[Spontaneous bladder perforation secondary to bacterial cystitis. Cause of acute abdomen in diabetic elderly]

Presentation of two clinical cases of spontaneous vesical rupture secondary to bacterial cystitis in elderly patients. One corresponds to an intraperitoneal perforation while the second case was extraperitoneal. The patients were, in both cases, diabetic women admitted in emergency due to acute abdomen. We considered that although vesical perforation secondary to bacterial cystitis is a very uncommon process, it should be taken into account in the differential diagnosis of acute abdomen in predisposed patients (diabetic elderly patients with pyuria). In such instances, a retrograde cystography would provide the diagnosis. Although extraperitoneal vesical perforations can be resolved with a vesical catheter or cystostomy, extravasation of the infected urine may result in a perivesical abscess and septic shock. Early surgical management should be considered in these cases.

[Polypoid cystitis in pregnant diabetic]

Presentation of one case of a diabetic patient, who after 8 weeks pregnancy presented polypoid cystitis, with no prior background of vesical catheterism. The rarity of the case, as well as the clinical and pathoanatomical characteristic are commented.

Glomerulations in women with urethral sphincter deficiency: report of 2 cases [corrected]

A classic feature of interstitial cystitis is the development of glomerulations during bladder distention while the patient is under anesthesia, which is thought to be a sign that the bladder was chronically under filled before distention. The cause for under filling is pain or sensory urgency in interstitial cystitis, and glomerulations have also been associated with conditions of decreased functional bladder capacity. Two cases of bladder glomerulations associated with severe intrinsic urethral sphincter deficiency (type 3 incontinence) are reported. Neither patient had symptoms of interstitial cystitis before or after anti-incontinence surgery. A likely explanation is that severe stress incontinence chronically prevented the bladder from filling to capacity before cystoscopy. Thus, these cases support the premise that glomerulations are a response to distending a previously under filled bladder [corrected].

[A comparative study of mortality and infectious complications in patients admitted to neurological and general wards]

We analyse the outcome of patients with cerebral infarction depending the admission in neurological department or in general wards. We find an improvement of the changes in Toronto, Mathew and Barthel scales and a reduction in the mortality in patients admitted in Neurological department. The improvement is related with a reduction in infectious complications observed in the Neurological ward. Our data suggest that the place of the patient admission in the hospital may influence the prognosis of stroke patients and should be consider in patients with cerebrovascular disease.

Effective management of urinary discomfort

Urinary discomfort is the second most common physical complaint affecting women. Although urinary discomfort is commonly a result of inflammation due to bacterial invasion, there are also nonbacterial causes. The development of antimicrobial resistance to bacteria is frequent and costs the patient and the medical community unnecessary time and money. Antimicrobial intervention should be instituted only after the uropathogen is identified through a urine culture. While awaiting the results of the urine culture or other laboratory or radiological tests, the patient's symptoms can be relieved with the use of urinary analgesics or antispasmodics. This conservative approach meets the immediate concern of the patient and better ensures a proper diagnostic workup and successful cure. Along with a conservative diagnostic approach, the patient should be included in all aspects of health care management.

[Characteristics of nephrotuberculosis in children, adolescents and young persons]

According to the author, urogenital tuberculosis in children and young subjects occurs in 10% of all the cases with this disease. Antituberculosis service registers 71.2% of cases in preschool children, whereas in schoolchildren 70.4% of diagnoses are made by general practitioners. 90% of nephrotuberculosis cases are detected early, in 85% bacteriological examination.

Eosinophilic cystitis: a rare case which presented as an invasive bladder tumor

Eosinophilic cystitis is a rare inflammatory lesion of the bladder of unknown etiology. It can be confused clinically and cytoscopically with invasive bladder cancer. We report a case in which the lesion presented as an invasive bladder tumor and we discuss the literature in brief.

[Adenovirus-induced kidney graft pyelonephritis following renal transplantation]

A 16-year-old female received a kidney transplantation from her mother 13 months before she suddenly noticed gross hematuria and painful micturition, and developed high fever with chills. The serum creatinine (S-Cr) level rose from 1.5 to 2.6 mg/dl, but there was no clinical sign of acute rejection. Despite the treatment with antibiotics and gamma-globulin, the the high fever and hematuria did not improve. The adenovirus antibody titer elevated from x8 to x1,024, while adenovirus was not isolated from the urine. On the 15th day of the disease, hematuria disappeared spontaneously and on the 19th day she became afebrile. The S-Cr level also was normalized spontaneously. Histological examination of the graft biopsy on the 14th day, showed severe tubulointerstitial nephritis localized in the renal medulla and full type intranuclear inclusions were revealed in tubular epithelial cells. From these findings, we diagnosed this case as adenovirus-induced kidney graft pyelonephritis associated with acute hemorrhagic cystitis.

[Emphysematous cystitis with inversion of the contrast and urine levels inside a bladder diverticulum in computerized tomography]

We report a case of emphysematous cystitis in a 70-year-old male with acute urinary retention. Patient evaluation included a CT scan that disclosed a large diverticulum in the bladder and inverted contrast medium-urine level. We discuss the possible causes of this unique, paradoxic and infrequent finding, which often indicates the presence of infectious sediment in the bladder.

CA 19-9 in carcinoma of the bilharzial bladder

Carbohydrate antigen 19-9 (CA 19-9) is a glycoprotein of molecular weight 360,000-390,000 daltons which is closely related to Lewis blood antigen. It is normally secreted by the urothelium and supposed to have a protective function against the harmful effect of low pH on the cells. With the development of malignancy its secretion increases, secondary to anaerobic glycolysis and lactate accumulation, (differentiation trait). It is secreted by the pancreas and may show increase in some gastrointestinal malignancies. Carcinoma of the urinary bladder is a major problem in Egypt. It represents 26% of malignant tumours, 86% of tumours occur on top of bilharzial cystitis. It has three histopathological types: squamous cell carcinoma (75.9%), transitional cell carcinoma (TCC) (16%), adenocarcinoma (6%) and undifferentiated (2.1%). CA 19-9 serum level was studied in the different groups. It was found to be elevated only in TCC. The level was proportional to the bulk of malignant tissue and it returned to normal after tumour resection. Recurrence was associated with high serum level. CA 19-9 could be of value in detection and follow-up of TCC of the bladder.

Management of urinary tract infections in pregnancy

Urinary tract infections (UTIs) are one of the most frequent complications of pregnancy. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. The associated decreased maternal morbidity and fetal prematurity are the goals of a screening and treatment program for pregnant women. This clinical article presents information on the etiology, incidence, diagnosis, and management of asymptomatic bacteriuria and cystitis. Nursing implications regarding teaching are included.

Management of severe hemorrhagic cystitis in pregnancy. A report of two cases

Acute hemorrhagic cystitis (AHC) is gross hematuria and symptoms of cystitis. Usually a self-limiting entity, it is found mainly in children and cancer patients receiving chemotherapy or radiation. In a small number of patients, AHC can be severe and require aggressive management. We present two cases of severe acute hemorrhagic cystitis in pregnant women that led to hemorrhage, resistance to antibiotic therapy and premature labor. Continuous bladder irrigation with normal saline was attempted with success in stopping the hematuria and arresting the premature labor. Severe hemorrhagic cystitis in pregnancy may require aggressive management when associated with a significant blood loss and preterm labor.

Persistence of carcinogen-altered cell population in rat urothelium which can be promoted to tumors by chronic inflammatory stimulus

Chronic inflammation of the urinary tract is a significant risk factor for the development of urinary bladder cancer in man. Previously we have shown that acute and chronic inflammation induced by repeated intravesical instillation of killed Escherichia coli (KEC) strikingly enhanced N-methyl-N-nitrosourea (MNU)-initiated bladder carcinogenesis in our heterotopically transplanted rat urinary bladder model. We conducted the present study to determine whether delayed onset of KEC treatment can still enhance carcinogenesis of the MNU-initiated urothelium and whether continuous KEC treatment is necessary for the development of tumors. After the initiation of carcinogenesis in heterotopically transplanted bladders by the instillation of a single dose (0.25 mg) of MNU, animals were divided into several groups, for which weekly KEC treatment (5 x 10(8) cells suspended in 0.5 ml of phosphate-buffered 2.1% NaCl solution) was begun 1, 5, and 18 weeks later and continued until termination of the experiment at 31 weeks. In addition, animals received 4-week KEC treatment, which was started 1 or 5 weeks after MNU administration. Treatment with KEC alone or MNU alone induced few tumors. Maximal tumor development was demonstrated in the group receiving KEC treatment continuously throughout the experimental period. Delaying the onset of continuous KEC treatment by 4 weeks resulted in a significant decrease in the number of tumors (P = 0.006). However, a substantial number of tumors were induced even when KEC treatment was delayed as many as 18 weeks, as compared to tumor development in the group receiving MNU only (P = 0.007). The tumor volume (size) was not different between continuous and short-term KEC treatment groups. We conclude that (a) although a large number of cells undergo promutagenic DNA damage by a single dose of MNU, the amounts are reduced quickly during the subsequent 4 weeks; but that (b) a substantial number of genetically altered cells remain for a long time and can be promoted to tumors when stimulated by a chronic inflammatory stimulus; and that (c) the duration of KEC treatment determines the number, but not the volume, of tumors.

Oral conjugated estrogen therapy for treatment of hemorrhagic cystitis

We report 7 cases of severe hemorrhagic cystitis that required repeated transfusions, surgical intervention and oral conjugated estrogens. Of these 7 cases hematuria resolved completely in 5 during estrogen therapy and decreased sufficiently in 1 to preclude further transfusion. We found conjugated estrogens to be an effective, simple, inexpensive, well tolerated and readily available treatment for hemorrhagic cystitis.

Schistosomiasis and malignancy

It is generally accepted that schistosomiasis, if not causative, is at least associated with malignancy. In this review, the epidemiology of schistosomiasis and bladder carcinoma, as well as the role of chronic bladder infection, are discussed together with known carcinogenic factors, possible abnormal vitamin metabolism and/or deficiencies and factors that influence conjugated carcinogens. Experimental evidence is briefly examined and recent work from the Far East on schistosomiasis and colon carcinoma reviewed.

Toxoplasma-induced cystitis in a patient with AIDS

We report a case of cystitis due to Toxoplasma gondii in a patient with AIDS who presented with dysuria and urinary frequency. To our knowledge, this is the first reported case of cystitis due to this organism. Microscopy of bladder specimens revealed inflammatory cystitis, with Toxoplasma cysts disseminated within the mucosa. No other pathogen could be detected by urine culture, cytoscopy, or staining of bladder specimens obtained at autopsy. Diagnosis of cystitis due to Toxoplasma gondii may be difficult because this illness is associated with misleading radiologic and endoscopic findings. Toxoplasmosis is a rare but potentially curable cause of culture-negative cystitis in patients with AIDS.

[A double blind controlled study on S6472 capsules and granules in complicated urinary tract infection]

The efficacy, safety and usefulness of S6472 capsules (cefaclor, long-acting preparation) were investigated in non-catheterized patients with complicated cystitis using the double blind method with S6472 granules as a control. Each of the patients was orally administrated with 375 mg of the drug twice a day for 7 days, and clinical effectiveness was evaluated according to the Criteria of Drug Efficacy of UTI (the Third Edition). The following results were obtained. 1. There was no significant bias between the capsule-administrated group (A) and the granule-administrated group (B) in background factors. 2. The overall clinical efficacy rates were 78.7% in Group A and 80.5% in Group B, which showed no significant difference. No significant difference was observed also between groups IV and VI in the efficacy for any of the UTI groups. 3. Eradication rates in bacteriological response were 85.9% and 86.0% in Group A and B, respectively. 4. Clinical efficacy rates evaluated according to doctors in charge of patients were 78.7% and 74.7% in Group A and B, respectively, showing no significant difference between the two groups. 5. The incidences of adverse reactions were 3.0% in Group A (3 out of 101 cases) and 7.1% in Group B (7 out of 98), thus no significant difference was found between the two groups. Abnormal test values in laboratory examinations included 5 cases (in 4 among 75 patients) in Group A, but were not detected in any of the 76 patients in Group B. No statistically significant difference were observed between the two groups, however. 6. No significant difference between the two groups was observed in the usefulness evaluation including efficacy and safety profiles on an analog scale by the doctors in charge of patients. These results indicate that S6472 capsules have the same efficacy, safety and usefulness as S6472 granules, suggesting that both drugs are equally excellent for non-catheterized patients with complicated cystitis.

Self-care regimens for patients with interstitial cystitis

For those who suffer from interstitial cystitis, living with the condition is a challenge that requires creativity, patience, determination, and a sound set of coping mechanisms. Because of the high percentage of gynecologic and systemic manifestations of interstitial cystitis, a customized treatment regimen is often necessary to achieve the therapeutic goal of a remission in symptoms. Treatment philosophies should be based on the proposed causative mechanisms, and a multimodality approach to therapy is usually successful. Self-care regimens give the patient a sense of control by active participation in treatment, which often improves coping mechanisms. Treatment of the sequelae of chronic pain (anxiety and depression) often improves response to overall therapy. Remission is the goal, coping is the key, and creativity opens the door to treating this most perplexing of conditions.