ABSTRACT
P-ANCA small vessel vasculitis is multisystemic disease, especially frequently involving the kidney. Diagnosis is delayed because it's non-specific clinical manifestation. Recently ANCA becomes available tools for diagnosis of vasculitis. Infection and gastrointestinal complications are relatively common in vasculitis. But spontaneous rupture of gastrointestinal artery is a rare complication. A 61-year-old housewife was admitted due to poor oral intake, weight loss and microscopic hematuria. Renal biopsy showed an extensive necrotizing glomerulonephritis, consistent with Wegener's granulomatosis or microscopic polyangitis. Serum test showed positive for P-ANCA. Despite steroid therapy, she expired due to spontaneous rupture of right gastroepiploic artery.
Subject(s)
Humans , Middle Aged , Antibodies, Antineutrophil Cytoplasmic , Arteries , Biopsy , Diagnosis , Gastroepiploic Artery , Glomerulonephritis , Hematuria , Hemorrhage , Kidney , Rupture, Spontaneous , Vasculitis , Granulomatosis with Polyangiitis , Weight LossABSTRACT
One of the evidences for the aggressive nature of invasive bladder tumor is that only 2O -40% of such patients survive for five years, even after meticulous radiation and thorough excision have been provided. It is conceivable that our best attempts at therapeutic manipulation may only slightly affect the natural course of events. Thus to search for the associated factors affecting the disease progression and survival rate we reviewed 53 cases of bladder cancer who were once diagnosed as invasive bladder cancer confined to muscle or perivesical fat tissue at the initial presentation or during following up between January l981 and December l986. The following results and conclusions were obtained. I. The disease progression was affected by the number, size, stage and grade of tumor but not affected by the shape of tumor. It seems already having aggressive invasive potential, even though papillary in shape. 2. The survival rate was higher in cases of having prior history of superficial bladder cancer than in cases of invasive bladder cancer at the initial diagnosis. It means that the survival rate is greatly influenced by the early diagnosis. Therefore early identification of predictive factors that affect the progression in superficial bladder cancer will offer the possibilities in selection of appropriate management and eventually prolong the survival. 3. We observed the low survival rates in cases of high stage and high grade tumors, especially combined with carcinoma in situ. These suggest already having subclinical metastasis at the time of definitive treatments. So use of adjutant chemotherapy should be considered to increase survival. 4. It is still early to presume the therapeutic effect of BCG in cases of invasive bladder cancer. If the systemic action is present, it will play a adjunctive role. Consequently, its use for invasive disease should be restricted to those patients enrolled in appropriate investigations or those who are not candidates for cystectomy until data confirm that BCG immunotherapy is an effective alternative to accepted treatments.