Barium granuloma involving urinary bladder

[Retroperitoneal fibrosis due to Schistosoma japonicum: a case report]

We report a case of retroperitoneal fibrosis due to Schistosoma Japonicum in patient with urothelial carcinoma. Retroperitoneal fibrosis was observed in a-83-year-old man during examinations for postrenal renal failure. The symptoms were improved by percutaneous nephrostomy and pulse therapy using corticosteroids, however, urothelial carcinoma was detected during follow-up examinations. The biopsy of retroperitoneal tissue was performed during the surgery for urothelial carcinoma. The histopathological examination revealed scattered calcified eggs of Schistosoma Japonicum in retroperitoneal fibrosis tissue. Therefore, in this case, we assumed Schistosoma Japonicum was the cause of retroperitoneal fibrosis. In our knowledge, there is no report about retroperitoneal fibrosis due to Schistosoma Japonicum. We hypothesize the pathway that the eggs penetrate into retroperitoneal space is extravasation from intestinal wall and peritoneal cavity, although the detail of this mechanism is not obvious. It is well known about the relationship between Schistosomasis and malignant tumors. However, it seemed no evidence regarding the relationship between Schistosoma Japonicum and urothelial carcinoma, since there is no report about it and the eggs were not found in specimen of urothelial carcinoma.

Histological and radiographic evaluation of polymethylmethacrylate with two different concentrations of barium sulfate in a sheep vertebroplasty model

Percutaneous vertebral augmentation with PMMA has been widely performed and usually provides good pain relief and stabilization of fractured vertebrae. Adequate visualization of PMMA during injection is desirable to minimize cement extravasation, so contrast agents such as barium sulfate are commonly added to the PMMA. The aim of this study was to evaluate the differences of histology and radiographic visualization when different concentrations of barium sulfate are mixed with PMMA. Six sheep were utilized in this study. Three vertebrae of each animal were exposed via retroperitoneal approach, and a cavity was created and then filled with either 10% or 30% BaSO4/PMMA, or left empty. Vertebrae were harvested and analyzed radiographically and histologically 12 and 90 days after surgery. Average CT value of the 30% BaSO4/PMMA group was 2.4-fold higher than that of the 10% BaSO4/PMMA group. Foreign-body giant cells were recognized around BaSO4particles at 90 days in the 30% BaSO4 group, whereas few particles were recognized in the 10% group at 90 days, or in either group at 12 days. A very mild giant-cell reaction is induced by a higher concentration of BaSO4 in PMMA, but the marked improvement in cement visualization by increased BaSO4 may be important to minimize more serious complications of cement extravasation during PMMA injection.

Bladder injury during laparoscopic surgery

The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.