[BLADDER PAIN SYNDROME - DOES DETRUSOR MASTOCYTOSIS PREDICT SYMPTOMATIC IMPROVEMENT FOLLOWING BLADDER HYDRODISTENTION UNDER ANESTHESIA?]

INTRODUCTION

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, debilitating syndrome involving bladder pain and lower urinary tract symptoms (LUTS), with a substantial effect on patients' quality of life. IC/BPS poses a diagnostic challenge, and its available treatment options remain only moderately effective. Bladder-wall biopsies from IC/BPS patients commonly uncover mastocytosis. While mast-cells are suspected as pivotal in disease pathogenesis, the clinical significance of their presence remains unclear. Clinical guidelines differ on whether or not bladder biopsies should be a part of routine IC/BPS workup.

AIMS

To determine whether detrusor mastocytosis can serve as a prognostic marker for treatment response and improvement duration.

METHODS

We retrospectively collected patient data for IC/BPS patients who underwent bladder hydrodistension under anesthesia. We used statistical modelling to determine the effect of mastocystosis and other possible predictive factors - age, comorbidity, Hunner lesions - on the presence and duration of symptom improvement.

RESULTS

A total of 35 patients (89% female, median age 63.5 [IQR 48.8-73.6] years) underwent hydrodistension, of whom 28 (89% female, median age 63.0 [44.8-73.1] years) had bladder biopsies; 11 (39%) of them had mastocystosis. Within a median follow-up of 8.8 [1.7-24.2] months, 11 (100%) of the patients with mastocytosis and 9 (53%) of the patients without it, experienced symptomatic improvement (p=0.007). Improvement duration was 8 months longer (p=0.006) in those with mastocystosis. Univariate logistic regression models were used to estimate odds ratios (OR). Mastocytosis (p=0.004) and Charlson Comorbidity score were the only variables with a statistically significant OR. Univariate survival models were fitted, and improvement duration was estimated to be longer in patients with mastocystosis (p=0.01). A multivariate Cox regression model found no variable to be statistically significant, though mastocystosis was borderline significant (p=0.055).

CONCLUSIONS

Mastocystosis defines a discernible phenotype of IC/BPS, which exhibits higher rates and longer duration of hydrodistention treatment response.

DISCUSSION

Notwithstanding limitations of sample size and retrospective study design, we were able to demonstrate that mastocystosis can serve as a prognostic factor for symptom improvement after hydrodistension in IC/BPS patients. Prospective studies are required to validate this finding and to investigate the mechanisms involved.

Clinical advice from the bench

This article discusses three aspects of family law: (1) a new approach to custody litigation currently in use in one family law court in New Mexico; (2) why some judges, lawyers, and family courts are slow to change the way family law cases are managed; and (3) how mental health professionals might change their interactions with the legal system to benefit both their professions and the people they serve.

Behavior of genes directly injected into the rat heart in vivo

Gene transfer can be achieved in the adult rat heart in vivo by direct injection of plasmid DNA. In this report we define the spatial and temporal limits of reporter gene expression after a single intracardiac injection. pRSVCAT (100 micrograms), in which the Rous sarcoma virus long terminal repeat is fused to the chloramphenicol acetyltransferase reporter gene, and p alpha MHCluc (100 micrograms), in which the alpha-cardiac myosin heavy chain promoter is fused to the firefly luciferase gene, were injected into hearts, and reporter gene activities were assayed at various times. Both chloramphenicol acetyltransferase and luciferase were detectable in 100% of the rats from 1 to 7 days, in 60% of the rats from 17 to 23 days, and in 30% of the rats from 38 to 60 days after injection. Reporter gene activity was largely limited to a 1-2-mm region of the ventricle surrounding the injection site. Closed circular DNA was far more effective than linear DNA in transfecting cells in vivo. The relative strengths of three different promoters, Rous sarcoma virus long terminal repeat, alpha-myosin heavy chain, and alpha 1-antitrypsin, all fused to the luciferase reporter gene were determined. The constitutive viral promoter was approximately 20-fold more active than the cardiac-specific cellular promoter, and the liver-specific cellular promoter was not active at all in the cardiac environment. Thus, direct injection of genes into the heart offers a simple and powerful tool with which to assess the behavior of genes in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)

[Does the light of soft lasers or of combination soft and middle-power lasers improve wound healing in rats? Continuing studies]

In recent years, soft and middle-power lasers have been employed in the treatment of wounds and various dermatoses, but as yet no experimental confirmation of their effects has come available. However, we have been able to show in a recent study that light from combined soft and middle-power lasers applied on postoperative days 1, 2, 3, 5 and 8 has a positive effect on wound healing in rats. The present study was intended to clarify the influence of the type of laser light and treatment duration under controlled conditions. In 24 rats, a 3-cm incision was made in the abdominal wall and sutured with 5 single knots. Eight of the animals served as controls, while the remaining animals were treated with laser light, 8 with a soft laser for 10 min/day on postoperative days 2, 3, 5, 8 and 15, the other 8 for 20 min. on day 1 only with combined soft and middle-power lasers. The wounds were photographed on post-operative days 1, 2, 3, 5, 8 and 15. 10 independent observers rated the photographs on a scale of 1 to 4 on the basis of edge approximation and absence of inflammation. Soft laser light alone did not improve wound healing as judged by these criteria. Nor did a single dose of combined soft and middle-power laser light have any statistically significant effect.