Malakoplakia in a healthy young female patient

Malakoplakia is a rare granulomatous disease that occurs commonly in the urinary tract and secondarily in the gastrointestinal tract. Most reported cases of malakoplakia are associated with immunosuppressive diseases or chronic prolonged illness. Here, we report a rare case of malakoplakia in a young healthy adolescent without any underlying disease. A 19-year-old female was referred to our hospital following the discovery of multiple rectal polyps with sigmoidoscopy. She had no specific past medical history but complained of recurrent abdominal pain and diarrhea for 3 months. A colonoscopy revealed diverse mucosal lesions including plaques, polyps, nodules, and mass-like lesions. Histological examination revealed a sheet of histiocytes with pathognomonic Michaelis-Gutmann bodies. We treated the patient with ciprofloxacin, the cholinergic agonist bethanechol, and a multivitamin for 6 months. A follow-up colonoscopy revealed that her condition was resolved with this course of treatment.

A Novel Pathway Underlying the Inhibitory Effects of Melatonin on Isolated Rat Urinary Bladder Contraction

The aim of the present study was to elucidate the direct effects of melatonin on bladder activity and to determine the mechanisms responsible for the detrusor activity of melatonin in the isolated rat bladder. We evaluated the effects of melatonin on the contractions induced by phenylephrine (PE), acetylcholine (ACh), bethanechol (BCh), KCl, and electrical field stimulation (EFS) in 20 detrusor smooth muscle samples from Sprague-Dawley rats. To determine the mechanisms underlying the inhibitory responses to melatonin, melatonin-pretreated muscle strips were exposed to a calcium channel antagonist (verapamil), three potassium channel blockers [tetraethyl ammonium (TEA), 4-aminopyridine (4-AP), and glibenclamide], a direct voltage-dependent calcium channel opener (Bay K 8644), and a specific calcium/calmodulin-dependent kinase II (CaMKII) inhibitor (KN-93). Melatonin pretreatment (10(-8)~10(-6) M) decreased the contractile responses induced by PE (10(-9)~10(-4) M) and Ach (10(-9)~10(-4) M) in a dose-dependent manner. Melatonin (10(-7) M) also blocked contraction induced by high KCl ([KCl]ECF; 35 mM, 70 mM, 105 mM, and 140 mM) and EFS. Melatonin (10(-7) M) potentiated the relaxation response of the strips by verapamil, but other potassium channel blockers did not change melatonin activity. Melatonin pretreatment significantly decreased contractile responses induced by Bay K 8644 (10(-11)~10(-7) M). KN-93 enhanced melatonin-induced relaxation. The present results suggest that melatonin can inhibit bladder smooth muscle contraction through a voltage-dependent, calcium-antagonistic mechanism and through the inhibition of the calmodulin/CaMKII system.

Bilateral Renal Parenchymal Malacoplakia Presenting as Fever and Acute Renal Failure / 대한신장학회잡지

Malacoplakia is a rare, chronic inflammatory disorder characterized by abnormal macrophage function and cell infiltration into normal tissues. We report a 72 year old male with bilateral renal parenchymal malacoplakia who presented with high fever and acute renal failure. The patient had anemia, leukocytosis, thrombocytopenia and bilateral nephromegaly with reduced renal function. Blood and urine cultures showed no micro-organisms. A kidney biopsy revealed diffuse interstitial histiocytic infiltration with intracellular inclusion bodies(Michaelis-Gutmann body). He was treated with antibiotics, and bethanechol, ascorbic acid without improvement. Following treatment with an intravenous methylprednisolone pulse therapy, clinical improvement was made. Renal parenchymal malacoplakia should be considered in the differential diagnosis when presented with high fever, enlarged kidneys and acute renal failure.

Bilateral Renal Parenchymal Malacoplakia Presenting as Fever and Acute Renal Failure / 대한신장학회잡지

Malacoplakia is a rare, chronic inflammatory disorder characterized by abnormal macrophage function and cell infiltration into normal tissues. We report a 72 year old male with bilateral renal parenchymal malacoplakia who presented with high fever and acute renal failure. The patient had anemia, leukocytosis, thrombocytopenia and bilateral nephromegaly with reduced renal function. Blood and urine cultures showed no micro-organisms. A kidney biopsy revealed diffuse interstitial histiocytic infiltration with intracellular inclusion bodies(Michaelis-Gutmann body). He was treated with antibiotics, and bethanechol, ascorbic acid without improvement. Following treatment with an intravenous methylprednisolone pulse therapy, clinical improvement was made. Renal parenchymal malacoplakia should be considered in the differential diagnosis when presented with high fever, enlarged kidneys and acute renal failure.

Effects of Bilateral Ovariectomy on the Functional Responses of the Rabbit Bladder Neck and Urethra / 대한비뇨기과학회지

Pregnancy and menopause induce morphological as well as functional changes in the female urethra. Symptoms of bladder irritation( frequency, urgency) and incontinence are frequent findings in these conditions and are considered to be due to alterations in the distribution of autonomic receptors caused by changes in hormonal milieu. In the present study, the functional responses to field stimulation(FS) and autonomic agonists of the bladder neck and urethra of ovariectomized and virgin New Zealand White rabbits were compared using isolated muscle strips. Passive length tension studies demonstrated substantially greater compliance of the strips ( bladder neck and urethra ) from ovariectomized than from virgin rabbits. FS elicited frequency dependent contractile responses in all strips. The maximal responses to FS were not significantly different in all strips of both groups. Phentolamine was more effective at inhibiting the response to FS of the bladder neck strips from ovariectomized than from virgin rabbits: No significant differences were noted from the urethral strips. Atropine was significantly more effective at inhibiting the response to FS of the strips from virgin than from ovariectomized rabbits. In virgin rabbits, phentolamine was more effectively inhibited the responses to FS for urethral than for bladder neck strips: atropine was more effective at inhibiting the response to FS of bladder neck than in urethra. No such differences were observed in the strips from ovariectomized rabbits. Strips of bladder neck isolated from virgin rabbits responded with significantly greater contraction to phenylephrine than strips from ovariectomized rabbits. No significant dif-ferences were noted in the response to bethanechol The magnitude of field stimulated relaxation was significantly greater in urethral strips isolated from virgin rabbits than in strips from ovariectomized rabbits. Isoproterenol induced slowly developing but significant relaxation ( 55-70 %) of all strips pre-stimulated by phenylephrine. Conclusively, ovariectomy cause profound hor-monal changes resulting in the alteration of the compliance and functional responses of the urethra to various forms of autonomic stimulation. In ovariectomized urethra, decrease of the contractile response to alpha-adrenergic agonist would be a theoretically causative factor of urinary incontinence after menopause. Relaxation of pre-contracted urethra by field stimulation are thought to be the same condition as an active opening of bladder outlet by NANC nitric oxide mediating nerve stimulation in physiologically distended bladder. Consequently, a decrease in the relaxation of urethral strips from ovariectomized rabbits would be a another factor of dysuria or voiding difficulty after menopause.