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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pseudocarcinomatous epithelial hyperplasia in the bladder is a little known phenomenon, recognized to be associated with prior irradiation and/or chemotherapy. Whether this process can occur outside of this setting has not been studied. We identified 8 of these cases mimicking invasive urothelial carcinoma from our consultation files from 07/04 to 07/06 with no prior history of radiation or chemotherapy. The mean age at diagnosis was 65 years (range, 42 to 81 y), with 5 of the 8 males. Seven patients had a potential etiology for these changes that could either have resulted in localized ischemia or injury to the urothelium. These included case 1: atrial fibrillation, hypertension, congestive heart failure, gastrointestinal bleeding, and coronary artery vascular disease; case 2: coronary angioplasty, atrial fibrillation, hyperlipidemia, and amputation of arm for ischemia; case 3: hypertension, uncontrolled diabetes, hyperlipidemia, and atrial fibrillation; case 4: underlying arteriovenous malformation of the bladder; cases 5 to 6: history of indwelling Foley catheter; and case 7: history of radical prostatectomy for prostate cancer but no radiation. One patient had no potential contributing factors. All 8 patients presented with gross hematuria. At cystoscopy, 7 patients had polypoid lesions with 1 appearing nonpolypoid. Histologically, all cases showed epithelial proliferation of urothelium with cells having prominent eosinophilic cytoplasm. This process that mimicked invasive cancer within the lamina propria was marked in 3 cases (38%). Moderate nuclear pleomorphism was seen in 6 cases (75%). Only 1 case revealed mitotic figures. Ulceration was seen in 1 case. All cases showed some degree of hemorrhage with hemosiderin deposition identified in 3 cases (38%). Fibrin deposition was present in 1 case within the stroma, 3 cases in the vessels, and 4 cases in both. Five cases show stromal fibrosis. Edema and vascular congestion were common features (90% and 100%, respectively). Six out of 8 cases were accompanied by moderate to marked acute and chronic inflammation. The original diagnosis included nested variant urothelial carcinoma (1 case), atypical suspicious for invasive carcinoma (5 cases), hemangioma (1 case), and eosinophilic cystitis (1 case). Patients were followed for a mean of 16.5 months (range, 10 to 34 mo), and none developed bladder cancer. As a rare response to ischemia and chronic irritation, pseudocarcinomatous epithelial proliferations in the bladder may be confused with invasive urothelial carcinoma. Pathologists must be aware of the histologic changes mimicking cancer, and recognize that it can occur outside of the setting of prior irradiation or chemotherapy.
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PMID:Pseudocarcinomatous epithelial hyperplasia in the bladder unassociated with prior irradiation or chemotherapy. 1816 75

A 91-year-old woman with type 2 diabetes presented at the emergency ward subconscious with lower abdominal swelling. Evaluation revealed dehydration and hyperglycaemia, and abdominal x-ray showed an air space surrounding a severely swollen bladder. After excluding enterovesical fistulae, the patient was diagnosed with emphysematous cystitis. Treatment for urinary retention, antibiotic treatment and control of the diabetes mellitus resulted in a rapid recovery. A second patient, a 65-year-old woman with a history of recurrent urinary tract infections and urolithiasis, presented with irritative urinary symptoms and pain in the lower abdomen. Explicit inquiry revealed that she also had intermittent pneumaturia. Urethrocystoscopy revealed submucosal bullae, which are a hallmark of emphysematous cystitis. The patient was given intravenous antibiotic therapy. Diabetes mellitus is a risk factor for emphysematous cystitis. The disorder is treated by draining the bladder with an indwelling catheter and intravenous antibiotic therapy, selected according to the urine culture results. In general, orally administered antibiotics are insufficient.
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PMID:[Emphysematous cystitis: from bullae to pneumaturia]. 1836 Nov 95

We present the case of a patient with diagnostic of cystitis enphisematous. We carry out the bibliographical revision of other published cases of this pathology. The cystitis enphisematous is an infectious square of strange presentation and more frequent in patient diabetic women, characterized by the presence of gas in the bladder cavity and infiltration of the walls bladder, due to the infection for germs producing of CO2, mainly gram (-). The peculiarity of our case is due to that the patient didn't suffer diabetes, being much more frequent that this alteration happens in the patients that yes they are it.
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PMID:[Emphysematous cystitis. Case report and review of literature]. 1904 8

Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other risk factors except for advanced age is reported. A review of the literature on emphysematous cystitis in immunocompetent, nondiabetic individuals is presented.
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PMID:Emphysematous cystitis in the absence of known risk factors: an unusual clinical entity. 1966 51

A 62-year-old man with uncontrolled diabetes mellitus under treatment in the department of internal medicine of our hospital presented with urinary retention. He was referred to our department, because it was impossible to conduct irrigation and catheter drainage after urethral catheterization. Computed tomographic scan showed abnormal air in his bladder and bladder wall. We diagnosed the patient with emphysematous cystitis, but we could not determine the reason for the failure of irrigation. By panendoscopy we found the inflammatory mucous flap in his urethra. This flap was thought to have caused the retention. Urinary catheter drainage is most important for the treatment of emphysematous cystitis. To our knowedge, this is the first report in Japan of a case in which catheter drainage was impossible.
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PMID:[Case of emphysematous cystitis with retention due to a inflammatory mucous flag of the bladder]. 1982 22

A 49-year-old female visited our hospital with a complaint of pelvic pain. She was under treatment for diabetes mellitus and dilated cardiomyopathy. Radiography revealed a radiolucent area in the bladder. We suspected vesicorectal fistula. Computed tomography showed gas within the bladder wall and the lumen. Cystoscopy revealed diffuse emphysema in the bladder wall without fistula. These findings were consistent with a diagnosis of emphysematous cystitis. The urine culture yielded Escherichia coli. After urinary drainage and antibiotic therapy, she was cured of emphysematous cystitis.
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PMID:[A case of empysematous cystitis which was found incidentally]. 2061 Sep 26

Infections are usually detected in diabetes mellitus. They may be divided into: common infections such as fungal infections, pulmonary tuberculosis, pneumonia, bacteraemia, urinary tract infections, and diabetic foot infections and specific infections. The latter occur almost exclusively in diabetes and include rhinocerebral mucormycosis, malignant external otitis, emphysematous pyelonephritis, perirenal abscess, emphysematous cystitis and emphysematous cholecystitis. Radionuclide tests are decisive in the diagnosis and localisation of foot osteomyelitis, as well as the distinction of osteomyelitis from other conditions, notably Charcot osteoarthropathy. Technetium-99m methylene disphosphonate and labelled leukocyte bone scans are the main imaging techniques employed, while emerging techniques include single-photon emission tomography/computed tomography (CT) and positron emission tomography/CT. Nuclear medicine is also useful in the diagnosis and follow-up of specific infections in diabetes like, malignant external otitis, rhinocerebral mucormycosis, acute pyelonephritis, renal papillary necrosis and cholecystitis. The main indications of nuclear medicine tests are diabetic foot osteomyelitis, malignant external otitis, rhinocerebral mucormycosis and renal infections.
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PMID:The role of nuclear medicine in the diagnosis of common and specific diabetic infections. 2080 89

The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60% of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4-14% of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400 mg on day 1 and 200 mg daily for 7 to 14 days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata).
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PMID:[Recommendations of the Infectious Disease Committee of the French Association of Urology. Diagnosis, treatment and monitoring candiduria]. 2151 33

Emphysematous cystitis is a rare lower urinary tract infection. A case of emphysematous cystitis with diabetes mellitus and transverse colon cancer is reported. The patient was an 81-year-old woman complaining of nausea and vomiting. Urinalysis showed hematopyuria. Plain abdominal film and CT scan showed gaseous shadow in the bladder wall. Urine culture contained Escherichia coli. A urethral catheterization and administration of antibiotics resulted in the marked improvement in the clinical course. To our knowledge, 53 cases of emphysematous cystitis have been reported in the Japanese literature including this case and the clinical features are reviewed.
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PMID:[A case of emphysematous cystitis : a case report]. 2179 36

Urinary tract infections occur very frequently in the community and in hospitalized patients and are mainly caused by Escherichia (E.) coli. Depending on virulence determinants of uropathogenic microorganisms and host-specific defense mechanisms, urinary tract infections can manifest as cystitis, pyelonephritis (bacterial interstitial nephritis), bacteremia or urosepsis. Uncomplicated urinary tract infections in otherwise healthy women should be treated for 3-7 days depending on the antibiotic therapy chosen, even if spontaneous remission rates of up to 40% have been reported. Antibiotics of the first choice for empirical treatment of uncomplicated urinary tract infection are fluoroquinolones, pivmecillinam and fosfomycin. A huge problem is the increasing antimicrobial resistance of uropathogenic microorganisms. Complicated urinary tract infections associated with anatomical and/or functional abnormalities of the urinary tract and/or comorbidities such as diabetes or immunosuppressive therapy, need longer antibiotic treatment (e.g. 10-14 days) as well as interdisciplinary diagnostic procedures. Treatment of community acquired urosepsis includes cephalosporins of the third generation, piperacillin/tazobactam or ciprofloxacin. For nosocomial urosepsis the combination with an aminoglycoside or a carbapenem is recommended.
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PMID:[Urinary tract infections]. 2185 May 38


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