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Guerreiro C, Rinaldi A, Brandão E, de Jesus M, Gonçalves L, Mateus N, de Freitas V, Soares S. A look upon the adsorption of different astringent agents to oral models: Understanding the contribution of alternative mechanisms in astringency. Food Chem 2024; 448:139153. [PMID: 38569410 DOI: 10.1016/j.foodchem.2024.139153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
Salivary proteins precipitation by interaction with polyphenols is the major mechanism for astringency. However, alternative mechanisms seem involved in the perception of different subqualities of astringency. In this study, adsorption of four astringent agents to in vitro oral models and their sensory properties were assessed. Overall, green tea infusion and tannic acid have shown a higher adsorption potential for models with oral cells and absence of saliva. Alum and grape seed extract presented higher adsorption in models with presence of oral cells and saliva. Multiple factor analysis suggested that adsorption may represent important mechanisms to elicit the astringency of alum. Models including saliva, were closely associated with overall astringency and aggressive subquality. Models with cells and absent saliva were closely associated with greenness, suggesting a taste receptor mechanism involvement in the perception. For the first time a correlation between an oral-cell based assay and astringency sensory perception was shown.
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Affiliation(s)
- Carlos Guerreiro
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal
| | | | - Elsa Brandão
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal
| | - Mónica de Jesus
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal
| | - Leonor Gonçalves
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal
| | - Nuno Mateus
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal
| | - Victor de Freitas
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal
| | - Susana Soares
- REQUIMTE/LAQV, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 689, Porto, Portugal.
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Molecular Mechanisms and Key Processes in Interstitial, Hemorrhagic and Radiation Cystitis. BIOLOGY 2022; 11:biology11070972. [PMID: 36101353 PMCID: PMC9311586 DOI: 10.3390/biology11070972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
Simple Summary Pathologies of the bladder are called cystitis. They cause discomfort for the patient. Due to persistent pain, bleeding, urinary incontinence, and uncontrolled urination, the chronic forms cause considerable degradation to patient quality of life. Currently, there is no curative treatment for the most severe forms. This is both an economic and a societal problem. Although the different forms of cystitis have different causes, they share common mechanisms. We propose to describe in detail the key processes and the associated mechanisms involved in abacterial cystitis. Abstract Cystitis is a bladder disease with a high rate of prevalence in the world population. This report focuses on Interstitial Cystitis (IC), Hemorrhagic Cystitis (HC) and Chronic Radiation Cystitis. These pathologies have different etiologies, but they share common symptoms, for instance, pain, bleeding, and a contracted bladder. Overall, treatments are quite similar for abacterial cystitis, and include bladder epithelium protective or anti-inflammatory agents, alleviating pain and reducing bleeding. This review summarizes the mechanisms that the pathologies have in common, for instance, bladder dysfunction and inflammation. Conversely, some mechanisms have been described as present in only one pathology, such as neural regulation. Based on these specificities, we propose identifying a mechanism that could be common to all the above-mentioned pathologies.
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Westerman ME, Boorjian SA, Linder BJ. Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: A contemporary evaluation. Int Braz J Urol 2017; 42:1144-1149. [PMID: 27509371 PMCID: PMC5117970 DOI: 10.1590/s1677-5538.ibju.2015.0588] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/13/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.
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Affiliation(s)
| | | | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Mallick S, Madan R, Julka PK, Rath GK. Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management. Asian Pac J Cancer Prev 2015; 16:5589-94. [DOI: 10.7314/apjcp.2015.16.14.5589] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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5
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Moch C, Salmon D, Rodríguez Armesto L, Colombel M, Pivot C, Pirot F. Bladder tissue permeability and transport modelling of intravesical alum, lidocaine hydrochloride, methylprednisolone hemisuccinate and mitomycin C. Int J Pharm 2014; 464:91-103. [DOI: 10.1016/j.ijpharm.2014.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 01/12/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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6
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Willhite CC, Ball GL, McLellan CJ. Total allowable concentrations of monomeric inorganic aluminum and hydrated aluminum silicates in drinking water. Crit Rev Toxicol 2012; 42:358-442. [DOI: 10.3109/10408444.2012.674101] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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7
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Is it safe to use aluminum in the treatment of pediatric hemorrhagic cystitis? A case discussion of aluminum intoxication and review of the literature. J Pediatr Hematol Oncol 2009; 31:285-8. [PMID: 19346883 DOI: 10.1097/mph.0b013e31819b591c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In pediatric oncology patients, hemorrhagic cystitis can be a life-threatening complication of bone marrow transplantation, chemotherapy, and radiation therapy. The treatment of this condition is often challenging and includes intravesical irrigation with aluminum, embolization, endoscopic laser coagulation, hydrostatic pressure, use of hyperbaric oxygen, instillation of formalin, prostaglandins, and oral sodium pentosan polysulfate. Although the efficacy of aluminum irrigation is well documented for the management of hemorrhagic cystitis in adults, there are limited reports describing its use in children. The potential multisystem toxic effects of aluminum are well described and the range and progression of aluminum toxicity can be devastating. We report a case of a 9-year-old girl suffering from acute lymphocytic leukemia with hemorrhagic cystitis. Although the symptoms resolved after intravesical aluminum treatment, she developed significant aluminum toxicity. We have reviewed the literature relating to aluminum toxicity in the pediatric age group and present our recommendations for the effective and safe use of aluminum in this cohort of patients.
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Friesen MS, Purssell RA, Gair RD. Aluminum Toxicity Following IV Use of Oral Methadone Solution. Clin Toxicol (Phila) 2008; 44:307-14. [PMID: 16749550 DOI: 10.1080/15563650600637077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Aluminum toxicity has been reported in renal failure patients exposed to aluminum-contaminated dialysate and oral phosphate binders. We report a case of significant aluminum toxicity in a non-hemodialysis patient. CASE REPORT A 43-year-old male IV drug user presented to the hospital with a seizure disorder of recent onset, progressive cognitive decline, ataxia, and dysarthria. The serum aluminum concentration was 180 micrograms/L (6.65 micromol/L). For 3 to 4 years prior, the patient had injected 'cooked' oral methadone. The methadone solution was heated in an aluminum pot to reduce the volume and then injected intravenously (IV). He was treated with IV deferoxamine over 9 months until he failed to return. Serum aluminum level after 9 months of treatment was 64.5 microgram/L (2.39 micromol/L). Neurological symptoms were partially improved. CONCLUSION Chronic IV injection of oral methadone solution heated in an aluminum-based cooking utensil may result in significant aluminum toxicity.
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9
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Oncologic Emergencies. EMERGENCIES IN UROLOGY 2007. [PMCID: PMC7120542 DOI: 10.1007/978-3-540-48605-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It has been estimated that genitourinary malignancies will account for 25% of new cancer diagnoses in the United States in 2005 (Jemal et al. 2005). While the incidence of many of these malignancies has increased over the past two decades, the mortality rates appear to be decreasing. Early cancer detection combined with improvements in surgical and nonsurgical oncologic therapy account for these trends. Although not common, newly diagnosed cancer patients occasionally present in an emergent, life-threatening manner that warrants immediate medical or surgical intervention. As the prevalence of genitourinary malignancies continues to expand, additional patients can be expected to develop disease or treatment-related complications. This chapter will serve to review the diagnosis and management of oncologic emergencies as they pertain to the urologist.
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Miodosky M, Abdul-Hai A, Tsirigotis P, Or R, Bitan M, Resnick IB, Gesundheit B, Zilberman I, Ioffe L, Leubovic A, Slavin S, Shapira MY. Treatment of post-hematopoietic stem cell transplantation hemorrhagic cystitis with intravesicular sodium hyaluronate. Bone Marrow Transplant 2006; 38:507-11. [PMID: 16921402 DOI: 10.1038/sj.bmt.1705474] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hemorrhagic cystitis (HC) is a well-known complication of HSCT. Its overall incidence has been reported to vary from 7-68%. The spectrum of clinical presentation varies from asymptomatic microhematuria to life-threatening bleeding. Sodium hyaluronate is a glycosaminoglycan present on the bladder mucosa, which serves as an important protective substance against uroepithelial damage. Preparations of this component have been shown to be effective in the treatment of interstitial cystitis. We report our experience in the treatment of post-transplant HC with intravesical instillation of sodium hyaluronate. Five out of the seven patients included in this study achieved complete response, while one patient had only partial response. Sodium hyaluronate administration was not associated with any local or systemic adverse effects. We consider that the results of our study are promising and the efficacy of sodium hyaluronate in the treatment of post-transplant HC should be tested in larger cohorts of patients.
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Affiliation(s)
- M Miodosky
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
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11
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Acute Aluminum Intoxication. STRUCTURE AND BONDING 2002. [DOI: 10.1007/3-540-45425-x_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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12
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Abstract
Aluminum is the most widely distributed metal in the environment and is extensively used in modern daily life. Aluminum enters into the body from the environment and from diet and medication. However, there is no known physiological role for aluminum within the body and hence this metal may produce adverse physiological effects. The impact of aluminum on neural tissues is well reported but studies on extraneural tissues are not well summarized. In this review, the impacts of aluminum on humans and its impact on major physiological systems are summarized and discussed. The neuropathologies associated with high brain aluminum levels, including structural, biochemical, and neurobehavioral changes, have been summarized. In addition, the impact of aluminum on the musculoskeletal system, respiratory system, cardiovascular system, hepatobiliary system, endocrine system, urinary system, and reproductive system are discussed.
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Affiliation(s)
- Prasunpriya Nayak
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102, Sikkim, India
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13
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Affiliation(s)
- S K Choong
- St. George's Hospital, Blackshaw Road, London, UK.
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14
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Nakamura H, Rose PG, Blumer JL, Reed MD. Acute encephalopathy due to aluminum toxicity successfully treated by combined intravenous deferoxamine and hemodialysis. J Clin Pharmacol 2000; 40:296-300. [PMID: 10709159 DOI: 10.1177/00912700022008847] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute aluminum intoxication is uncommon in clinical practice but can be fatal. This limited experience is reflected in the paucity of data assessing a viable approach to the treatment of these patients. In this report, the authors describe the clinical course and successful, pharmacokinetic-based deferoxamine-hemodialysis treatment regimen of a patient with severe aluminum encephalopathy following alum bladder irrigation. The combined use of deferoxamine and appropriately timed hemodialysis appears to be a very reasonable means of treating patients with severe acute aluminum intoxication.
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Affiliation(s)
- H Nakamura
- Division of Pediatric Pharmacology and Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH 44106-6010, USA
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15
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Phelps KR, Naylor K, Brien TP, Wilbur H, Haqqie SS. Encephalopathy after Bladder Irrigation with Alum: Case Report and Literature Review. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40610-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Phelps KR, Naylor K, Brien TP, Wilbur H, Haqqie SS. Encephalopathy after bladder irrigation with alum: case report and literature review. Am J Med Sci 1999; 318:181-5. [PMID: 10487408 DOI: 10.1097/00000441-199909000-00013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 70-year-old man with advanced obstructive nephropathy began to hemorrhage from the bladder after decompression with a Foley catheter. Manifestations of encephalopathy appeared after continuous irrigation with 1% alum for 2 days and were associated with elevated serum aluminum concentrations. Repeated treatments with deferoxamine and hemodialysis accomplished some aluminum removal, but the patient succumbed to bronchopneumonia. Brain aluminum content was not excessive at autopsy. A literature review suggests that intact renal function is essential to rapid disposal of a parenteral aluminum load and indicates that most reported instances of encephalopathy after alum irrigation have occurred in patients with compromised renal function. We conclude that alum should not be employed as a bladder irrigant in patients with acute or chronic renal failure.
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Affiliation(s)
- K R Phelps
- Medical, Laboratory Medicine, and Surgical Services, Stratton Department of Veterans' Affairs Medical Center, and Albany Medical College, New York 12208, USA
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17
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Mor Y, Hitchcock RJ, Zaidi SZ, Quimby GF, Duffy PG, Ransley PG, Mouriquand PD. Bladder hemangioma as a cause of massive hematuria in a child. A case report and literature review. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1997; 31:305-7. [PMID: 9249900 DOI: 10.3109/00365599709070355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 12-year-old girl with bladder hemangioma presenting with massive hematuria is described. The patient was previously operated for removal of cystic hygroma from the chest wall. The association of those two pathological entities suggests possible common etiology and pathogenesis and the various therapeutic options are reviewed.
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Affiliation(s)
- Y Mor
- Department of Paediatric Urology, Hospital For Sick Children, London, U.K
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18
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Kanwar VS, Jenkins JJ, Mandrell BN, Furman WL. Aluminum toxicity following intravesical alum irrigation for hemorrhagic cystitis. MEDICAL AND PEDIATRIC ONCOLOGY 1996; 27:64-7. [PMID: 8614395 DOI: 10.1002/(sici)1096-911x(199607)27:1<64::aid-mpo13>3.0.co;2-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mental status changes in an immunosuppressed child can be due to a variety of causes; aluminum toxicity is rarely considered. We report a teenage girl with acute lymphoblastic leukemia who developed mental status changes, speech disturbance, coarse tremor, and abnormal EEG findings following intravesical 1% alum irrigation and administration of aluminum-containing antacids. Her serum aluminum levels were mildly elevated (14-22 milligram(s), normal 0-6 milligram(s)), and bone marrow biopsy specimens demonstrated aluminum deposition on special staining (Krueger's method). All abnormalities resolved after a nine-week course of intravenous deferoxamine.
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Affiliation(s)
- V S Kanwar
- Department of Hematology Oncology, St. Jude Children's Research Hospital, Mcmphis, TN 38101-0318, USA
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19
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Abstract
OBJECTIVES Patients undergoing bone marrow transplantation are at risk for hemorrhagic cystitis despite appropriate preventive measures. This complication could have an impact on patient survival and other outcome variables. METHODS A retrospective study of patients subjected to bone marrow transplantation was conducted to determine risk factors for hemorrhagic cystitis and evaluate the impact of hemorrhagic cystitis on certain outcome variables. Patients who experienced hemorrhagic cystitis received various forms of therapy, at the discretion of the treating physician. RESULTS Hemorrhagic cystitis occurred more frequently in younger patients and those undergoing allogeneic transplantation. The occurrence of hemorrhagic cystitis was associated with increased hospital costs, length of hospitalization, and mortality. Gender, race, type of malignancy, other pretransplantation comorbidity, and the occurrence of other peritransplantation complications were not associated with occurrence of hemorrhagic cystitis. CONCLUSIONS Hemorrhagic cystitis is a significant complication of bone marrow transplantation, which influences economic and survival outcome. Since the number of bone marrow transplants being performed is increasing, urologists should be prepared to play an active role in treating patients who experience this complication.
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Affiliation(s)
- C C Yang
- Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina
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20
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Severe hemorrhagic cystitis. Int Urogynecol J 1993. [DOI: 10.1007/bf00376420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Goswami AK, Mahajan RK, Nath R, Sharma SK. How safe is 1% alum irrigation in controlling intractable vesical hemorrhage? J Urol 1993; 149:264-7. [PMID: 8426397 DOI: 10.1016/s0022-5347(17)36051-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A prospective study was done to evaluate the efficacy and safety of intravesical instillation of 1% alum solution in 12 cases of hematuria of vesical origin, uncontrolled by saline irrigation for 24 hours via a 3-way Foley catheter. There were 10 cases of transitional cell carcinoma and 2 of radiation cystitis. Complete response was noted in 6 patients and a partial response in 4. Local side effects included suprapubic pain and vesical tenesmus, which were controlled by antispasmodic and/or analgesic drugs. Transient low grade pyrexia (maximum up to 38.2C) was noted in 4 patients. Among the other various clinical and biochemical parameters, serum aluminum level and prothrombin time showed statistically highly significant changes. Serum aluminum increased from an average baseline value of 1.68 to 3.36 mumol./l. without clinical evidence of aluminum toxicity and with levels well below the recommended safe limit. Prothrombin time increased parallel with the increase in serum aluminum level to a maximum of 1 1/2 times the control. Prothrombin values, therefore, can be used clinically, since they are readily obtainable whereas serum aluminum levels are not. Vesical irrigation with 1% alum solution is a safe method to control hematuria of vesical origin in properly selected cases.
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Affiliation(s)
- A K Goswami
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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22
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Perazella M, Brown E. Acute aluminum toxicity and alum bladder irrigation in patients with renal failure. Am J Kidney Dis 1993; 21:44-6. [PMID: 8418625 DOI: 10.1016/s0272-6386(12)80719-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Intravesical alum instillation is an increasingly common treatment for hemorrhagic cystitis. It has been claimed that this therapy is safe in patients with renal failure. We report the case of a patient with renal failure following a bone marrow transplantation who developed an acute encephalopathy from apparent aluminum intoxication following intravesical alum. In a review of the literature, we have found two similar cases of acute aluminum intoxication from alum in patients with renal failure who have received multiagent chemotherapy. We suggest that alternate therapies be selected for hemorrhagic cystitis in such patients.
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Affiliation(s)
- M Perazella
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06510
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23
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24
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Shoskes DA, Radzinski CA, Struthers NW, Honey RJ. Aluminum toxicity and death following intravesical alum irrigation in a patient with renal impairment. J Urol 1992; 147:697-9. [PMID: 1538463 DOI: 10.1016/s0022-5347(17)37356-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intravesical alum irrigation is the safest and most effective method of treatment for intractable hematuria. Systemic absorption is reported to be minimal and there have been no reported deaths following its use. We describe an elderly man with compromised renal function (serum creatinine 420 mumol./l.) who was treated with 1% alum irrigation for 48 hours for hematuria due to inoperable bladder cancer. He received a total of 9.6 l. during 48 hours, which controlled the bleeding. After cessation of the alum he became lethargic, suffered respiratory depression and died the next day. Laboratory data showed mild metabolic acidosis and increasing daily aluminum levels that peaked at 7,014 nmol./l. (toxic greater than 2,000) beginning on the day after treatment was commenced. The efficacy and safety profile of alum irrigation is discussed.
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Affiliation(s)
- D A Shoskes
- Division of Urology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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25
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Moreno A, Domínguez P, Domínguez C, Ballabriga A. High serum aluminium levels and acute reversible encephalopathy in a 4-year-old boy with acute renal failure. Eur J Pediatr 1991; 150:513-4. [PMID: 1915506 DOI: 10.1007/bf01958436] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report a 4-year-old boy, in acute renal failure, who had acute encephalopathy with very high serum aluminium levels (135 micrograms/l [5 mumol/l]) after receiving vesical irrigations with alum. We believe that in situations of non-focal neurological deterioration with no apparent cause in patients with impaired renal function receiving aluminium-containing preparations, the possibility of acute aluminium poisoning should be considered.
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Affiliation(s)
- A Moreno
- Department of Paediatrics, Children's Hospital, Vall d'Hebron, Autonomous University of Barcelona, Spain
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26
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Seear MD, Dimmick JE, Rogers PC. Acute aluminum toxicity after continuous intravesical alum irrigation for hemorrhagic cystitis. Urology 1990; 36:353-4. [PMID: 2219619 DOI: 10.1016/0090-4295(90)80247-k] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An encephalopathy and cardiomyopathy developed in a seventeen-year-old girl with chemotherapy-induced renal failure while receiving an intravesical aluminum infusion for hemorrhagic cystitis. Premortem serum and postmortem tissue aluminum levels were markedly elevated. It is likely that her inability to excrete absorbed aluminum contributed to her death. Aluminum infusions should be used with caution in patients with renal failure.
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Affiliation(s)
- M D Seear
- Department of Pathology, University of British Columbia, Vancouver, Canada
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Abstract
Acute, fulminant bladder hemorrhage usually is seen at tertiary care centers in which cancer patients are treated with oxazaphosphorine alkylating agents, particularly cyclophosphamide and isophosphamide. These agents also are used to treat benign conditions, such as lupus erythematosis and Wegener's granulomatosis. Radiation effects from treatment of prostatic or cervical carcinoma can appear for the first time as late as 15 to 20 years after initial treatment. Other iatrogenic causes of bleeding include treatment with penicillins and, rarely, danazol. Occasionally, bladder hemorrhage may be the presenting sign of metabolic disease, such as secondary amyloidosis in rheumatic arthritis. Cases of mild to moderate hemorrhagic cystitis arising in the otherwise healthy patients should lead one to pursue the possibility of environmental toxins, accidental poisoning, recreational drug use or viruses. In all cases the diagnosis should be reserved until more common causes of hematuria, such as bacterial or fungal infection, stones, cysts or tumors, have been ruled out. Prevention of chemotherapeutically induced cystitis ideally will follow careful attention to adequate hydration and the prophylactic use of antitoxins, such as mesna. Treatment, as outlined previously, consists of a series of measures beginning with the most conservative. Intervention thereby is tailored to the gravity of the clinical situation.
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Affiliation(s)
- C R deVries
- Division of Urology, Stanford University School of Medicine, California
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Schootstra R, van Driel MF, Hassankhan R, van de Werff R, Oremus ET, Uges DR, Mensink HJ. The use of an alum irrigation in the treatment of massive bladder haemorrhage. PHARMACEUTISCH WEEKBLAD. SCIENTIFIC EDITION 1989; 11:175-8. [PMID: 2594469 DOI: 10.1007/bf01959467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Severe, massive bladder haemorrhage is a difficult and often frustrating clinical problem. The aetiologies are numerous and include irradiation, malignancy, severe infection and drug-induced changes. Among the numerous modalities of treatment that have been reported formalin, phenol and silver nitrate instillations have often been associated with significant side effects, morbidity and mortality and have had varying degrees of success. During the last two years we have used continuous closed irrigation of a sterile 0.5% alum solution in 16 patients. Alum is an astringent and acts by protein precipitation over the bleeding surface. Because of a low cell permeability its action is limited to the cell surface and interstitial spaces. The permeability of the cell membrane is reduced but remains viable. The preparation and the pharmaceutical aspects of the 0.5% alum irrigation will be discussed. The conclusion is that the technique of managing massive bladder haemorrhage is simple, efficient, nontoxic and less expensive than previously reported therapies. Therefore, irrigation with alum before instituting invasive means to control bleeding is recommended.
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Affiliation(s)
- R Schootstra
- Department of Pharmacy, University Hospital, Groningen, The Netherlands
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Affiliation(s)
- L A Levine
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois 60637
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Abstract
We report a patient with severe renal failure in whom massive bladder hemorrhage was successfully treated with alum irrigation. There was no substantial potassium or aluminum absorption with alum irrigation.
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Affiliation(s)
- K B Modi
- Renal Unit, Royal Infirmary, Glasgow, Scotland
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