Bilharziasis of urinary bladder and ureter: comparative histopathologic study.

The relative incidence and intensity of oviposition in schistosomiasis in different layers of both the urinary bladder and the ureter are presented. Histopathological changes in both organs are elucidated. Oviposition was heaviest in the submucosa of the urinary bladder, while the muscle layer was affected in 15% of specimens. Oviposition was mainly periureteral and in outer muscle layer of the ureter, and was present in only 22% in the ureteral submucosa. Epithelial changes, namely, Brunn nests, cystitis glandularis, cystitis cystica, and squamous metaplasia, were more marked in the bladder specimens than in the ureteral specimens. Squamous cell papilloma and squamous metaplasia associated with acanthosis of the bladder specimens were identified. Results indicate unanimously that the heavy deposition of ova in the submucosa of the bladder leads through its mechanical and toxic irritation to marked epithelial and premalignant changes which pave the way for the disturbing frequency of carcinoma of the bladder in the bilharzial patients which is not the case in the ureter.

Effects of contraceptive pills and intrauterine devices on urinary bladder.

The incidence of bacteriuria and cystoscopic changes in women on oral contraceptives or users of IUD (intrauterine devices) were evaluated compared with a control group. Subjects with bacteriuria accounted for 40.5 per cent of pill users, 20 per cent of women fitted with IUD, and 16 per cent of the control group. Bladder trabeculations were found in 50.5 per cent of the pill group, 8.7 per cent of the IUD group, and 8 per cent of the controls. Congested bladder trigone was observed in 24.6 per cent of women fitted with an IUD. The mode of action of ovarian hormones and their possible side effects on the bladder are discussed. The relation of IUD to pelvic inflammatory disease and its effect on the urinary bladder are evaluated.

PIP: The incidence of bacteriuria and cystoscopic changes in 200 women using oral contraceptives from 1 month to 2 years and 150 users of IUD were compared with 50 women using neither method. Bacteriuria in midstrean urine samples of all subjects were identified qualitatively and quantitatively by the method of Stamey et al. Cystoscopy was performed on all subjects. Positive bacteriuria were found in 40.5% of patients on oral contraceptives, 20% of IUD users, and 16% of the control group. Positive pathogenic bacterial cultures in women using oral contraceptives were proportional to the length of time the pill had been used: 27% for 1 year users, 35% for 2 year users, and 50% for longer users. The potency and dosage is correlated with the pathogenic effects observed. Bladder trabeculations were found in 50.5% of oral contraceptive users, 8.7% of IUD users, and 8% of control subjects. The highest incidence was in subjects using pills for 2 years or more, and is correlated with the dosage used. Bladder trigone congestion was observed in 24.6% of IUD users; 56% of users from 1 to 3 months, 35% of users more than 2 years, and no users between these time extremes. The high incidence of bladder trabeculations might be explained by the effect of progestogens and estrogens on bladder tone; progestogens producing hypotonia and estrogens hypertonia. The IUD should not be used more than 2-3 years continuously to avoid urinary bladder effects and inflammatory pelvic disease.

The complications of injection sclerotherapy of bleeding oesophageal varices.

The complications of injection sclerotherapy were retrospectively studied in 122 patients with acute variceal bleeding. Initial control of bleeding was achieved in 72.5 per cent of patients and the final success rate of sclerotherapy was 86.1 per cent. The overall morbidity rate was 30.3 per cent. Minor complications occurred in 13.9 per cent of patients and major complications were recorded in 16.4 per cent. Twenty patients developed complications directly attributable to sclerotherapy: 14 minor and 6 major. The overall mortality rate was 21.3 per cent, and 7.4 per cent of the patients died due to complications. Pulmonary complications occurred in 15 patients and resulted in 3 deaths. Retrosternal pain developed in 8 patients, but dysphagia and oesophageal ulceration were rare. No stricture was recorded. The incidence of liver failure in 17 Child's grade C cases was almost certainly a complication of the underlying disease rather than the injection therapy. It is suggested that injection sclerotherapy is an effective and relatively safe treatment for variceal bleeding.