The distribution of hematoporphyrin derivative has been studied in patients undergoing transurethral resections and total cystectomy for carcinoma of the bladder. Although hematoporphyrin derivative fluorescence was not confined to malignant tissues with the dose used there was preferential localization in malignant and pre-malignant epithelium. Also high intensity illumination of an area of hematoporphyrin derivative sensitized carcinoma caused tumor destruction. Therefore, it is suggested that hematoporphyrin derivative could be used as an aid to the diagnosis and treatment of carcinoma of the bladder.
Each year in the US, more than 10 000 patients benefit from allogeneic haematopoietic stem cell transplantation (HSCT), a modality that offers an excellent chance of eradicating malignancy but confers a higher risk of treatment-related mortality. An uncommon but devastating consequence of HSCT is transplantation-associated thrombotic microangiopathy (TA-TMA). The incidence of TA-TMA ranges from 0.5% to 76%, with a mortality rate of 60-90% despite treatment. Although there appears to be a consistent treatment approach to idiopathic thrombotic thrombocytopenic purpura (TTP) using plasma exchange, corticosteroids and rituximab, the treatment strategies for TA-TMA are perplexing, in part, because the literature regarding this complex condition does not provide true consensus for incidence, aetiology, diagnostic criteria, classification and optimal therapy. The classic definition of idiopathic TTP includes schistocytes on the peripheral blood smear, thrombocytopenia and increased serum lactate dehydrogenase. Classic idiopathic TTP has been attributed to deficient activity of the metalloproteinase responsible for cleaving ultra-large von Willebrand factor multimers. This protease is a member of the 'a disintegrin and metalloprotease with thrombospondin type 1 motif' family and is subsequently named ADAMTS-13. Severely deficient ADAMTS-13 activity (<5% of normal) is associated with idiopathic TTP in 33-100% of patients. In constrast to the pathophysiology of idiopathic TTP, patients with TA-TMA have >5% ADAMTS-13 serum activity. These data may explain why plasma exchange, a standard treatment modality for idiopathic TTP that restores ADAMTS-13 activity, is not effective in TA-TMA. TA-TMA has a multifactorial aetiology of endothelial damage induced by intensive conditioning therapy, irradiation, immunosuppressants, infection and graft-versus-host disease. Treatment consists of substituting calcineurin inhibitors with an alternative immunosuppressive agent that possesses another mode of action. One candidate may be daclizumab, especially in those with mild to moderate TMA. Rituximab therapy or the addition of defibrotide may also be beneficial. In general, plasma exchange is not recommended.
Eleven human bladder carcinomata of different degrees of differentiation were implanted in mice immunosuppressed by thymectomy, anti-thymocyte serum and x-rays. Seven carcinomata grew well and one poorly and 3 produced mainly fibrous nodules in the mice. Normal human bladder tissues were grown from 4 other patients. The administration of a haematoporphyrin derivative (HpD), followed 24 h later by exposure to white light, caused marked destruction of tumours but little or none of normal bladder tissues. HpD or light alone caused no damage to tumours or normal tissues. It is suggested that photodynamic therapy may be applicable in the treatment of superficial transitional cell carcinoma of the bladder. Images Fig. 2 Fig. 3
Aims-To localise the source of bleeding in the urinary tract in patients presenting with haematuria. Methods-Urine samples were obtained from 109 patients with symptoms referable to the urinary tract. The sample was examined for the presence of red blood cells by phase contrast microscopy (PCM) and the proportion of dysmorphic and isomorphic red blood cells was determined. If more than 20% of the red blood cells were dysmorphic a glomerular origin for the site of bleeding was suspected; if less than 20% of the red blood cells were isomorphic a non-glomerular origin was suspected. Phase contrast microscopy and clinical findings were correlated. Results-The correct bleeding site was shown in 27 of 30 (90%) patients with glomerulopathy and in all 17 patients with bleeding from the lower urinary tract, indicating that this method of analysis has a sensitivity of 90% and specificity of 100% for detecting the glomerular source of bleeding. Conclusions-The examination of urine for dysmorphic and isomorphic red blood cells by phase contrast microscopy is strongly recommended in routine clinical practice for the detection of glomerular and non-glomerular lesions. This technique may avoid unnecessary investigations for the diagnosis of the site ofbleeding in patients with haematuria. (i Clin Pathol 1993;46:642-645)
Eight patients with hitherto uncontrollable vesical bleeding were treated by irrigating the bladder with a 1% solution of alum. The method does not require anaesthesia and bleeding ceased in every case.
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