A rare case of urothelial carcinoma metastasizing to the gallbladder wall with manifestations as acute cholecystitis.

BACKGROUND: Metastasis to the gallbladder is very rare. This case report highlights a rare cause of acute cholecystitis, which should be considered by the surgeon and other treating physicians in the differential diagnosis of patients with urothelial carcinoma. CASE: We report the case of a 73 year-old man with follow-up oncology care. He was diagnosed with infiltrating urothelial carcinoma in 2019, received neoadjuvant chemotherapy, and subsequently underwent radical cystectomy with ureteroileostomy in April 2020. Histology confirmed complete regression of bladder cancer, the lymphonodes were also free of tumour infiltration. In July 2021, the patient was examined for intermittent abdominal pain, predominantly of the right upper quadrant. On clinical examination, the gallbladder hydrops was palpable and a positive Murphy's sign was present. Due to the signs of acute cholecystitis, the patient was indicated for acute cholecystectomy. Gallbladder histology revealed metastatic involvement of the gallbladder wall by urothelial carcinoma. CONCLUSION: If patients with bladder cancer present with intermittent right subcostal pain or signs of acute cholecystitis and diagnostic imaging shows a thickened gallbladder wall, clinicians and radiologists should consider the possibility of metastatic origin of lesion.

What is the source of free radicals causing hemolysis in stored blood?

The quality of stored blood can be deteriorated by hemolysis caused by free radicals. The purpose of this study was to elucidate whether neutrophile leukocytes are the source of free radicals in stored blood as in hemodialyzed patients. Resuspensions with low (LL) or high (HL) leukocyte concentrations were prepared from samples of twenty healthy volunteers. The samples were incubated for 10 days at 4 degrees C and then for one day at 37 degrees C. Markers of hemolysis and free radical metabolism were examined before and after incubation in LL and HL samples. In spite of the difference of leukocytes counts in LL and HL resuspensions (p<0.0001), the pre-incubation values of all laboratory parameters were practically identical. In post-storage samples, superoxide dismutase and glutathione peroxidase activities did not differ in either group. Reduced glutathione in erythrocytes and extracellular antioxidant capacity were insignificantly lower in HL resuspensions, but the increase of malondialdehyde was much more pronounced in the HL samples (p<0.0001). The degree of hemolysis, expressed as the extracellular increase of potassium (p<0.001), hemoglobin (p<0.05) and lactate dehydrogenase (p<0.05), was higher in the HL samples. Our results support the hypothesis that leukocytes participate in free radical production in stored blood.

[Indicators of effects of free radicals in workers at risk of lead exposure]. / Ukazatelé pusobení volných radikálu u pracovníku v riziku olova.

The authors examined indicators of the action of free radicals in 40 workers exposed to the risk of lead (work with lead containing glazing and prints). The lead concentration in the atmosphere did not exceed the highest permissible concentrations and the biological exposure tests as regards lead exposure did not exceed the highest permissible limits. In the examined subjects the authors found a significantly elevated level of superoxide dismutase activity (p < 0.05) which suggests long-term increased peroxide formation. The correlation of the selenium concentration in blood and the period of lead exposure was at the borderline of statistical significance (p = 0.1159). Further investigations will be focused on subjects with symptoms of increased exposure to lead and lead intoxication where the probability of pathological findings is greater.

[The effect of antioxidant therapy on indicators of activity of free radicals in workers exposed to risks of styrene]. / Ovlivnení ukazatelu pusobení volných radikálu u pracovníku z rizika styrenu antioxidacní lécbou.

To 30 workers exposed to the risk of styrene for a period of 30 days a mixture of antioxidants was administered: vitamin C 200 mg, vitamin E 300 mg, selenium 20 mg, troxerutin 600 mg and beta-carotene 6 mg. Before the onset of supplementation and immediately afterwards laboratory indicators of antioxidant protection and lipid peroxidation were investigated. Before treatment workers exposed to the risk of styrene had a significantly higher malondialdehyde concentration (p < 0.01) and antioxidant capacity (p < 0.01) as compared with the control group. Due to the established positive correlation between these parameters (r = 0.42, p < 0.05) the findings can be evaluated as the result of increased exposure to free radicals. After supplementation a marked decline of the malondialdehyde concentration occurred p < 0.001) and a further rise of the antioxidant capacity (p < 0.001). The selenium concentration increased also markedly, the rise being more marked in subjects who had originally a lower concentration. There was a significant rise of uric acid which has an antioxidant effect (p < 0.01). The antioxidant enzymes superoxide dismutase and gluathione peroxidase did not change significantly. The results indicate the favourable effect of antioxidant treatment in subjects exposed to the risk of styrene.

[Antioxidants and malondialdehyde during hemodialysis with cellulose diacetate and polysulfone membranes]. / Antioxidanty a malondialdehyd pri hemodialýze s celulózodiacetátovou a polysulfonovou membránou.

BACKGROUND: Free radicals (FR) may cause lipid peroxidation and damage macromolecules and cellular structure of the organism, e.g. endothelium and erythrocytes. Some studies have shown that haemodialysis is connected with increased FR production. The aim of the study was to evaluate the effects of two dialysis membranes on lipid peroxidation and some antioxidant protective factors. METHODS AND RESULTS: The authors followed nine patients treated in a regular dialysis programme. In a cross controlled study the patients underwent haemodialysis with the use of cellulose diacetate (CDA) and polysulfone (PS) dialysis apparatus. Malondialdehyde in plasma was determined as a marker of lipid peroxidation. The haemodialysis with CDA or PS did not result in increased malondialdehyde levels in min. 30 or at the end of the procedure. The antioxidant capacity of plasma decreased after haemodialysis in a similar way with both types of membranes (PS, 1.67 +/- 0.10 mumol/l versus 1.47 +/- 0.23, P < 0.05; CDA: 1.72 +/- 0.10 versus 1.55 +/- 0.12, P < 0.05). The selenium blood level did not change. Activity of glutathione peroxidase (GSHPx) in blood before the dialysis was higher in the observation with subsequent use of CDA than while using PS (38.6 +/- 9.4 versus 34.5 +/- 6.6, P < 0.05). In the cohort with polysulfone membrane GSHPx further decreased in min. 30 of haemodialysis (34.0 +/- 6.6 IU/g Hb versus 31.1 +/- 5.0, P < 0.05). Superoxide dismutase (SOD) was also higher in dialysis with CDA membrane that while using PS (846 +/- 171 IU/g Hb versus 522 +/- 141, P < 0.05). CONCLUSIONS: The activity of antioxidant enzymes GSHPx and SOD was lower with polysulfone membrane than with the cellulose acetate membrane. GSHPx activity also further decreased from min. 30 of dialysis with the PS membrane. It may be due to increased production of superoxide anion and hydrogen peroxide during haemodialysis with the PS. Lipid peroxidation has not been proved to increase during haemodialysis with the CDA or PS membrane.