Morphometric and vascular analyses and MMP-2 expression in bladders of animals with bovine enzootic haematuria

Background: Bovine enzootic haematuria is a chronic, non-infectious disease caused by the ingestion of bracken Pteridiumaquilinum that contain ptaquiloside, substance responsible for the development of neoplasms in combination with bovinepapillomavirus infection. Studies examining metalloproteinases have shown that these enzymes may be useful as prognosticmarkers and many studies have correlated the intratumoural microvessel density and incidence of metastasis in a varietyof cancers, including bladder cancer. This study aimed to evaluate the urothelial morphology and vasculature and quantifythe expression of the enzyme metalloproteinase-2 in the bladder lesions of bovine with enzootic haematuria.Materials, Methods & Results: Forty bladders with macroscopic lesions were subjected to routine histological processing. The material was stained using the Hematoxylin-Eosin (HE) and Weigerts resorcin-fuchsin staining methods. Themorphometric analysis included the measurement of the total thickness of the urothelium. Microscopically, the lesionswere differentiated as neoplastic or non-neoplastic, and the vascular changes were characterised as vascular proliferation,ectasia, dilation and thickening and the material stained using the Weigerts resorcin-fuchsin method was used to evaluatesclerosis and the vascular fibroelastosis. The metalloproteinase expression was evaluated using an anti-metalloproteinase-2antibody. The main non-neoplastic lesions found in the urothelium included clear cell metaplasia, dysplasia, hyperplasia,haemorrhage, cystitis cystica and Brunns nests and the neoplastic lesions were haemangioma, myxoma, transitional cellcarcinoma, adenocarcinoma, in situ carcinoma and haemangiosarcoma. The urothelium measurements revealed differencesbetween the epithelial thicknesses of bladders with and without neoplasms. The bladder vasculature evaluation revealed...(AU)

Morphometric and vascular analyses and MMP-2 expression in bladders of animals with bovine enzootic haematuria

Background: Bovine enzootic haematuria is a chronic, non-infectious disease caused by the ingestion of bracken Pteridiumaquilinum that contain ptaquiloside, substance responsible for the development of neoplasms in combination with bovinepapillomavirus infection. Studies examining metalloproteinases have shown that these enzymes may be useful as prognosticmarkers and many studies have correlated the intratumoural microvessel density and incidence of metastasis in a varietyof cancers, including bladder cancer. This study aimed to evaluate the urothelial morphology and vasculature and quantifythe expression of the enzyme metalloproteinase-2 in the bladder lesions of bovine with enzootic haematuria.Materials, Methods & Results: Forty bladders with macroscopic lesions were subjected to routine histological processing. The material was stained using the Hematoxylin-Eosin (HE) and Weigert’s resorcin-fuchsin staining methods. Themorphometric analysis included the measurement of the total thickness of the urothelium. Microscopically, the lesionswere differentiated as neoplastic or non-neoplastic, and the vascular changes were characterised as vascular proliferation,ectasia, dilation and thickening and the material stained using the Weigert’s resorcin-fuchsin method was used to evaluatesclerosis and the vascular fibroelastosis. The metalloproteinase expression was evaluated using an anti-metalloproteinase-2antibody. The main non-neoplastic lesions found in the urothelium included clear cell metaplasia, dysplasia, hyperplasia,haemorrhage, cystitis cystica and Brunn’s nests and the neoplastic lesions were haemangioma, myxoma, transitional cellcarcinoma, adenocarcinoma, in situ carcinoma and haemangiosarcoma. The urothelium measurements revealed differencesbetween the epithelial thicknesses of bladders with and without neoplasms. The bladder vasculature evaluation revealed...

Evaluación de efectividad y seguridad comparativas del mesna para la prevención de cistitis hemorrágica, en pacientes con cáncer sometidos a quimioterapia con oxazofosfamidas / Evaluation of comparative effectiveness and safety of mesna for the prevention of hemorrhagic cystitis in patients with cancer undergoing oxazophosphamide chemotherapy

Introducción: la cistitis hemorrágica es una complicación frecuente en pacientes con cáncer sometidos a quimioterapia con ciclofosfamida o isofosfamida. Entre las opciones para prevenir esta complicación está el mesna. Esta evaluación de tecnología se desarrolló para informar la toma de decisiones en el marco de la actualización integral del Plan Obligatorio de Salud para Colombia. Objetivo: examinar la efectividad y seguridad comparativas del mesna para la prevención de cistitis hemorrágica, en pacientes con cáncer sometidos a quimioterapia con oxazofosfamidas. Metodología: se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects y LILACS. La tamización de referencias se realizó por dos revisores de forma independiente y la selección de estudios fue hecha por un revisor, aplicando los criterios de elegibilidad predefinidos en el protocolo de la evaluación. La calidad de las revisiones sistemáticas se valoró con la herramienta AMSTAR. Se realizó una síntesis narrativa de las estimaciones del efecto para las comparaciones y desenlaces de interés. Resultados: los hallazgos de efectividad y seguridad de la presente evaluación se basan en una revisión narrativa y diez ensayos clínicos cabeza a cabeza, nueve de ellos aleatorizados, para un total aproximado de 787 pacientes. Se identificó evidencia de los efectos del mesna comparado con diuresis forzada, irrigación vesical continua, N-acetilcisteína, placebo y no mesna para una variedad de desenlaces incluyendo, cistitis hemorrágica, microhematuria, macrohematuria, hematuria de diferentes grados y eventos adversos específicos. La evidencia disponible corresponde principalmente a adultos con cáncer de pulmón, leucemias, linfoma no Hodgkin, enfermedad de Hodgkin, cáncer de mama y sarcomas, tratados con ifosfamida o ciclofosfamida y sometidos a trasplante de médula ósea. También se presentan los eventos adversos reportados en la etapa post-clínica con el uso del mesna. Conclusiones: la evidencia identificada en esta evaluación de tecnología, muestra efectos mixtos en la efectividad y seguridad del mesna para la prevención de cistitis hemorrágica, en pacientes con cáncer sometidos a quimioterapia con oxazofosfamidas: algunos resultados de efectividad demuestran que este medicamento es superior a sus comparadores y para otros desenlaces resulta similar. Respecto a su seguridad, algunos datos indican que esta tecnología no representa diferencias frente a sus alternativas y en otros efectos muestra ser inferior. A juicio de los expertos clínicos y representantes de los pacientes, el mesna tiene una relación favorable entre los beneficios y riesgos, esto sugiere que los efectos deseables con el uso de esta tecnología superan a los efectos indeseables.(AU)

Effects of prepubertal corticosterone treatment on urinary bladder.

PURPOSE: The aim of this work was to analyze the bladder wall modifications after a chronic treatment with high doses of corticosterone in prepubertal rats. METHODS: This study included 26 male rats assigned into four groups: T30 was treated with corticosterone until 29 days of age and killed at day 30, while T65 group received the same treatment but was killed at day 65. Each group had its own control group (C30 and C65). For treated animals, daily intraperitoneal injections of corticosterone (20 mg/Kg) were administered between 7th and 29th day of life. Bladders were removed and collagen, smooth muscle, elastic fibers system, vascular density and epithelium were analyzed by morphometrical methods, immunofluorescence, and biochemistry. RESULTS: Vascular density in lamina propria was reduced by 40% (p<0.05) in group T65. Collagen organization was altered in T30 and T65, although total collagen concentration was unchanged. The T65 group had an increase in elastic system fibers. There was no difference in epithelial height and cell density between the groups. Concerning the smooth muscle fibers density we observed a 19% increase (p<0.05) in the T65 group. CONCLUSION: Prepubertal administration of corticosterone induces structural modifications in the bladder of rats in a medium term analysis.

Effects of prepubertal corticosterone treatment on urinary bladder

PURPOSE: The aim of this work was to analyze the bladder wall modifications after a chronic treatment with high doses of corticosterone in prepubertal rats. METHODS: This study included 26 male rats assigned into four groups: T30 was treated with corticosterone until 29 days of age and killed at day 30, while T65 group received the same treatment but was killed at day 65. Each group had its own control group (C30 and C65). For treated animals, daily intraperitoneal injections of corticosterone (20 mg/Kg) were administered between 7th and 29th day of life. Bladders were removed and collagen, smooth muscle, elastic fibers system, vascular density and epithelium were analyzed by morphometrical methods, immunofluorescence, and biochemistry. RESULTS: Vascular density in lamina propria was reduced by 40% (p<0.05) in group T65. Collagen organization was altered in T30 and T65, although total collagen concentration was unchanged. The T65 group had an increase in elastic system fibers. There was no difference in epithelial height and cell density between the groups. Concerning the smooth muscle fibers density we observed a 19% increase (p<0.05) in the T65 group. CONCLUSION: Prepubertal administration of corticosterone induces structural modifications in the bladder of rats in a medium term analysis. .

Nutritional supplementation with L-arginine prevents pelvic radiation-induced changes in morphology, density, and regulating factors of blood vessels in the wall of rat bladder.

PURPOSE: To determine whether L-arginine has protective effects against radiation-induced alterations in the morphology and regulatory factors of vesical blood vessels in rats. METHODS: Male rats aged 3-4 months were divided into groups of 10 animals each: (a) controls, consisting of non-treated animals; (b) radiated-only rats; and (c) radiated rats receiving L-arginine supplementation. Radiation was in one session of 10 Gy and was aimed at the pelvic-abdominal region. L-arginine was administered once a day (0.65 g/kg body weight), starting 7 days before radiation and continuing until killing on the 16th day after radiation. The density, relative area, and wall thickness of blood vessels were measured in the vesical lamina propria using histological methods, and the expression of vascular endothelial growth factor (VEGF) and fibroblast growth factors (FGF) in the bladder wall was assessed by RT-PCR. RESULTS: Compared with controls, radiation alone decreased the density and relative area of blood vessels by 32 % (p < 0.01) and 25 % (p < 0.05), respectively, and reduced the arterial wall thickness by 42 % (p < 0.004). VEGF and FGF mRNA levels after radiation were diminished by 67 % (p < 0.002) and 56 % (p < 0.04), respectively. The radiated animals supplemented with L-arginine were not significantly different from controls. CONCLUSIONS: Pelvic radiation leads to significant vesical modifications, as in the morphology of blood vessels and in VEGF and FGF expression. All these changes, however, were prevented by L-arginine treatment. These results emphasize, therefore, the potential use of this amino acid as a radioprotective drug.

Vascular therapy for radiation cystitis.

PURPOSE: The underlying pathology of radiation cystitis is cellular and vascular damage followed by increased fibrosis and inflammation. This study was to determine if neovascular-promoting therapy could reduce the pathological changes in the bladder wall associated with pelvic irradiation. METHODS: Adult female Lewis inbred rats were irradiated with a single dose of 20 Gy directed at their bladder. Four weeks later, 30 rats were divided equally into one of three treatment groups for bladder wall injection of: (1) PBS (Control); (2) PBS containing 50 ng vascular endothelial growth factor (VEGF (165)); or (3) PBS containing 1 × 10(6) rat endothelial cells (EC). Age-matched non-irradiated rats (n = 10) served as untreated controls. At either 1.5 or 3 months following radiation, bladders were analyzed for collagen deposition using Masson's Trichrome staining of collagen and muscle and vascularization using Von Willebrand factor staining of ECs. Quantitative-PCR was used to examine markers of angiogenesis, hypoxia, and fibrosis. RESULTS: The collagen/muscle ratio was doubled in the control group 3 months post-irradiation (P < 0.05 vs. non-irradiated bladders). Both ECs and VEGF inhibited increases in collagen content (P < 0.05 vs. control). Similarly, irradiation reduced bladder wall vessel counts compared to non-irradiated controls (P < 0.05) and both ECs and VEGF maintained vessel counts similar to that of non-irradiated controls (P < 0.05). PCR analysis showed a higher expression of neovascular markers (CD31, KDR) in the EC and VEGF groups compared to non-irradiated controls (P < 0.05). CONCLUSIONS: Angiogenesis therapy may be useful in the prevention and/or treatment of the underlying pathology of radiation cystitis.

Conceito, diagnóstico e tratamento de placenta prévia acreta com invasão de bexiga: revisão sistemática da literatura / Concept, diagnosis and treatment of placenta previa accreta with urinary bladder invasion: systematic revision of literature

A placenta prévia consiste na implantação placentária no segmento inferior, distando no máximo 7 cm do colo do útero. Ao aderir-se diretamente ao miométrio, denomina-se placenta acreta; ao estender-se mais profundamente, placenta increta, e ao invadir a serosa uterina ou órgãos adjacentes, percreta. A incidência de placenta prévia varia de 0,3 a 1,7%, e a incidência do acretismo varia de 1:540 a 1:93.000 partos. Essa com acretismo é relacionada à alta morbimortalidade materna e, maior necessidade de terapêutica transfusional; a complicações durante a cesárea e à infecção. O acretismo é diagnosticado por ultrassom, ressonância magnética e, ultrassom com Doppler. A adequada detecção do acretismo permitirá o planejamento da via de parto e das medidas de segurança, com consequente redução da mortalidade materna. Feito o diagnóstico antenatal de acretismo placentário e invasão da bexiga, a conduta será a cesárea eletiva às 35 semanas com posterior histerectomia total abdominal, sempre com necessidade de uma equipe multidisciplinar (anestesistas, obstetras, cirurgião vascular intervencionista e urologista)

The placenta previa consists of a placental implantation in the inferior segment, distant at the most 7 cm of the cervix uteri. When adhering directly to the myometrium, it is called placenta accreta; when extending more deeply, increta and when invading the uterine's serous or even adjacent organs, the percreta. The placenta previa incidence varies from 0,3 to 1,7%, and the accretism from 1:540 to 1:93.000 childbirths. The placenta previa accreta is associated with high maternal morbidity and mortality, need of blood transfusion, complications during cesarean section and infection. The accretism is diagnosed by ultrasound, magnetic resonance and, ultrasound with Doppler. The appropriate detection of the accretism will allow the childbirth planning and safety's measures, with consequent reduction of maternal mortality. When the antenatal diagnosis of placenta accreta and invasion of the bladder are made, the conduct will be the elective cesarean section to the 35 weeks with subsequent abdominal total hysterectomy, with the aid of a team (anesthetists, obstetricians, surgeon vascular and urologist)

[Isolated manifestation of necrotizing vasculitis of the bladder: a case report]. / Isolierte Manifestation einer nekrotisierenden Vaskulitis an der Harnblase: Ein Fallbericht.

Isolated vasculitis involving the bladder is rare. We describe a case of irritative voiding and hematuria with slightly elevated inflammatory parameters. In order to exclude a neoplastic process we performed cystoscopy and computed tomography. Secondary systemic causes such as lupus erythematosus or rheumatoid arthritis were excluded. Cytopathological examination of the biopsies showed necrotizing vasculitis of the small bladder vessels, which responded to treatment with steroids and cyclophosphamide.

Urinary bladder partial carbon dioxide tension during hemorrhagic shock and reperfusion: an observational study.

INTRODUCTION: Continuous monitoring of bladder partial carbon dioxide tension (PCO2) using fibreoptic sensor technology may represent a useful means by which tissue perfusion may be monitored. In addition, its changes might parallel tonometric gut PCO2. Our hypothesis was that bladder PCO2, measured using saline tonometry, will be similar to ileal PCO2 during ischaemia and reperfusion. METHOD: Six anaesthetized and mechanically ventilated sheep were bled to a mean arterial blood pressure of 40 mmHg for 30 min (ischaemia). Then, blood was reinfused and measurements were repeated at 30 and 60 min (reperfusion). We measured systemic and gut oxygen delivery and consumption, lactate and various PCO2 gradients (urinary bladder-arterial, ileal-arterial, mixed venous-arterial and mesenteric venous-arterial). Both bladder and ileal PCO2 were measured using saline tonometry. RESULTS: After bleeding systemic and intestinal oxygen supply dependency and lactic acidosis ensued, along with elevations in PCO2 gradients when compared with baseline values (all values in mmHg; bladder DeltaPCO2 3 +/- 3 versus 12 +/- 5, ileal DeltaPCO2 9 +/- 5 versus 29 +/- 16, mixed venous-arterial PCO2 5 +/- 1 versus 13 +/- 4, and mesenteric venous-arterial PCO2 4 +/- 2 versus 14 +/- 4; P < 0.05 versus basal for all). After blood reinfusion, PCO2 gradients returned to basal values except for bladder DeltaPCO2, which remained at ischaemic levels (13 +/- 7 mmHg). CONCLUSION: Tissue and venous hypercapnia are ubiquitous events during low flow states. Tonometric bladder PCO2 might be a useful indicator of tissue hypoperfusion. In addition, the observed persistence of bladder hypercapnia after blood reinfusion may identify a territory that is more susceptible to reperfusion injury. The greatest increase in PCO2 gradients occurred in gut mucosa. Moreover, the fact that ileal DeltaPCO2 was greater than the mesenteric venous-arterial PCO2 suggests that tonometrically measured PCO2 reflects mucosal rather than transmural PCO2. Ileal DeltaPCO2 appears to be the more sensitive marker of ischaemia.

Presión intravesical basal en mujeres / Baseline vesical pressure in women

Para medir las presiones reales durante la urodinamia se recomienda iniciar ésta calibrando las presiones al cero atmosférico colocando los transductores a nivel de la sínfisis púbica. La presión vesical(Pves) basal puede verse alterada por factores como el peso, la posición o movimientos del paciente. Nuestro objetivo fue determinar el valor promedio de la Pves basal en posición de pie en mujeres chilenas, sometidas a estudio urodinámico por síntomas de almacenamiento del tracto urinario inferior(STUI). Realizamos una revisión retrospectiva de los estudios urodinámicos realizados los años 2000, 2001 y 2002 en mujeres con STUI, rescatamos los valores de la Pves basal y la edad de cada paciente, determinando el promedio y desviación estándar de la Pves basal del total de pacientes y por grupos de edad. De 496 pacientes analizadas, obtuvimos una presión vesical basal promedio de 33,5 ±6,5 cm de agua. Nuestros resultados son concordantes con las pocas series publicadas en la literatura mundial y representa la primera publicación nacional al respecto.

[Use of flavonoids (hesperidin) in the treatment of bleeding bladder varices]. / Uso de flavonoides (Hesperidina) en el tratamiento de venas varicosas vesicales sangrantes.

OBJECTIVE: To inform of the use of the Flavonoids in the treatment of bladder varicose veins, and their effectiveness. PATIENT: It is informed of 4 cases that went for haematuria, and that in the cystoscopy one observes bladder varicose veins, bleeding in 2 cases, in them you uses Hesperidina 150 mg bid or tid for 30 days. RESULTS: They were good, the 2 cases that bled the haematuria disappeared and in the 4 cases in the control cystoscopy the varicose veins had disappeared. CONCLUSIONS: The treatment antivaricose or antihemorrhoidal can be useful in the treatment of bladder varicose veins. It should be given as minimum by 30 days.

Effect of estrogen-progestogen hormonal replacement therapy on periurethral and bladder vessels.

This study assessed the effect of hormone replacement therapy using estrogens and/or progestogens on the number of vessels in the proximal and distal urethra, vesicourethral junction and bladder of castrated adult female rats. Forty-five virgin adult rats (Rattus norvegicus albinus) castrated for at least 30 days were used. They were assigned to five groups; group I (control) received no medication; the others received via the subcutaneous route, respectively, 17-beta-estradiol (group II), medroxyprogesterone acetate (group III), a maize oil and benzyl acid solution - placebo (group IV) and 17-beta-estradiol combined with medroxyprogesterone acetate (group V), for a minimum of 28 days. Increased vascularization throughout the urinary tract, except in the distal urethra, was found following estrogen replacement alone. In the group that received combined estrogens and progestogens, no increase was found. It was concluded that estrogen replacement in castrated rats significantly increased the number of vessels in the lower urinary tract.

Comparison of esophageal, rectal, axillary, bladder, tympanic, and pulmonary artery temperatures in children.

Our objective was to determine the most reliable site for temperature measurement in children. In anesthetized children esophageal temperature readings were closest to those in the pulmonary artery (mean difference 0.1 degree C +/- 0.5 degree C compared with Genius tympanic thermometer (mean difference 0.6 degree C +/- 1.0 degree C), IVAC tympanic thermometer (mean difference 0.8 degree C +/- 1.0 degree C), rectal probe (mean difference 0.7 degree C +/- 1.7 degrees C), bladder probe (mean difference 0.9 degree C +/- 1.4 degrees C), and axillary probe (mean difference 1.3 degrees C +/- 1.3 degrees C).

Efeitos da distensäo vesical aguda sobre o sistema cardiovascular de cäes anestesiados / Effects of acute bladder distention on the cardiovascular system of anesthetized dogs

Estudaram-se parâmetros cardiovasculares em cinco cäes anestesiados submetidos a distensäo vesical aguda. Foram medidos: pressäo arterial, pressäo de artéria pulmonar, pressäo capilar pulmonar, débito cardíaco, frequência cardíaca e traçado eletrocardiográfico. Nenhuma alteraçäo significante desses parâmetros foi observada com a distensäo vesical aguda