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PubMed1987

Urinary excretion of a metabolite of histamine (1,4-methyl-imidazole-acetic-acid) in painful bladder disease.

Thirteen patients with interstitial cystitis (detrusor mastocytosis) and 12 other patients with painful bladder disease without mastocytosis collected 24-h urine specimens that were analysed for the major metabolite of histamine, 1,4-methyl-imidazole-acetic-acid (1,4-MIAA), by reversed phase ion-pair high performance liquid chromatography. The median urinary excretion of 1,4-MIAA was 3.34 mg/24 h (range 1.47-4.66) in the patients with detrusor mastocytosis and 1.75 mg/24 h (range 0.18-4.30) in the other patients with a painful bladder (P less than 0.01). It was concluded from this study that patients with a painful bladder and detrusor mastocytosis had a significantly elevated urinary excretion of 1,4-MIAA compared with other painful bladder patients without mastocytosis, whose urinary excretion of 1,4-MIAA was within the normal range (0.72-2.34 mg/24 h). We suggest that the urinary excretion of 1,4-MIAA might be useful in the diagnosis of interstitial cystitis.

Cystitis↗
PubMed1976

Radiology of acalculous gall-bladder disease - a new sign.

Radiography of excised gall-bladders, immersed in water, has shown that chronically infected gall-bladders frequently contain fat. This fat can be seen in vivo, and the frequency of the finding was assessed by reviewing 43 patients with acalculous gall-bladder disease. Other radiological signs in the cholecystograms were looked for retrospectively, and their incidence assessed. In 20 cases out of 40, no radiological abnormality was found.

Adipose Tissue↗
PubMed1980

HIDA scanning in gall-bladder disease.

HIDA labelled with 99Tcm is a new hepatobiliary imaging radiopharmaceutical which is selectively taken up by the liver and excreted into the biliary tree; it has been shown to demonstrate the gall bladder in normal subjects. Using a gamma-camera computer system, dynamic liver scans were performed during the first hour on 97 patients who, on the basis of standard investigations and on the findings at surgery, were divided into six groups as follows. 1. Normal. 2. Hepatocellular disease. 3. Biliary obstruction. 4. Chronic gall-bladder disease. 5. Acute gall-bladder disease. 6. Acute abdomen (not due to gall-bladder disease). Pictures were taken and activity-time curves of "regions of interest" were generated from the computer data. From these the presence or absence of a gall-bladder image was easily determined. The gall bladder was visualized in all normals but in none of the patients with acute gall-bladder disease. In the group with an acute abdomen suggestive of acute gall-bladder disease, but subsequently shown to be otherwise, the gall bladder was visualized in all cases. The gall bladder was not visualized in 42% of hepatocellular disease patients, nor in any of those with biliary obstruction, due to poor uptake or poor secretion of the HIDA. In cases of chronic gall-bladder disease, visualization of the gall bladder corresponded with gall-bladder opacification on the oral cholecystogram; in these cases the HIDA scan offers no advantage over the oral cholecystogram. These results suggest that in cases of "acute abdomen" an absent gall bladder image with a normal hepatogram will strongly support the diagnosis of acute gall-bladder disease, and that visualization of the gall bladder excludes such a diagnosis, making the HIDA scan a useful first-line investigation in these patients.

Abdomen, Acute↗
PubMedDate not supplied

[The efficacy of rigid and flexible endoscopes in the diagnosis of bladder diseases].

A comparative assessment of the efficiency of rigid and flexible endoscopes used for the diagnosis of bladder diseases (cystitis, papilloma, carcinoma in a total of 250 patients) is reported. Cystoscopy made use of a rigid catheter in 101 patients and of a flexible one, in 149. With rigid cystoscope procedure, the diagnosis was correct in 72.2%, doubtful in 13.9%, and erroneous in 13.9%. Major causes of the failure of cystoscopy in this group of patients were bleedings small volume of the bladder, tumor disintegration incontinence, prostatic adenoma, fistula, the tumor outside rigid endoscope's visibility range, or grave condition of the patient. Fiber cystoscopy made use of 6 mm endoscopes, corresponding to No 18 by Charrière's scale. Flexible endoscope procedure proved effective in 98.7% of the patients, including 11 patients after a failure with rigid cystoscopy. Principal advantages of vesicle fibroscopy are that the method is absolutely atraumatic, painless, quick, has no dead zones and makes possible complete examination of the mucosa of diverticula or any exophytic formation, and target biopsy.

Cystoscopes↗
PubMed2001

Oral cimetidine gives effective symptom relief in painful bladder disease: a prospective, randomized, double-blind placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy of oral cimetidine as a treatment for painful bladder disease (PBD, variously described as a 'symptom complex' of suprapubic pain, frequency, dysuria and nocturia in the absence of overt urine infection) by assessing symptom relief and histological changes in the bladder wall tissue components, compared with placebo. PATIENTS AND METHODS: The study comprised 36 patients with PBD enrolled into a double-blind clinical study with two treatment arms, i.e. oral cimetidine or placebo, for a 3-month trial. Patients were asked to complete a symptom questionnaire (maximum score 35), and underwent cystoscopy and bladder biopsy before treatment allocation. On completing treatment the patients were re-evaluated by the questionnaire and biopsy. The symptom scores and bladder mucosal histology were compared before and after treatment, and the results analysed statistically to assess the efficacy of cimetidine. RESULTS: Of the 36 patients recruited, 34 (94%) completed the study. Those receiving cimetidine had a significant improvement in symptoms, with median symptom scores decreasing from 19 to 11 (P < 0.001). Suprapubic pain and nocturia decreased markedly (P = 0.009 and 0.006, respectively). However, histologically the bladder mucosa showed no qualitative change in the glycosaminoglycan layer or basement membrane, or in muscle collagen deposition, in either group. The T cell infiltrate was marginally decreased in the cimetidine group (median 203 before and 193 after) and increased in the placebo group (median 243 and 250, P > 0.3 and > 0.2, respectively). Angiogenesis remained relatively unchanged. The incidence of mast cells and B cells was sporadic in both groups. CONCLUSIONS: Oral cimetidine is very effective in relieving symptoms in patients with PBD but there is no apparent histological change in the bladder mucosa after treatment; the mechanism of symptom relief remains to be elucidated.

Administration, Oral↗
PubMed1989

Gall bladder diseases in Zimbabwe.

A five-year study of patients treated for gall bladder disease in Harare was done. The aim of the study was to highlight the importance of the disease and its unusual presentation as compared to the typical European pattern. The disease is still relatively uncommon, seeing that only 54 patients were treated, while the total hospital admissions for the period was forty-one thousand eight hundred and ninety-one. The disease affects mainly house wives and mainly middle aged. The patients tend to present as semi-surgical emergencies with pain, 77.7%; vomiting, 44.2%; and palpable right upper quadrant mass (RUQ), 24.7%, and in some cases as peritonitis, 5.5%. Diagnosis was mainly by Ultrasound scan (U/S) and oral Cholangiograms. Interestingly, 7.4% had radio opaque gall stones on X-ray. 61.1% had straight forward cholecystectomy but 18.5% needed exploration of common bile duct (ECBD), and 7.4% were difficult enough to need ECBD and duodenotomy and sphincterotomy. Operative complications were few considering mode of presentation and mortality rate was 3.7%.

Age Factors↗
PubMed1986

Augmentation cystoplasty in the management of neurogenic bladder disease and urinary incontinence.

Vesical augmentation procedures were performed on 15 patients for neurogenic bladder disease and urinary incontinence. Enterocystoplasty with ileum, cecum and sigmoid was used associated with different operations to prevent upper tract deterioration or urinary incontinence. The small bowel stored larger amounts of urine at a lower maximal detrusor pressure at capacity than the large bowel. All ureterointestinal and ureterovesical reimplantations were successful, including 5 ureteroileal with the Camey procedure. The 2 failures, characterized by persistent urinary incontinence, included a male patient who refused intermittent catheterization and a girl with persistent hypersecretion of mucus and recurrent urinary tract infections.

Adolescent↗
PubMed1992

Is gall bladder ejection fraction a reliable predictor of acalculous gall bladder disease?

The use of quantitative 99Tcm-EHIDA imaging with cholecystokinin and the measurement of gall bladder ejection fraction in a prospective study of 89 patients with right upper quadrant pain is described. Correlation with surgical and histological findings and clinical follow-up suggests that gall bladder ejection fraction < or = 35% is a reliable and accurate indicator of acalculous gall bladder disease.

Cholecystokinin↗
PubMed1988

Looking for gall bladder disease in the patient's iris.

In alternative health care iridology is used as a diagnostic aid. The diagnosis of gall bladder disease was used to study its validity and interperformer consistency. The presence of an inflamed gall bladder containing gall stones is said to be easily recognised by certain signs in the lower lateral part of the iris of the right eye. Stereo colour slides were made of the right eye. Stereo colour slides were made of the right eye of 39 patients with this disease and 39 control subjects of the same sex and age. The slides were presented in a random order to five leading iridologists without supplementary information. The prevalence of the disease was estimated at 56%. The median validity was 51% with 54% sensitivity and 52% specificity. These results were close to chance validity (iota = 0.03). None of the iridologists reached a high validity. The median interperformer consistency was 60%. This was only slightly higher than chance consistency (kappa = 0.18). This study showed that iridology is not a useful diagnostic aid.

Complementary Therapies↗
PubMed1990

Gall bladder disease as seen in a Harare referral hospital centre.

A five-year study of patients treated for gall bladder disease in Harare was done from 1984-1988. The aim of the study was to highlight the importance of the disease and its unusual presentation as compared to the typical European pattern. The disease is relatively uncommon since only 54 patients were treated while the total hospital admission for the period was 41,891. The disease affected mainly middle-aged housewives. The patients tend to present as semi surgical emergencies. Diagnosis was made most often by Ultrasound scan (U/S) and oral cholangiogram. A few patients had radio opaque gall stones. The majority of the patients, 33, had straightforward cholecystectomy. Ten needed exploration of common bile duct (ECBD) and four were difficult enough to need ECBD, Duodenotomy and sphincterotomy. Operative complications were few considering the mode of presentation. Two patients died, a mortality rate of 3.7 percent.

Adult↗
PubMed1998

[Clinical assessment of contrast-enhanced ultrasonography for the diagnosis of gall bladder diseases].

We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) with intra-arterial injection of CO2 microbubbles in 37 cases of gall bladder diseases. CEUS clearly visualized arterial flow and vascularity in every lesions without debris and gave us the precise information of vascular structure for the differential diagnosis of gall bladder tumors. For example, highly bifurcated tumor vessels and strong enhancement was observed in gall bladder cancer and we could detect relatively strong enhancement along the lumen with lack of enhancement of Rokitansky-Aschoff sinus in localized-type adenomyomatosis. Though CEUS is now an invasive modality, it will enable us to understand the non-invasive modality such as color doppler imaging with intra-venous administration of microbubbles in the future.

Carbon Dioxide↗
PubMed1977

The use of sacral nerve blocks in the evaluation and treatment of neurologic bladder disease.

We describe the use of sacral nerve blocks in conjunction with air cystometry and sphincter electromyography to determine the functional innervation of the bladder and sphincters. This technique has aided in the selection of patients for sacral rhizotomy. Phenol sacral nerve blocks have been used successfully in treating hyperactive bladder disease and intractable perineal pain.

Humans↗