestine, one ovarian cancer and one bile duct cancer. CDDP was administered into the peritoneal cavity at the dose of 150 mg while STS was injected i.v., at the dose of 20 g to inactivate CDDP in peripheral blood. Out of 13 patients with malignant ascites, ascites disappeared completely in 3 cases and markedly decreased in 2 cases, and the efficacy rate was 38.5%. Five out of 32 registered patients with peritoneal disseminated tumors were evaluated. One complete response (CR), 1 partial response (PR), 2 with no change (NC) and 1 case of progressive disease (PD), were observed. The efficacy rate was 40%. The one-year and two-year cumulative survival rate was 18.2% and 13.7%, respectively. Nausea and vomiting were observed as side effects in about half of the patients, but these symptoms were mild and improved in a few days. These results indicate that this method is a useful therapy for peritonitis carcinomatosa.
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PMID:[Clinical efficacy of two-route chemotherapy with CDDP and STS in patients with peritonitis carcinomatosa]. 278 87

Ten patients with carcinomatous peritonitis of gastrointestinal cancer have been treated with administrations of CDDP-Ip (50-150 mg/body), in combination with systemic chemotherapy simultaneously combined with sodium thiosulfate (STS) iv in 4 patients. All patients received transfusions of specific hydration. The pharmacokinetics of CDDP was studied in 4 patients, and the following results were obtained. (1) As for its effect on malignant ascites, according to Koyama's and Saito's criteria, 2 patients showed a complete response, 3 showed a partial response, and 5 showed no change. (2) As for its effect on the primary site, only one patient showed a partial response, and the others no change. (2) As to its side effects, 6 patients manifested nausea and vomiting, and only one showed a mild kidney dysfunction, and no myelosuppression. No significant difference in the side effects between the STS-combined group and the non-STS-combined group was found. (3) Serum CDDP levels were reached maximum 1-2 hours after Ip, and gradually decreased during the beta-phase of iv administration. Significant levels of non-protein-bound CDDP were found in the serum within 4 hours after Ip. These results indicate that the CDDP Ip is safe and useful for carcinomatous peritonitis of gastrointestinal cancer, however the combination of STS might weaken the systemic anti-cancer effect of CDDP by neutralizing the non-protein-bound CDDP in the serum.
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PMID:[Intraperitoneal (Ip) administration of cisplatin in combination with systemic chemotherapy in patients with malignant ascites of gastrointestinal cancer: clinical evaluation and pharmacokinetics]. 312 33

In a retrospective review of 214 children with nephrotic syndrome seen at Children's Medical Center and Parkland Memorial Hospital in Dallas throughout the 20-year period from 1967 to 1986, 62 cases of primary peritonitis were identified in 37 patients (17.3% rate). Streptococcus pneumoniae was the major pathogen, accounting for 38% of the cases. An additional 27% of patients had negative culture results but were clinically responsive to penicillin. Gram-negative organisms were cultured from only 3% of patients; 5% were caused by alpha-streptococci and 2% each by enterococcus and anaerobes. In 23% of cases the cause was unknown. Our findings differ from the recent trend in the literature in which Gram-negative organisms associated with these infections are increasingly implicated. The incidence and bacteriology of peritonitis do not appear to have changed significantly during the 20-year period. Clinically, peritonitis was characterized by abdominal pain (98%), fever (95%), rebound tenderness (85%), and nausea and vomiting (71%). A total of 79% of patients were either in relapse or receiving steroid therapy at the time peritonitis was diagnosed; 13% had infiltrates visible on their chest radiographs. Based on our data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis using a combination of penicillin plus either an aminoglycoside or a cephalosporin. This regimen should continue until culture results are available, unless Gram-positive diplococci are identified in a Gram-stained specimen of peritoneal fluid, in which case penicillin alone should suffice.
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PMID:Peritonitis in children with nephrotic syndrome. 336 84


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