Tumour necrosis factor production in patients with carcinoma of the bladder associated with bilharziasis

Tumour necrosis factor [TNF] is produced by activated macrophages in response to the presence of a malignant tumour. In this study we evaluated the level of TNF in patients bearing carcinoma of the bladder with bilharziasis in comparison either to similar patients who underwent surgical procedures or even normal individuals. Twenty three patients eight of whome were bearing cancer bladder associated with bilharziasis. The remaining fifteen patients had a surgical intervention for removal of their cancer bladder. They underwent either total cystectomy with urine diversion [11 cases] or transurethral resection with or without intravesical therapy [4 cases]. The TNF level in the urine and serum of the 23 patients was assayed. The TNF level in urine and serum of 11 normal individuals [control] was also measured. The mean value of TNF level in the urine and serum of patients who underwent different surgical procedures [10.78 pg/ml. and 16. 2pg/ml] was higher when compared to the normal control [4.68 pg/ml and 12.77 pg/ml]. Also the mean value of the TNF level in the urine of the same group of patients was higher than the group of patients who had cancer bladder associated with bilharziasis before treatment [6.814 pg/ml]. Yet, there was a slight decrease in the mean value of the TNF level in the serum of the postoperative group when compared to the preoperative [17.375 pg/ml] although it was statistically insignificant. At the same time it was found that patients with carcinoma of the bladder associated with bilharziasis had a significantly higher TNF level in serum and urine [P<0.01 and P<0.05] when compared to normal individuals. Our conclusion was that TNF level assay in the urine and serum of patients bearing cancer bladder associated with bilhariziasis after being surgically treated is of an insignificant value since there are many factors to interplay [metabolic, metastasize, recurrence intravesical therapy. Also it is possible to take the TNF level whether in urine or serum of patients having cancer bladder associated with bilharziasis before treatment as an indication to the existance of the malignant tumour

diagnostic role of the enterobacterial common antigen in haematobiasis associated with urinary tract infection

The enterobacterial common antigen [ECA] is a common antigenic determinant shared by members of the family Enterobacteriaceae. The antigen modifies erythrocytes for agglutination by ECA antibody. This property has been of great help in the diagnosis of Enterobacteria as causative pathogens of various infections. The present study comprised 62 adult patients and 14 healthy controls. All patients suffered from different stages of urinary schistosomiasis associated with urinary tract infection [UTI]. Cancer bladder was also associated in 16 of the patients. They were further categorized accorrding to the number of isolated pathogens and accordingly intensity of infection into: significant counts of > 100, 000 cfu/ml of Enterobacteria in 45 patients, insignificant counts < 100, 000 cfu/ml of Enterobacteria in 7 patients, significant Gram positive bacteruria in 8 patients and Candida albicans in 2 patients. Ten of the healthy controls bad sterile urine and 4 revealed asymptomatic bacteruria due to Enterobacteria. ECA was assayed in urine of all subjects by means of passive haemagglutination using slide and microtitration plate techniques. The ECA antigen was detected by slide test in 37.8% and in 40% by microtitration plate in cases of significant bacteruria due to Enterobacteria and in 42.8% and 57% in case of insignificant count due to Enterobacteria. ECA was not detected in urine of apparently healthy subjects nor in cases of Gram positive bacteruria or Candiduria; the sensitivity, specificity and diagnostic efficacy of the microtitration plate test being 42.5, 100% and 71% respectively. It is concluded that ECA+ represent a virulence factor which may contribute to the pathogenesis of UTI irrespective of the bacterial count. The ECA- strains may also cause UTI in high risk patients suffering from predisposing urinary lesions