Comparison of different tests to diagnose feline infectious peritonitis.

Clinical data from 488 cats (1979-2000) with histopathologically confirmed feline infectious peritonitis (FIP) and 620 comparable controls were evaluated retrospectively to assess the value of several diagnostic tests frequently used in the evaluation of cats with suspected FIP. Diagnostic utility of serum albumin to globulin ratio for the diagnosis of FIP was greater than of the utility of serum total protein and gamma-globulin concentrations. Diagnostic utility of these variables was higher when performed on effusion. On effusion, positive and negative predictive values of Rivalta's test, a test that distinguishes between exudates and transudates (0.86 and 0.97), anti-coronavirus antibody detection (0.90 and 0.79), and immunofluorescence staining of coronavirus antigen in macrophages (1.00 and 0.57) were investigated. The positive and negative predictive values of presence of anti-coronavirus antibodies were 0.44 and 0.90, respectively, antibody concentrations (1:1,600) were 0.94 and 0.88. presence of immune complexes measured by a competitive enzyme-linked immunosorbent assay were 0.67 and 0.84, and detection of viral RNA by serum reverse-transcriptase polymerase chain reaction (RT-PCR) were 0.90 and 0.47. Effusion RT-PCR was performed in 6 cats; it was positive in all 5 cats with FIP and negative in the cat with another disease. Diagnostic assays on the fluid in cats with body effusion had good predictive values. Definitive diagnosis of FIP on the basis of measurement of various variables in serum was not possible. Serum tests can only be used to facilitate the decision for more invasive diagnostic methods.

Sensitivity in detecting free intraperitoneal fluid with the pelvic views of the FAST exam.

The multiple-view focused assessment with sonography for trauma (FAST) exam is an integral tool in the assessment of blunt abdominal trauma. A prospective observational study was performed to compute the average minimum volume of detectable intraperitoneal fluid with the pelvic views of the FAST exam. All adult patients from October 1999 to May 2001, who presented to the ED with blunt abdominal trauma and underwent a clinically indicated diagnostic peritoneal lavage (DPL), were candidates for admission to the pelvic ultrasound study. In the supine position, patients were administered lavage fluid in 100 cc increments until the examiner detected the fluid on ultrasound. An independent reviewer also examined the hard-copy ultrasound images for fluid detection. Patients were excluded if they had (1) a positive DPL for hemoperitoneum (defined as 10 cc of gross blood or >100,000 red blood cells/mL), (2) a positive initial ultrasound for free fluid, or (3) lacked sufficient hard-copy ultrasound images. The mean minimal volume of fluid needed for pelvic ultrasound detection by the examiner and reviewer was 157 and 129 cc (n = 7), respectively. The median quantity of fluid for ultrasound detection by both the examiner and reviewer was 100 cc. The pelvic views of the FAST exam identified a significantly smaller quantity of intraperitoneal fluid than previous studies of the right upper quadrant single-view exam.

[The evaluation of IL-12 levels in peritoneal fluid and serum of women with endometriosis]. / Ocena stezenia IL-12 w plynie otrzewnowym i surowicy u kobiet z endometrioza.

We studied levels of IL-12 in peritoneal fluid and serum in patients with minimal, advanced and recurrent endometriosis compared to women without endometriotic lesions in pelvis minor. The aim of the study was to determine whether level of IL-12 detected in peritoneal fluid or serum changes with grading of severity of endometriosis. To assess IL-12 levels immunosorbent ELISA was used. There were no statistically significant differences in IL-12 levels in peritoneal fluid nor in serum in any of studied groups. There was higher concentration (without statistical significance) of IL-12 in peritoneal fluid of healthy women compared to women with endometriosis.

The differential roles of LFA-1 and Mac-1 in host defense against systemic infection with Streptococcus pneumoniae.

Mice deficient in CD18, which lack all four CD11 integrins, have leukocytosis and increased susceptibility to bacterial infection. To determine the effect of deficiencies in LFA-1 (CD11a/CD18) or Mac-1 (CD11b/CD18) on host defense against systemic bacterial infection, knockout mice were inoculated i.p. with Streptococcus pneumoniae. Increased mortality occurred in both LFA-1(-/-) (15 of 17 vs 13 of 35 in wild type (WT), p < 0.01) and Mac-1(-/-) (17 of 34 vs 6 of 25, p < 0.01) mice. All deaths in LFA-1(-/-) mice occurred after 72 h, whereas most deaths in Mac-1(-/-) mice occurred within 24-48 h. At 24 h, 21 of 27 Mac-1(-/-) mice were bacteremic, vs 15 of 25 WT (p = 0.05); no difference was observed between LFA-1(-/-) and WT. Increased bacteria were recovered from Mac-1(-/-) spleens at 2 h (p = 0.03) and 6 h (p = 0.002) and from livers (p = 0.001) by 6 h. No difference was observed at 2 h in LFA-1(-/-) mice, but by 6 h increased bacteria were recovered from spleens (p = 0.008) and livers (p = 0.04). Baseline and peak leukocyte counts were similar between Mac-1(-/-) and WT, but elevated in LFA-1(-/-). At 8 h, peritoneal neutrophils were increased in Mac-1(-/-), but not significantly different in LFA-1(-/-). Histopathologically, at 24 h Mac-1(-/-) animals had bacteremia and lymphoid depletion, consistent with sepsis. LFA-1(-/-) mice had increased incidence of otitis media and meningitis/encephalitis vs WT at 72 and 96 h. Both Mac-1 and LFA-1 play important but distinct roles in host defense to S. pneumoniae.

Value of ascitic fibronectin and cholesterol concentration in the differentiation between malignancy-related and non-malignant ascites.

In this prospective study, we tried to evaluate various "humoral tests of malignancy" regarding their efficiency of discriminating between malignancy-related and non-malignant ascites. Fibronectin, total protein, number of cells, LDH, pH, specific gravity and cytology were compared in the ascitic fluid of 51 patients with malignancy-related and 52 patients with non-malignant ascites; patients with tuberculous peritonitis were not included. Ascitic fluid cholesterol was determined in 36 of 51 malignancy-related and in 37 of 52 non-malignant ascites. Cytology and fibronectin were found 100% specific with diagnostic efficiency 87.5% and 94.2% respectively under optimal conditions. Cholesterol was neither sensitive nor specific. It is concluded that fibronectin was a valuable test for malignancy-associated ascites.

Intravascular and peritoneal coagulation and fibrinolysis in horses with acute gastrointestinal tract diseases.

Components of the coagulation and fibrinolytic cascades, prothrombin and activated partial thromboplastin times, endotoxin activity, and albumin concentration were measured in blood and peritoneal fluid from 20 healthy horses and from 153 horses with acute gastrointestinal tract diseases at admission. Overall, 77% (117/153) of affected horses survived to discharge from the hospital, and 85% (82/97) of horses discharged were reported to be normal 9 to 14 months later. Significant differences in hemostatic factors were more common in peritoneal fluid than in blood. Tissue plasminogen activator, plasminogen, protein C, antithrombin III, and alpha 2-antiplasmin activities and concentrations of fibrinogen and fibrin degradation products were significantly (P < 0.05) greater in peritoneal fluid from horses with colic, and, with the exception of fibrinogen concentration, were associated with detection of endotoxin. Higher values for these variables, except tissue plasminogen activator activity, were significantly (P < 0.05) associated with survival. Plasminogen, antithrombin III, and alpha 2-antiplasmin activities were significantly (P < 0.05) greater in peritoneal fluid from horses with inflammatory or strangulating lesions, compared with those in horses with simple colic. Plasminogen-activator inhibitor type 1 activity, fibrin degradation products concentration, and prothrombin time were significantly (P < 0.05) greater in the blood of horses with colic. Survival was inversely associated with significantly (P < 0.05) greater intravascular concentrations of fibrin degradation products and fibrinogen and prothrombin time. This study revealed marked contrasts between peritoneal and intravascular coagulation and fibrinolysis in horses with colic, indicating that inferences regarding the peritoneal environment, particularly with respect to fibrinolytic capacity, should not be made on the basis of factors measured in blood.

Regulation of equine fibrinolysis in blood and peritoneal fluid based on a study of colic cases and induced endotoxaemia.

Much of the pathophysiology associated with equine gastrointestinal diseases is attributed to the effects of endotoxin on haemostasis. Because little is known about the responses of the equine fibrinolytic system to endotoxin, regulation of the system was investigated. Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor type-1 (PAI-1) were identified as the primary plasminogen activator and plasminogen activator inhibitor, respectively, in equine blood. Under experimental conditions, the equine fibrinolytic system responded to endotoxin in a manner similar to that reported in man, with an early, transient increase in t-PA activity followed by an overwhelming and prolonged increase in activity of PAI-1. To investigate the response of the equine fibrinolytic system to clinical endotoxaemia, endotoxin concentrations were measured in plasma and peritoneal fluid, and activities of t-PA and PAI-1 were compared between healthy horses (n = 38) and horses with naturally occurring gastrointestinal diseases (n = 150). It was observed that plasma PAI-1 and peritoneal t-PA were increased concurrently in abnormal horses; and that these increases were associated with the presence of endotoxin. The results of this study suggest that 1) fibrinolysis is regulated in horses in a manner similar to that in man; 2) regulation of fibrinolysis is altered in endotoxaemic horses with gastrointestinal diseases; 3) events occurring in the vascular system may not reflect those in the peritoneal cavity; and 4) t-PA activity is increased in the peritoneal fluid of endotoxaemic horses with gastrointestinal diseases.

Peritoneal lavage enzyme determinations following blunt and penetrating abdominal trauma.

Diagnostic peritoneal lavage (DPL) provides a rapid and sensitive means of investigating the peritoneal cavity following blunt and penetrating trauma. However, its shortcomings include insensitivity in the early identification of isolated hollow viscus injuries. We have routinely assayed lavage amylase (LAM) and alkaline phosphatase (LAP) in acutely injured patients for more than 4 years to assess the contribution of lavage enzyme analysis to the overall accuracy of DPL. From 1,969 DPLs, LAM was analyzed in 1,881 (96%) and LAP in 1,734 (88%) of 1,536 blunt and 433 penetrating trauma cases. Of 28 patients with negative lavage by LRBC but LAM greater than or equal to 20 IU/L, 13 (46%) had clinically significant injury requiring laparotomy. Seventy-seven percent of these cases involved the small bowel. In this group, LAM greater than or equal to 20 IU/L had a sensitivity of 87%, specificity of 75%, and positive predictive value of 46% for significant intra-abdominal injury. Seven patients had LAM greater than or equal to 20 IU/L and LAP greater than or equal to 3 IU/L. These values had a sensitivity of 54%, specificity of 98%, and positive predictive value of 88% for significant abdominal injury. Elevations of LAM (greater than or equal to 20 IU/L) and LAP (greater than or equal to 3 IU/L) mandate laparotomy where the history is consistent with possible small bowel injury. Elevation of either enzyme alone should raise the suspicion of hollow visceral organ injury and warrant close observation.

Lymphocyte activity in the presence of peritoneal fluid from fertile women and infertile women with and without endometriosis.

Peritoneal fluid from women with endometriosis, unexplained infertility, and fertile controls were compared to one another and to normal human serum for effects on lymphocyte proliferation in vitro. Peritoneal fluid samples were also assayed for both interleukin-1 and interleukin-2. All peritoneal fluid samples significantly enhanced lymphocyte proliferation in both mitogen-stimulated and unstimulated cultures compared with serum controls. Mitogen-induced leukocyte proliferation was higher in the presence of peritoneal fluid from women with endometriosis compared with other samples. Five out of 23 samples from endometriosis patients contained elevated levels of interleukin-1 and three out of 23 contained elevated levels of interleukin-2. Six out of eight peritoneal fluid samples from unexplained infertility patients also had elevated levels of interleukin-2; samples from fertile women did not contain elevated levels of either cytokine. Our data indicate that peritoneal fluid from women with endometriosis and unexplained infertility support the activation and proliferation of lymphocytes. Leukocyte products may locally affect the progression of disease and fertility.

[Relation between fibrin/fibrinogen degradation products in malignant fluids and the fibrinolytic activity of the peritoneum].

The mechanism of production of fibrin/fibrinogen degradation products (FDP) in malignant fluid was investigated. Levels of FDP in three malignant fluids were high (1200-3000 mcg/ml), but they declined to about 500 mcg/ml after anti cancer treatment. The average levels of FDP in 12 malignant fluids were almost the same as those in nine benign fluids. In a vitro experiment, the fibrinolytic activity of the peritoneum was found to be much higher than that of the tumor. In conclusion, production of FDP in fluid is more closely related to the fibrinolytic activity of the peritoneum than that of the tumor. Intracavitary administration of antifibrinolytic agents is thought to be effect for malignant effusion.

[Influence of protein malnutrition on the phagocytic function of neutrophils in rats]. / Influência da desnutrição proteica sobre a função fagocitária de neutrófilos de ratos.

A study was carried out to determine the effect of protein deficiency on the phagocytic function of blood neutrophils and of peritoneal exudate of rats. The deficient animals exhibited significantly lower leukocyte and neutrophil values, as well as NBT reduction and diminished peroxidase and bactericidal capacity. Englobement of S. aureus and latex particles was found to be normal in both groups. Alkaline phosphatase activity in the neutrophils appear to be increased in the deficient animals.

Influência da desnutriçäo protéica sobre a funçäo fagocitária de neutrófilos de ratos / Influence of protein malnutrition on the phagocytic function of neutrophils in rats

Estudou-se os efeitos da carência proteica sobre a funçäo fagocitária de neutrófilos do sangue e do exsudato peritoneal de ratos. Os animais carentes apresentaram valores significativamente menores para o número de leucócitos e de neutrófilos, para testes de reduçäo do NBT, para a atividade da peroxidase e para a atividade bactericida. A ingestäo de S. aureus e de particulas inertes näo mostrou diferença entre os grupos. A fosfatase alcalina leucocitária apresentou-se aumentada nos neutrófilos dos animais deficientes

Mononuclear phagocyte thromboplastin, bacterial counts and endotoxin levels in experimental endogenous gram-negative sepsis.

The relationship between mononuclear phagocyte thromboplastin activity, microorganisms and levels of endotoxin in peritoneal fluid and splanchnic and systemic circulation was evaluated during experimental endogenous gram-negative peritonitis in the rat. Significant rise in thromboplastin activity of mononuclear phagocytes was demonstrated in all three compartments. This newly synthesized thromboplastin is a trigger for important biologic systems such as the coagulation cascade, and thus may play a major role in the development of disseminated intravascular coagulation so often occurring in gram-negative sepsis. It probably also participates in the formation of fibrous intraabdominal adhesions. Aerobic and anaerobic microorganisms together with endotoxin were detected already 1 1/2 hours after induction of peritonitis, and subsequently were found to increase in parallel fashion. Determination of endotoxin is a rapid and seemingly reliable method for early detection of gram-negative infection and thus may be of clinical value.

White count, pH and lactate in ascites in the diagnosis of spontaneous bacterial peritonitis.

In order to evaluate the diagnostic accuracy of ascitic pH and lactate for early confirmation of spontaneous bacterial peritonitis (SBP), 109 consecutive patients with ascites were studied. The mean ascitic leukocyte [white blood cell (WBC)] and polymorphonuclear cell (PMN) counts, pH and lactate levels in 42 patients with sterile "normal" ascites were 124 +/- 157 per mm3, 41 +/- 77 per mm3, 7.502 +/- 0.097 and 11.1 +/- 7.9 mg per dl, respectively. Mean ascitic WBC and PMN counts were significantly increased in 10 patients with SBP (10,452 +/- 8,091 and 9,522 +/- 7,470 per mm3), in 10 patients with bloody ascites (2,591 +/- 4,284 and 1,057 +/- 1,494 per mm3) and in 11 patients with cytology positive malignant ascites (1,529 +/- 2,071 and 868 +/- 1,601 per mm3) (p less than 0.001). Mean ascitic pH was significantly reduced in SBP (7.335 +/- 0.048), in bloody ascites (7.384 +/- 0.037) and in cytology positive malignant ascites (7.355 +/- 0.167) (p less than 0.001). Mean ascitic lactate was also significantly elevated in these three groups of patients (36.8 +/- 17.0, 42.8 +/- 35.8 and 24.0 +/- 17.5 mg per dl, respectively; p less than 0.001) as well as in patients with bacteremia (51.6 +/- 78.0 mg per dl, p less than 0.005). However, ascitic pH less than 7.31, ascitic lactate greater than 33 mg per dl were observed only in three of the patients with SBP.(ABSTRACT TRUNCATED AT 250 WORDS)