Effect of clean intermittent catherization on lower urinary tract : an experimental study

Objective To investigate the effect of clean intermittent catheterization (CIC) on the lower urinary tract in experimental animals. Patients and Methods: Eight male spinalized cats were subjected to CIC for a period of 6 - 9 weeks. A urine specimen for culture was obtained weekly. A pathological examination of the proximal and distal urethra and the bladder was performed. Results Urinary tract infection was detected in all cats starting from the second week. It responded to antibiotics but recurrence occurred after discontinuing the treatment. One animal died in the 4th week from fibrinopurulent peritonitis caused by necrotizeng ulcerative cystitis. False passage occurred in another cat at the end of the 6th week. It was managed by fixation of a urethral catheter for a week; and CIC was then continued for another two weeks. Pathological examination showed a thickening of the urethral wall that progressed with the duration of CIC. Microscopic examination of the urethra showed epithelial hyperaemia; ulceration and an inflammatory reaction with oedema as well as an inflammatory reaction of the lamina propria. The muscular layer showed progressive hypertrophy with continuing CIC. The bladder wall showed epithelial ulceration; Brunn nests and squamous metaplasia with islands of degenerated cells. Conclusion Recurrent urinary tract infection; local traumatic reactions of the urethral and bladder wall; especially epithelial damage of the mucosa; and false passages are common complications occurring with CIC in the experimental animal. Although the situation in the experimental animal has no relevance in humans; yet; it may throw light on some aspects of possible complications of long-term CIC

Response of osteogenic sarcoma to the combination of etoposide and cyclophosphamide as neoadjuvant chemotherapy.

A Phase II study of the combination of etoposide (VP-16) and cyclophosphamide (CPM) was conducted in an attempt to identify active and potentially less toxic agents for treating patients with osteogenic sarcoma (OS). VP-16 was given as a 72-hour infusion for a total dose of 600 mg/m2. CPM was given as six pulses of 300 mg/m2 every 12 hours for a total dose of 1800 mg/m2. Seventeen newly diagnosed patients, including five (29%) with metastatic disease, were evaluated before and after two courses of VP-16 and CPM for clinical, radiologic, and biochemical (serum alkaline phosphatase [SAP]) responses of the primary tumor and metastases. Fifteen (88%) patients achieved complete or partial clinical responses. Fourteen (82%) patients achieved radiologic responses. Thirteen (87%) of 15 patients with higher than normal SAP levels for their age showed partial or complete responses. Three (60%) of the five patients with metastatic disease achieved complete or partial responses. The only major toxicity was myelosuppression, which led to 21 (62%) brief admissions after 34 courses of chemotherapy for intravenous antibiotic therapy for fever and neutropenia, without associated mortality. It was concluded that the combination of VP-16 and CPM is effective chemotherapy for both primary and metastatic OS. Although myelosuppression is inevitable, it is rapidly reversible in the drug dosages used. Further studies are needed to evaluate the effect of these drugs in combination with established agents in improving the disease-free survival of patients with OS.

Severe hyperphosphatemia associated with tumor lysis in a patient with T-cell leukemia.

Hyperphosphatemia is an infrequent complication of the tumor lysis following induction therapy for lymphoproliferative disorders that can result in acute renal failure. We report a case of severe hyperphosphatemia resulting in transient acute renal failure corrected rapidly by hemodialysis.

Metastatic retinoblastoma successfully treated with immunomagnetic purged autologous bone marrow transplantation.

There are no documented cases of long-term, disease-free survival in retinoblastoma (RB) metastatic to the bone marrow. The following study details successful outcome in a 3-year-old child with extensive marrow replacement 7 months postenucleation in an otherwise untreated group V RB. Therapy consisted of combinations of vincristine, doxorubicin, and cyclophosphamide for 3 months. After demonstrating cross-reactivity by a panel of six monoclonal neuroblastoma (NB) antibodies with the patient's RB cells, her marrow was purged by using microsphere-linked monoclonal antibodies, and then reinfused as rescue therapy after ablative doses of etoposide and cyclophosphamide. The authors conclude that short-term induction therapy followed by marrow ablative combination chemotherapy and immunomagnetically purged autologous marrow rescue can (1) effect successful outcome in widely metastatic RB, and (2) eliminate the risk of therapy-induced second malignancies.

Distal embolisation from the surface of PTFE grafts in vivo and the effect of low molecular weight dextran.

Platelet deposition onto the surface of biomaterial is an important component of the interaction between blood and a synthetic arterial graft. Once platelet deposition has occurred, the possibility of distal embolisation exists. Using PTFE interposition femoral grafts and Indium-III-levelled autologous platelets in 16 adult sheep we have studied platelet uptake onto the graft surface using a gamma camera. Radioactivity in the legs was measured by a miniature cadmium-Telluride counter and blood flow was simultaneously recorded. In 8 animals low molecular weight dextran (LMWD) was infused intravenously. It was found that platelet deposition onto PTFE grafts was significantly lower in the LMWD treated group than in controls (P less than 0.001). These differences were confirmed by histological examination and in vitro measurement of graft activity. Furthermore, distal embolisation was frequently seen in both groups with a simultaneous drop in graft activity seen in both groups with a simultaneous drop in graft activity with an increased activity in the peripheral circulation. This distal embolisation was less pronounced in the LMWD treated group.