Bladder outcome

Early clinical studies clearly demonstrated that cisplatin could be administered safely and concurrently with radiation therapy (73-75). Early clinical trials that demonstrated the promise of the combination of cisplatin and radiation therapy included the treatment of brain tumors (76,77), head and neck tumors (78), malignant melanoma (79), and bladder cancer (80). Early clinical trial integrating carboplatin administration with radiation therapy was carried out in patients with locally advanced nonsmall cell lung cancer (NSCLC) (81). A hypothesis put forth by Coughlin and colleagues (81) was that the best clinical outcomes would be achieved with the combination of cisplatin and radiation therapy in tumors that were responsive to cisplatin. 

Herr HW, Bajorin DF, Scher HI. Neoadjuvant chemotherapy and bladder-sparing surgery for invasive bladder cancer ten-year outcome. J Clin Oncol 1998 4 1298-1301. 

Cytogenetic abnormalities are frequent in most tumor types and are often associated with tumor characteristics or patient outcome. Altered DNA ploidy (copy number changes) in the cancer genome was described in the 1960s when it was demonstrated that bladder and prostate cancer patients with diploid or tetraploid tumor nuclei had a longer survival rate than patients with triploid or hexaploid tumor nuclei (19). 

Zack and Gaffey (1983) reported the mortality status of 884 white men employed for at least one year between 1955 and 1977 by a chemical plant in Nitro, WV, USA, involved in the production of 2,4,5-trichlorophenol and 2,4,5-T. 4-Aminobiphenyl, a human bladder carcinogen (see lARC, 1982), was produced from 1941 to 1952 in this plant. There were nine cases of bladder cancer, with 0.91 expected deaths from cancer other than of the bladder were not in excess. One case of liposarcoma was reported among workers assigned to 2,4,5-T operations. Zack and Suskind (1980) reported cancer outcomes of a cohort of 121 males involved in a 1949 accident at the same plant. Followup revealed nine cancer deaths between 1949 and 1978, with 9.0 expected. Three of these were lymphatic or haematopoietic in origin (0.9 expected p = 0.047]), and one was a primary dermal fibrous histiocytoma (0.15 expected). 

Proper patient selection seemB to play a crucial role in the outcome of chemonucleolysis [1051. There are a laiw. number of conditions that can disqualify a patient, such as previous laminectomy, rapidly progressive neurological deficit, especially with involvement of bladder and bowel dysfunction, spinal... 

A survey in 2000, carried out in Los Angeles by a group at the University of Southern California School of Medicine, found a link with bladder cancer. It involved 1541 people with this condition and they were compared to 897 people who were not so afflicted. Adjustments were made to take into account smokers, who are liable to be more at risk of this disease in any case, and it found that those who used permanent hair dyes every month had a slightly higher risk of bladder cancer, especially if they had used hair dyes continuously for 15 or more years. Hairdressers had an even higher risk. This revelation prompted the Scientific Committee on Cosmetic Products and Non-Food Products ofthe EU (SCCNFP) to issue a discussion paper in February 2002. This was followed in December that year by a requirement that manufacturers must submit by July 2005 all their data on hair dyes together with studies to assess their safety in terms of cancer and toxicity. The outcome of this has yet to be published, but it will take the form of an approved list of hair dyes which will be issued in 2007. 

Many head-injured patients experience fever, and recent data indicate that bladder temperature and rectal temperature often underrepresent brain temperature after TBI, particularly when the patient is hypo-or hyperthermic (21). In that study, brain temperature was usually greater than rectal or bladder temperature in adults with severe brain injury. In another study, the duration of fever was reported to be associated with poor outcome in patients with supratentorial hemorrhage (5). Taken together, these experimental and clinical findings (4,5) indicate that fever should be aggressively treated when core temperature is mildly elevated above normal levels (22,23). 

In 1983, Godec and Gleich reviewed all published results of treatment of intractable hematuria with formalin. Dilutions of 1-10% formalin (containing 0.37-3.7% formaldehyde) were used the most commonly used concentration of formalin was 10%. The authors concluded that formalin was probably the most effective tool for controlling massive hematuria, but also probably the most dangerous. The review covered 23 articles and 118 patients in 104 cases, treatment was successful. However, in only 10 reports had the treatment been used without serious adverse effects the other 13 articles listed four deaths and many serious local and systemic complications. The complication rate increased when the formalin concentration was higher, but the contact time and the volume instilled did not influence the occurrence of adverse effects. The most frequent local complications were reflux and hydronephrosis. Fibrosis of the bladder with reduced capacity was the usual clinical outcome. A systemic effect was tubular necrosis with anuria, with two deaths. Another complication was ureteric obstruction, which was not related to ureteric fibrosis or bladder wall fibrosis obstructing the intramural ureter in two cases the obstruction appeared to be due to retroperitoneal fibrosis (SEDA-11, 476) (4). 

Like cyclophosphamide, ifosfamide causes a hemorrhagic cystitis in a high proportion of patients, with an occasionally fatal outcome. The damage to urinary bladder epithelium is caused by acrolein, a metabolite that is excreted in the urine. In bone marrow transplant recipients, prior administration of busulfan, which itself causes hemorrhagic cystitis, can increase this risk of oxazaphosphorines (12). Mesna (sodium... 

Methemoglobin formation was considered the most serious health outcome following exposure to 2NA until the increased rate of urinary bladder tumors were confirmed in the workers. Methemoglobinemia is symptom-less until acutely toxic. In one report workers exposed to 2NA were required to pass through the medical department following their shift so that any cyanosis could be ascertained. 

Sanchez-Carbayo M, Socci ND, Fozano J, et al. Defining molecular profiles of poor outcome in patients with invasive bladder cancer using oligonucleotide microarrays. I Clin Oncol. 2006 24 778. 

Basu S, Brown JE, Flannigan GM, et al. The immunohistochemical analysis of NAD(P)H quinone oxidoreductase and NADPH cytochrome P450 reductase in human superficial bladder tumors relationship between tumor enzymology and clinical outcome following intravesical mitomycin C therapy. Int J Cancer 2004 109 703-709. 

Parasitic worms (called helminths) are able to subtly dampen immune response so that they can live for long periods of time in the human body. Some of these creatures can cause very unpleasant outcomes themselves. Schistosoma, for instance, burrows under the skin and moves to the intestines or bladder, gorges on blood cells, and causes fevers, blindness, or liver damage. 

Stenzl A, Penkoff H, Daje-Sommerer E, Zumbraegel A, Hoeltl L, Scholz M, Riedl C, Bugelnig J, Hobisch A, Burger M, Mikuz G, Pichlmeier U. Detection and clinical outcome of urinary bladder cancer with 5-aminolevulinic acid-induced fluorescence cystoscopy a multicenter randomized, double-blind, placebo-controlled trial. Cancer 2011 117(5) 938 7. 

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