PERITONEAL dialysis is a method of renal replacement therapy in patients with end-stage chronic renal failure. Over time, PERITONEAL dialysis damages the PERITONEAL membrane, which can adversely affect PERITONEAL function, leading to cessation of PERITONEAL dialysis and the onset of hemodialysis, and even malnutrition and death. Due to the invasive nature of PERITONEAL biopsy to evaluate PERITONEAL injury and fibrosis, the structure of the PERITONEAL membrane is evaluated based on biomarkers that are secreted by the PERITONEAL membrane and measured in the PERITONEAL dialysis effluent. Several biomarkers were studied for this purpose, including interleukin-6, hyaluronan, vascular endothelial growth factor and etc. One of these markers is CA125 antigen, which is considered as a measure of the health and mass of mesothelial cells lining the peritoneum, which, unlike other biomarkers named above, is not secreted by any cell other than mesothelial cells. CA125 is a glycoprotein produced by ovarian cancer cells and is widely used for ovarian cancer screening today. This antigen is also secreted by mesothelial cells lining the PERITONEAL membrane and can be measured in PERITONEAL dialysis effluent. Its amount is not affected by the type of dialysis solution. Visser et al. (1995) first proposed the theory of measuring CA125 levels of dialysis FLUID at the end of a four-hour PERITONEAL equilibration test (PET) as a diagnostic biomarker for mesothelial cell function in patients undergoing PERITONEAL dialysis. Therefore, finding a suitable diagnostic biomarker for rapid detection and identification of PERITONEAL membrane damage as well as PERITONEAL function at a lower cost is very valuable and will be of great help in patient management. In this review article, 25 studies with a total of 623 patients over 18 years old and 73 patients under 18 years old undergoing PERITONEAL dialysis were reviewed and summarized. These 25 studies included clinical trials, descriptive studies, and prospective studies to evaluate the relationship between CA125 dialysis effluent and PERITONEAL function and to evaluate the value of using this biomarker in evaluating mesothelial cell health and dialysis quality and its relationship with peritonitis and demographic characteristics. Patients were evaluated and summarized. Normal baseline values for CA125 dialysis concentration have not yet been determined. To date, numerous studies have been performed on PERITONEAL dialysis patients in both age groups of children and adults to determine the concentration of CA125 in dialysis effluent. In these studies, the level of CA125 dialysis had a wide distribution range between 0. 5-65 U / ml and values CA125-AR U / min / 1. 73m2 was variable 3. 471-6. Due to the fact that CA125 dialysis levels in patients are significantly different, its serial measurement in each individual may be a more valuable indicator in the follow-up of specific patients, so that deviation from the process of time reduction can be a worrying sign. Significant difference between CA125 and CA125-AR peripheral concentrations (CA-125 Apearrance rate) with patients' demographic information including age, sex, BMI (Body mas index), primary biopsy results and cause of chronic renal failure leading to dialysis Not seen in various studies. Degradation of the mesothelium over time due to contact with high concentrations of PERITONEAL dialysis solution, toxicity of glucose metabolites, and the occurrence of peritonitis may explain the decrease in CA125 dialysis concentration. PERITONEAL biopsy data show loss of mesothelial layer integrity after 5 years in patients undergoing PERITONEAL dialysis. It is a gradual process, so its changes over time can be an indication of mesothelial cell mass. This can be used in the longitudinal follow-up of rolling patients. Information on the relationship between CA125 concentration and PERITONEAL transport is somewhat inconsistent. Only in three papers a positive correlation between CA125 dialysis level and PERITONEAL transport parameters was reported (11, 14, 15) and no similar correlation was seen in other studies. Dialysis levels of CA125 are temporarily increased during peritonitis and return to the level of patients without peritonitis after recovery. Due to the fact that the increase in CA125 concentration in the acute peritonitis episode occurs due to both reversible damage to mesothelial cells and cell death, it can not have a prognostic effect in patients with acute peritonitis. Despite more than 30 years of initial research introducing CA125 as a biomarker of the mesothelial mass of the PERITONEAL membrane, many of the results are still contradictory and a full understanding of the biological significance of this biomarker has not yet been established. Changes in its level in each person are unique and valuable over time, and further studies are needed in this regard.

Background: PERITONEAL cytology has received little attention in the literature, but it may be an additional useful means in evaluating patients with primary gastric cancer. The aim of this study was to examine the diagnostic accuracy of PERITONEAL FLUID lavage cytology in detecting PERITONEAL seeding in patients with gastric adenocarcinoma.Methods: A total of 50 patients with gastric adenocarcinoma who were candidates for laparotomy based on the findings of computed tomographic examination were recruited. Diagnostic PERITONEAL lavage (DPL) was performed just before laparotomy and the PERITONEAL lavage FLUID was sent for cytological examination for presence or absence of malignant cells. Findings in terms of PERITONEAL involvement during laparotomy were regarded as the standard results.Results: DPL cytology was positive for the presence of malignant cells in the PERITONEAL FLUID in 25 cases (50%). According to the intraoperative findings 22 patients (44%) had PERITONEAL metastatic disease, whereas in 28 patients (56%) no gross indicator of metastasis was detected. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of cytology in detecting PERITONEAL seeding were 59%, 57%, 52%, 64%, 1.38 and 1.40, respectively. The agreement between cytology and diagnostic laparotomy was 58%.Conclusion: According to the findings of the present study PERITONEAL lavage solely is not a proper diagnostic method for early recognition of resectable/nonresectable gastric cancers.

Thirty clinical cases of obstructive urolithiasis, 15 with intact urinary bladder and 15 with ruptured urinary bladder, were used to study the changes in PERITONEAL FLUID cytology. The percentage of neutrophils was highly increased than the normal reference range reported for cattle with slight decrease in lymphocyte percentage. The value for neutrophil percent was almost similar in both intact and ruptured urinary bladder cases. The monocyte/mesothelial cells/macrophage percent, though increased than the normal reference range were identical in both the groups. There was a predominant decrease in eosinophil percentage with more decrease in intact urinary bladder cases. Polymorphonuclear-to-mononuclear cell ratio was same in both the groups, but higher than the normal reference value (1:1). Eosinophils £ 8% and neutrophil ³ 30% could be established as a reference range of peritonitis in calves. Red blood corpuscles (RBCs) were totally absent in the PERITONEAL FLUID samples obtained from intact urinary bladder cases except in one case. However, in the PERITONEAL FLUID samples obtained from ruptured urinary bladder cases, RBCs were found in abundance in 3 cases and very few in 2 cases. The morphology and the different cell type present in the PERITONEAL FLUID samples also varied according to the status of urinary bladder. In intact urinary bladder cases, neutrophils were mature and nondegenerate, while in ruptured urinary bladder cases degenerate and hypersegmented neutrophils were more. Mesothelial cells were equally distributed in both the groups. Bacteria were found extracellularly as well as intracellularly in degenerate neutrophils in 4 cases with ruptured urinary bladder and only extracellularly in 2 cases with intact urinary bladder. PERITONEAL FLUID cytology can be used for differentiation of peritonitis from normal cases and non septic peritonitis from septic peritonitis besides diagnosing the uroperitoneum in calves.

Background: Endometriosis is a chronic inflammatory disease with the growth of endometrial cells out of uterus and in the PERITONEAL cavity. T cell subsets participate in the establishment and progress of the disease by producing different cytokines. Objective: To investigate a group of cytokines related to Th1/Th2/Th17/Treg subsets within both peripheral blood and PERITONEAL FLUID (PF) samples from infertile endometriosis women. Methods: Peripheral blood and PF samples were collected from 30 infertile endometriosis and 30 non-endometriosis fertile women during laparoscopy. Concentration of cytokines, including TNF-α , IFN-γ , TGF-β 1, IL-4, IL-10, IL-17 and IL-23 were evaluated using ELISA method. Results: Results indicated that the concentration of IFN-γ within serum was significantly reduced in endometriosis group (p=0. 001). Regarding PF cytokines, TGF-β 1 was increased in endometriosis group (p=0. 030). Furthermore, the ratios of IFN-γ /TGF- 1 and IL-17/IL-23 were significantly different between endometriosis and non-endometriosis women in serum samples (p<0. 001 and p<0. 01 respectively). The ratios of TNF-α /IL-10 and IL-17/IL-10 were also significantly different regarding PF samples between the two studied groups (p<0. 04 and p<0. 03 respectively). Finally, significant correlations were observed between the levels of IL-17 and IL-23, inflammatory and anti-inflammatory cytokines, in both samples and serum to PF inflammatory cytokines. Conclusion: Based on the results of the present study, in women with endometriosis, the disturbance of cytokines network might gradually activate the inflammatory responses and tissue repair, resulting in endometriosis development after several years.

Early detection of free air in the PERITONEAL cavity is vital in diagnosis of life-threatening emergencies, and can play a significant role in expediting treatment. We present a series of cases in which bedside ultrasound (US) in the emergency department accurately identified evidence of free intra-PERITONEAL air and echogenic (dirty) free FLUID consistent with a surgical final diagnosis of a perforated hollow viscus. In all patients with suspected perforated viscus, clinicians were able to accurately identify the signs of pneumoperitoneum including enhanced PERITONEAL stripe sign (EPSS), PERITONEAL stripe reverberations, and focal air collections associated with dirty shadowing or distal multiple reflections as ring down artifacts. In all cases, hollow viscus perforation was confirmed surgically. It seems that, performing US in patients with suspected perforated viscus can accurately identify presence of intra-PERITONEAL echogenic or “dirty” free FLUID as well as evidence of free air, and may expedite patient management.

Foreign body reaction is a tissue response against implanted materials. We described for the first time the eosinophilic peritonitis and foreign body giant cell reaction to dialysis catheter in a nonatopic child on continuous ambulatory PERITONEAL dialysis. We found tenderness, redness, and swelling without purulent discharge around the PERITONEAL catheter; increased eosinophil count in cloudy dialysis FLUID; and blood and hyperechoic granulomatous formation appearance surrounding the PERITONEAL catheter on ultrasonography and foreign body giant cell reaction to dialysis catheter in pathologic examination of granulomatous lesionin in our patient. The PERITONEAL dialysis catheter was removed due to resistance to antibiotic and antihistamine treatments for suspected peritonitis and tunnel infection. Foreign body reaction and eosinophilic peritonitis with eosinophilic cloudy dialysis effluent can exist simultaneously. Foreign body reaction should be considered in the differential diagnosis of exit site and/or tunnel infection. Ultrasonography helps distinguish between foreign body reaction and exit-site or tunnel infection.