Bladder calcification

Mitomycin Nausea and vomiting tissue necrosis fever Bone marrow depression (cumulative) stomatitis alopecia acute pulmonary loxlcJty pulmonary fibrosis hepatotoxicity renal toxicity amcnorrhoca haemolytic-uraemic syndrome bladder calcification (with intravesical administration)... 

Other rare complications have been seldom reported, namely cryoglobulinemia with evidence of disseminated BCG infection (16), ruptured mycotic aneurysm of the abdominal aorta (17), bladder wall calcification (18), rhabdomyolysis (19), iritis or conjunctivitis with arthritis or Reiter s syndrome (20,21), and severe acute renal insufficiency due to granulomatous interstitial nephritis, which can occur even in the absence of other systemic complications (22). 

Spirnak JP, Lubke WL, Thompson IM, Lopez M. Dystrophic bladder wall calcifications following... 

Ten cases of bladder wall calcification have been reported after intravesicular administration of mitomycin. These lesions can resemble tumor recurrence in the bladder, and biopsy is advocated to distinguish between the two (15). 

Other tissues in which paraffinomas have been reported include the orbit and eyelids (82-86), the lungs (87-94), the limbs (95-97), sometimes with subsequent calcification (98), the face (99-101), nose (102), and scalp (103), muscle (104), the bladder (105), and the ureter (106). 

Probably no single causal mechanism functions in the calcification process of neointima-lined or smooth surface polyurethanes. Rather, surface calcification is most likely a result of the combination and interaction of mechanical and surface chemical effects at the blood-surface interface. Mechanical damage to or physical imperfections on the polymeric substrate in smooth surface devices or the neointima lining of textured bladders may be capable of inducing a deposition and mineralization process. Calcification of tissue valve leaflets has been proposed to result from the diffusion of blood elements into mechanically disrupted tissue (10), thus providing a site for mineralization to occur. Likewise, deposits of calcium-chelating proteins or lipids in defects in neointimal tissue or the polymer substrate may act as precursor binding sites for the observed mineralization. 

The experimental work described here relates to studies done to characterize the affinity of lipids for Biomer and to determine their role in observed calcification of AHD and LVAD elastomeric bladders in vivo. 

In Vivo Studies. Segments of bovine-implanted Biomer LVAD bladders were obtained from researchers at the Thermo Electron Corporation. Segments that possessed observed calcifications were also obtained. In addition, a control bladder sample, steam sterilized at 121.1°C for 3 h, was obtained. Samples were vacuum dried at 50°C for 24 h, followed by a 24-h CHC13 solvent extraction. Extract solutions were reduced to 1 mL prior to gas chromatographic (GC) analysis. 

A rapid calcification process on in vitro lipid-exposed Biomer samples occurred within a 1-week period. Strips exposed to the synthetic plasma for less than 2 weeks underwent a rapid surface calcium complexation following a 7-day exposure to a calcium-containing physiological medium (pH 7), whereas unexposed Biomer samples did not calcify. The development of calcium deposits as seen in in vivo bovine LVAD bladders probably would arise from this initial nucleation process. 

Polymer-derived monomeric and oligomeric species are readily extractable from Biomer LVAD bladders. Lipid sorption definitely occurs in vitro on/in various elastomers presently being used or considered for LVAD or AHD applications. Apparently, lipid sorption does occur in vivo, and may be involved in surface calcification observed on both smooth and textured... 

Fig. 9.33a,b. Ovarian fibroma in CT. Transaxial pelvic CT at the uterine level (a) and above (b) in a 55-year-old woman with abdominal fullness. A large lesion (asterisk) is found in the mid pelvis above the level of the uterus and bladder (b). It is well demarcated and displays a slightly inhomogeneous solid structure. Contrast enhancement is distinctly less than that of the myometrium (arrow). No calcifications were found throughout the lesion. Minimal ascites was seen. Histopathology revealed a 9-cm fibroid of the left ovary... 

Fig. 10.4. Calcifications in ovarian cancer. Multiple plaquelike calcifications are demonstrated within a mixed solid and cystic bilateral ovarian tumor. They also cloak the peritoneal surface of the uterus (U). These small calcifications present psammoma bodies and are found in approximately 10% of serous ovarian adenocarcinomas in CT.B, bladder...

An AP radiograph of the entire abdomen is taken unless one has been obtained recently for any reason and there was no breakthrough event. An additional film in upright position is unnecessary. Abnormal calcification, nephrocalcinosis, spinal deformation, bony abnormality, spinal surgery, pubic symphysis abnormality, and the position of prosthesis (VP shunt, JJ tube, bladder catheter, nephrostomy tube or other) all can easily be shown prior to administration of contrast medium. Attention should be paid to extra urinary anatomy (think of congenital hip dislocation). 

Curvilinear intratumoral calcifications may be observed in 5-10% of WT (Navoy et al. 1995). Macroscopic fatty components are rarely observed (Parvey et al. 1981), but may occur in teratoid forms (Park et al. 2003). CPDN presents as a well-limited, purely cystic mass with multiple septations (Fig. 24.3) (Agrons et al. 1995). This form has to be recognized because it is treated with primary surgery and has an excellent prognosis. Botryoid forms have been reported as WT with primarily intrapelvic development (Fig. 24.4) (Honda et al. 2000) and exceptional extension down the ureter into the bladder (Mitchell and Yeo 1997). 

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