The use of an alum irrigation in the treatment of massive bladder haemorrhage.

Severe, massive bladder haemorrhage is a difficult and often frustrating clinical problem. The aetiologies are numerous and include irradiation, malignancy, severe infection and drug-induced changes. Among the numerous modalities of treatment that have been reported formalin, phenol and silver nitrate instillations have often been associated with significant side effects, morbidity and mortality and have had varying degrees of success. During the last two years we have used continuous closed irrigation of a sterile 0.5% alum solution in 16 patients. Alum is an astringent and acts by protein precipitation over the bleeding surface. Because of a low cell permeability its action is limited to the cell surface and interstitial spaces. The permeability of the cell membrane is reduced but remains viable. The preparation and the pharmaceutical aspects of the 0.5% alum irrigation will be discussed. The conclusion is that the technique of managing massive bladder haemorrhage is simple, efficient, nontoxic and less expensive than previously reported therapies. Therefore, irrigation with alum before instituting invasive means to control bleeding is recommended.

Changed pharmacokinetics under the influence of age.

Age significantly affects therapeutics in both general and specific ways. In newborns and in infants various physiological processes are still developing, whereas in elderly there may be decreased efficiency or capacity of physiological processes. Unexpected or 'idiosyncratic' responses to drugs in the very old or in the very young often can be explained by age-related changes in absorption, distribution, metabolism, end-organ responsiveness and excretion. Adolescence is often associated with rapid growth and changing body composition. Special problems with adolescents are poor compliance and drug abuse. Adults show a rather stable pharmacokinetic profile, although the cardiac output diminishes and the peripheral resistance increases about 1% annually. Exposure to enzyme-inducing agents (nicotine, cimetidine) influences the pharmacokinetic parameters of both adolescents and adults.