Cystoscopic staging of carcinoma uterine cervix, revisited

Of the 378 cases of stage 3 carcinoma uterine cervix, only 10 showed vesical invasion, while 19 of 24 cases of stage 4 disease had vesical invasion. Results of this procedure did not alter the management of the disease in any of these cases. From the whole series it was concluded that cysto-urethroscopy is an unnecessary, cost ineffective, invasive procedure which has no role in either diagnosis or in planning the definitive treatment of carcinoma uterine cervix.     

Influence of urinary management on urologic complications in a cohort of spinal cord injury patients

OBJECTIVE: To study urologic complications in patients with spinal cord injury (SCI) in relation to their bladder management. DESIGN AND SETTING: A cohort study of patients with SCI in a rehabilitation center. PARTICIPANTS: One hundred eighty-two patients were studied; demographic data, disease characteristics, and urologic history were obtained for each. INTERVENTION: Patients responding to a questionnaire were given a clinical exam. Their medical records were reviewed, with particular attention given to the following urologic complications: lithiasis, urinary infections, orchiepididymitis, urethral trauma, vesicorenal reflux, and renal failure. RESULTS: Results are reported for 123 patients. Time since SCI was 8 years. Intermittent catheterization was the main method of bladder management. Only 32 patients had changed their method of vesical voiding. Urinary complications had developed in 75% of patients. The most common complication was urinary infection. Vesicoureteral reflux occurred in 26% of patients using percussion. Trauma related to catheterization was the main problem with intermittent catheterization, responsible for a high rate of orchiepididymitis. CONCLUSION: Intermittent catheterization is the most-used method of bladder management, but with a nonnegligible rate of urethral trauma in men. Percussion and Credé maneuver appear to be acceptable techniques of bladder management if the patient is closely monitored.     

Intestinal uptake of macromolecules. V. Comparison of the in vitro uptake by rat small intestine of antigen-antibody complexes prepared in antibody or antigen excess

The in vitro absorption by rat jejunal and ileal gut sacs of soluble antigen-antibody complexes and of antigen alone was compared. Complexes prepared in 2-fold antibody excess were absorbed in significantly smaller quantities than was antigen alone. Complexes prepared in 50-fold antigen excess were absorbed by jejunal gut sacs in quantities equivalent to that antigen alone, whereas the absorption of such complexes by ileal sacs was somewhat decreased compared to that of antigen. There was less radiolabeled antigen tightly bound to the intestinal mucosa of gut sacs exposed to complexes prepared in antigen or antibody excess compared to antigen alone. Complexes prepared in antibody excess appeared to stimulate secretion of mucus and complexes were associated with the mucus fraction. It was suggested that the large size of complexes prepared in antibody excess may result in their trapping in the mucus coat of the gut, thereby preventing contact with the surface of the enterocyte from whence uptake by pinocytosis is initiated. In addition, complexes appear to be shed from the surface with mucus by a mechanism still to be elucidated.     

Laparoscopically assisted colpopoesis using sigmoid colon]

Presentation of one case of scrotal vesical hernia in a 66-year old patient who presented with scrotal mass, micturition difficulty and two-phase micturition that improved when pressure was exerted on the scrotum. Diagnosis was established by physical examination and CUMS. The patient underwent surgery during which a direct inguinal hernia due to paraperitoneal vesical sliding was found. Right herniorrhaphy was performed with Shouldice's technique. Postoperative radiological monitoring showed normal vesical morphology. The pathogeny, classification and treatment, as well as the differential diagnosis uncommonly reported by the authors consulted, are commented.     

Urethral sphincterotomy for delivery of vesical calculus in the mare: a case report

A case of vesical calculus in which haematuria was not a presenting sign is described. Methods of removal of vesical calculi are discussed. In this case, urethral sphincterotomy facilitated delivery.     

The arterial supply of the urinary bladder

(1) The urachal artery has a primary origin from the umbilical artery itself, and is at first bilateral. (2) The arterial pattern in newborn infants is not identical to that of adults. Obliteration of the umbilical artery in older infants carries with it obliteration of some of its branches, especially at their origin from its distal part, with a resulting change in arterial pattern. (3) The middle vesicle artery is a fairly constant branch of the umbilical artery, supplying the bladder neck and the front of the bladder above the neck. (4) The urachal and middle vesicle arteries, when unilateral, occur with equal frequency on both sides. (5) The anastomosis between superior vesical and inferior episgastric arteries was confirmed in the subperitoneal tissues, but was very rare in the wall of the bladder, occurring only when an abnormal obturator artery was the source of a superior vesical branch. (6) The constancy of the vesiculo-deferential artery is confirmed.     

The silent epidural abscess as a complication of acute otitis media in children

Vesical hernia is defines as a vesical shift associated to a direct or indirect inguinal hernia. It accounts for 0.4-3% of all inguinal hernias, but the existence of a massive vesical hernia formation at the inguinoscrotal level is uncommon; a total of 114 cases have been found in the literature. Clinically it should be suspected every time an inguinoscrotal hernia is found in patients over 50 years old with urinary flow obstruction. Diagnosis is usually reached through serial voiding cystouretrography (SVCU). The preferred treatment should be extraperitoneal inguinal herniorrhaphy associated to correction of the obstructive process.     

Rare-earth, 2d-generation image enhancement screens and their use in x-ray study of the gastrointestinal tract

It is technically feasible to examine human urothelial biopsy specimens by light microscopy after the same specimen has been examined by scanning electron microscopy. This combined microscopic procedure demonstrates that surface microfeatures of human urothelial cells, including pleomorphic microvilli, are variably present in atypical and in malignant vesical tissues. Scanning electron microscopy of a urothelial specimen requires direct light microscopic correlation of the pathologic disorder which is present in a particular area of the specimen which has been examined by scanning electron microscopy.     

Vesicovaginal and vesicocutaneous fistulas: transurethral suture cystorrhaphy as a new closure technique

PURPOSE: We assessed the usefulness of endoscopic treatment of vesical fistulas. MATERIALS AND METHODS: Two bladder fistula patients underwent transurethral surgery in an attempt to close the fistula. RESULTS: Both patients were cured of the fistula, without undergoing an open procedure. CONCLUSIONS: Cystoscopically assisted suture closure of vesical fistulas can be a successful procedure in selected patients. Nontraditional instrumentation and technique allowed for transurethral closure of these fistulas.     

Variations in Valsalva leak point pressure with increasing vesical volume

PURPOSE: Although leak point pressure testing is a valuable tool in the diagnosis of female stress urinary incontinence, little standardization in methodology exists. We examined the effect of vesical volume on leak point pressure to assess the need for determining an optimal volume for leak point pressure testing. MATERIALS AND METHODS: Video urodynamic testing was performed in 52 consecutive women with a mean age of 52 years who presented with stress urinary incontinence. By fluoroscopic criteria stress urinary incontinence was type I in 12 patients, type II in 20 and type III in 20. Leak point pressure determined at 50 cc volume increments was correlated with fluoroscopic criteria. RESULTS: Women with type I stress urinary incontinence had high leak point pressure, which remained high at increasing vesical volumes, and those with type III had low leak point pressure, which remained low at increasing volumes. In patients with type II incontinence initially high leak point pressure decreased significantly at increasing vesical volumes. The most appropriate classification of patients occurred at a volume of 250 to 300 cc. CONCLUSIONS: Leak point pressure is affected by vesical volume. At a volume of 250 to 300 cc leak point pressure correlates best with fluoroscopic findings, and it may be used to guide therapy in women presenting with stress urinary incontinence.     

Acute renal failure due to oxalate ingestion

Analysis of the infiltrant tumours of the bladder diagnosed in our service between 1986-1996 both inclusive, with associated tumour of the upper tract during its evolution. From a total of 262 infiltrant transitional tumours of the bladder and 52 transitional tumours of the upper urinary tract, 8 patients were found to have both types of tumours in association, which accounted for 3.05% of all infiltrant vesical tumours. Mean age of our patients, all male, was 65. The pathological anatomy of the upper tract tumours was: 4 pT1 and 4 pT3. 75% presented relapsing tumours of the bladder, 50% had a background of bladder Cys, 87.5% were multifocal vesical tumours and 100% were larger than 3 cm. In addition, 62% cases were ipsilateral to the tumours of the upper urinary tract. It can therefore be concluded that for tumours of the bladder, multifocality, relapse, presence of vesical Cys and tumour size, are all concurring features when association of these two types of tumours occurs.     

Nuchal translucency screening for chromosomal abnormalities in a routine ultrasound practice

Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.     

Evaluation of 20 years' experience of enuresis in children

The clinical and urodynamic approach to enuretic children over a period of more than 20 years has allowed the authors to develop a multifactorial pathophysiological concept of this disorder. The main factors involved are psychological, familial, genetic, vesical, due to bladder immaturity, hormonal, due to a defect of nocturnal ADH secretion, hygiene and dietary habits, etc. The sleep factor is predominant in the majority of cases. Although nocturnal enuresis is apparently isolated in many cases, it is often associated with a state of bladder immaturity, sometimes latent during the day, but occurring at night with episodes of detrusor hyperactivity, occurring during various phases of sleep. In practice, the recognition, in children, of these factors, some of which require specific treatments, implies a management combining several of these therapeutic modalities.     

Digestion of delta-endotoxin by gut proteases may explain reduced sensitivity of advanced instar larvae of Spodoptera littoralis to CryIC

The present study describes the correlation between gut protease activity of lepidopteran larvae of different instars, the inactivation of Bacillus thuringiensis delta-endotoxins in crystalline and noncrystalline forms, and the reduced susceptibility of advanced larval instars of Spodoptera littoralis to the toxin. The original assembly of delta-endotoxins in a crystal structure is essential for causing efficient larval mortality. Denaturation and renaturation (D/R) of delta-endotoxin crystals increased the vulnerability of the toxin molecules to proteolysis, reduced their capability to kill neonate larvae of S. littoralis, but sustained most of their larval growth-inhibition activity. E. coli-produced CryIC delta-endotoxin applied as a fraction of inclusion bodies exerted a growth inhibition effect, similar to the molecules released from the crystals by denaturation and subsequent renaturation. Incubation of CryIC with gut juice of 1st or 2nd instar larvae, left part of the CryIC toxin intact, while the toxin was completely degraded when incubated with gut juice of 5th instar larvae. The degradation rate was consistent with the increase of protease specific activity of the gut juice during larval development. This increase in toxin degradation may account for the loss of sensitivity of 5th instar larvae to CryIC. Specific protease inhibitors such as PMSF and Leupeptin were shown to inhibit gut proteases activity in all instar larvae, while, 1,10 phenanthroline, TLCK and TPCK were effective only in young instar larvae. The differential effect of protease inhibitors on proteases obtained from different larval instars indicated that gut juice protease profiles change with larval age. The observed quantitative and qualitative differences in degradation of delta-endotoxin by larval gut proteases that occur during larval maturation may account for the difference in susceptibility to the delta-endotoxin. This finding should be taken into consideration when designing strategies for the development of transgenic crops expressing delta-endotoxins as potent insecticidal proteins.     

Lymphatic staging by laparoscopic surgery

Lymphadenectomy is mandatory in vesical and prostatic tumours for a precise staging of candidates to radical surgery. Presentation of our series of 18 ilioobturative lymphadenectomies between May 1992 and February 1993, performed in 14 prostate carcinoma and 4 vesical tumours. As most interesting results, the average number of nodes removed, which was 8, and the discovery of nodular affectation in 5 cases, understaged by the non-invasive procedures, are highlighted; likewise, the reduction in surgery duration up to the current frame of 80 to 120 minutes must be emphasized. Mortality due to the procedure was null. We believe that laparoscopic lymphadenectomy should be the choice technique in the staging of tumoral dissemination in the ilioobturative domain.     

Cytochrome P4502E1 is present in rat pancreas and is induced by chronic ethanol administration

OBJECTIVE: To determine if the monoclonal antibody 7E12H12, which reacts with a 40 kDa protein in normal human enterocytes and has been shown to be a marker for intestinal metaplasia and adenocarcinoma arising in the bladder, could assist in distinguishing prostatic, urachal and vesical adenocarcinoma, using a sensitive immunohistochemical assay. MATERIALS AND METHODS: Fifteen primary prostatic adenocarcinomas and five adenocarcinomas of the urinary bladder were selected for a retrospective evaluation. The monoclonal antibody 7E12H12 (IgM isotype) was used in an immunoperoxidase assay to survey formalin-fixed, paraffin-embedded archival tissue specimens. RESULTS: All vesical adenocarcinomas reacted positively with the antibody, regardless of grade; none of the 15 prostatic specimens reacted positively in either the benign or malignant glandular epithelium. CONCLUSION: The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder from secondary adenocarcinoma arising in the prostate and may be a useful tool in diagnostic pathology.     

Intestinal phospholipase, a novel enzyme

We evaluated phospholipase activity in the intestine of rats and other species. Phospholipase activity was assayed by a surface barostat technique or an egg yolk titration system. Mucosal activity was found only by the surface barostat technique with phosphatidylglycerol as substrate; it was not found with phosphatidylcholine as substrate in assays by either technique. In gut luminal fluid activity was found when both phosphatidylcholine and phosphatidylglycerol were used as substrate in assays by the surface barostat technique, and phosphatidylcholine as substrate yielded activity in egg yolk titration. In rats in which pancreatic juice had been diverted, mucosal and gut luminal phospholipase activity was greater than in controls, thus demonstrating that enzyme activity was not due to pancreatic phospholipase. Bacterial origin of phospholipase activity was excluded in that phospholipase activity was found in germ-free rats; gastric and salivary gland origins were excluded in that continued phospholipase activity was found in rats with gastric fistula. The physiological importance of the enzyme was established by the finding that rats with pancreatic fistula absorbed 111 mumol of phosphatidylcholine and that controls absorbed 119 mumol of a 135-mumol load. Activity was found to be three times greater in the distal than in the proximal intestine; in cryptal cells it was 10 times greater than in villus tip cells. 65% of the activity in the gut lumen was tightly bound to particulate matter. We propose that intestinal phospholipase may be important in gut bacterial control, in the digestion of vegetable matter (phosphatidylglycerol is a major phospholipid in both plants and bacteria), and in the digestion of phospholipids in the gut lumen.     

Normal levels of collagen-type-I telopeptide in the first 90 days of life

The viscosity of some routine hydrosoluble contrast media used in operational cholangiography (Bilignost and Verographin) was studied. The different viscosity of hepatic and vesical bile and of the contrast media was determined. This fact shows that the data of any direct cholangiography in accordance with the law of Hagen-Poiseuille is misinterpreted. As a result it may lead to a wrong surgical procedure, for example, sphincterotomy, and vice versa.     

Helix pomatia lectin, an inducer of Drosophila immune response, binds to hemomucin, a novel surface mucin

We describe the isolation and initial characterization of hemomucin, a novel Drosophila surface mucin that is likely to be involved in the induction of antibacterial effector molecules after binding a snail lectin (Helix pomatia A hemagglutinin). Two proteins of 100 and 220 kDa were purified from the membrane fraction of a Drosophila blood cell line using lectin columns. The two proteins are products of the same gene, as demonstrated by peptide sequencing. The corresponding cDNAs code for a product that contains an amino-terminal putative transmembrane domain, a domain related to the plant enzyme strictosidine synthase, and a mucin-like domain in the carboxyl-terminal part of the protein. The gene is expressed throughout development. In adult flies, high expression is found in hemocytes, in specialized regions of the gut, and in the ovary, where the protein is deposited onto the egg surface. In the gut, the mucin co-localizes with the peritrophic membrane. The cytogenetic location of the gene is on the third chromosome in the region 97F-98A.