Cystitis

Interstitial cystitis Interstitial-free steels Intersystem crossing Intestinal flukes... 

The proteolytic enzymes, trypsin, chymotrypsin, and chymoral [8076-22-0] in combination, have been used for the treatment of post-operative hand trauma, athletic injuries, and sciatica (214—216). Trypsin has also been used successfully in treating hyaline membrane disease of newborn babies, a condition usually fatal without treatment (217). Immobilized preparations of trypsin are useful in treating acute radiation cystitis following pelvic x-irradiation therapy (218). 

Clinical trials showed therapeutic efficacy in a broad spectrum of tumors these include SCLC, testicular tumors, sarcomas, breast cancer, renal cell cancer, pancreatic tumors and lymphomas. Ifosfamide is less myelosuppressive than cyclophosphamide but is more toxic to the bladder. Therefore it is recommended that ifosfamide is coadministered with the thiol compound mesna to avoid hemorrhagic cystitis and to reduce the risk of developing bladder cancer. Other side effects include neurotoxicity and myelosuppression. 

Few side effects can be alleviated by the use of antidotes. An example is the prevention of hemorrhagic cystitis caused by cyclophosphamide by the concomitant infusion of mesna. 

Renal—hematuria, cystitis, elevated blood urea nitrogen, polyuria, dysuria, oliguria, and acute renal failure in those with impaired renal function... 

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

Urinary tract infection (UTI) is an infection caused by pathogenic microorganisms of one or more structures of the urinary tract. The most common structure affected is the bladder, with the urethra, prostate, and kidney also affected (see Pig. 47-1). Display 47-1 identifies the disorder most frequently associated with each of these structures within the urinary system. Clinical manifestations of a UTI of the bladder (cystitis) include urgency, frequency, burning and pain on urination, and pain caused by spasm in the region of the bladder and the suprapubic area. 

Nausea, diarrhea, stomatitis, hypotension, anorexia, bone marrow depression, pulmonary congestion, dyspnea, oliguria Dysuria, urinary frequency, cystitis, hematuria, urinary incontinence... 

Escherichia coli is a cause of enteritis in young infants and the young of farm animals, where it can cause diarrhoea and fatal dehydration. It is a common infectant ofthe urinary tract and bladder in humans, and is a cause of pyelitis, pyelonephritis and cystitis. 

Organic acids Citric acid Aspergillus niger Effervescent products sodium citrate used as an anticoagulant potassium citrate used to treat cystitis... 

TRPVl also plays a central role in intercellular pro-inflammatory feedback loops. An important example is mast cells and sensory nerves. Mast cells release tryptase that, in turn, activates the protease-activated receptor PAR-2 activation of PAR-2 then opens TRPVl via PKC [50]. In keeping with this, PAR-2 agonists reduce the heat activation threshold of TRPVl from 42 °C to below body temperature [51]. Excited nerve endings release SP that, as a positive feedback, binds to neurokinin NKl receptors on mast cells. Mast cells also express TRPVl [52]. Consequently, endovanilloids can act in concert to stimulate mast cells and activate capsaicin-sensitive nerve endings. Of relevance is the finding that PAR-2 is up-regulated in the bladder during experimental cystitis [53]. 

Capsaicin-sensitive nerves sense bladder fullness and form the afferent limb of the micturition reflex [132]. In conditions of bladder hypersensitivity, TRPVl is up-regulated on these nerves (presumably via NGL [133, 134]) and deafferentation of the bladder by intravesical capsaicin or RTX was proven beneficial [135-137]. Parenthetically, intravesical RTX is also an effective analgesic agent during experimental cystitis in the rat [138]. By... 

Patients may or may not be in acute distress. In early stages of disease, the patient may complain of obstructive voiding symptoms. If untreated, in late stages of disease the patient may complain of irritative voiding symptoms, or acute urinary retention, which is painful due to maximal distention of the urinary bladder. Also, the patient may be symptomatic of disease complications, including urosepsis, pyelonephritis, cystitis, or overflow urinary incontinence. 

Cyclophosphamide Hemorrhagic cystitis due to acrolein metabolite (prevent with MESNA)... 

Bacteriuria, or bacteria in the urine, does not always represent infection. For this reason a number of quantitative diagnostic criteria have been created to identify the amount of bacteria in the urine that most likely represents true infection (hence the term significant bacteriuria ). These are shown in Table 76-1. Furthermore, UTIs are classified as lower tract or upper tract disease. Patients will present differently with upper versus lower tract disease, and upper tract disease is thought of as a much more severe infection, as patients are more likely to be admitted to the hospital with upper urinary tract disease than lower tract disease. An example of lower tract infection is cystitis. Cystitis refers to the syndrome associated with a UTI involving dysuria, frequency, urgency, and occasional suprapubic tenderness. An example of upper urinary tract disease is pyelonephritis. Pyelonephritis is an inflammation of the kidney usually due to infection. Frequently, patients with uncomplicated UTI are treated as outpatients, while those patients with complicated UTIs are treated as inpatients. 

Ampicillin is the standard penicillin that has broad-spectrum activity, and is the drug of choice for enterococci sensitive to penicillin. Amoxicillin is frequently used as well. Increasing E. coli resistance has limited amoxicillin use in acute cystitis. Amoxicillin-clavulanate is empirically preferred due to resistance. 

Warren JW, Abrutyn E, Hebei JR, et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis. Clin Infect Dis 1999 29 745-758. 

Alkylating agents Cyclophosphamide Myelosuppression, hemorrhagic cystitis Alopecia, stomatitis, amenorrhea, aspermia, secondary leukemias... 

CHOP Cyclophosphamide Alkylating agent Prodrug CYP 3A4/5, 2D6 Hemorrhagic cystitis... 

List the nonhematologic toxicity to high-dose chemotherapy used in myeloablative preparative regimens, specifically busulfan-induced seizures, hemorrhagic cystitis, gastrointestinal toxicities, and sinusoidal obstruction syndrome. 

The use of effective prevention strategies can decrease the incidence of hemorrhagic cystitis to less than 5% in patients receiving cyclophosphamide or ifosfamide. There are three methods to reduce the risk administration of mesna, hyperhydration, and bladder irrigation with catheterization. 

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