Complications associated with primary and secondary perforation of the bladder following immediate instillations of epirubicin after transurethral resection of superficial urothelial tumours

Significant decreases in tumour recurrence rates of up to 50% are reported after one immediate postoperative instillation of chemotherapeutic drugs, such as epirubicin or mitomycin C. However, the extremely rare occurrence of complications related to perforation of the bladder can be detrimental. Perforation of the bladder seems to be iatrogenic (primary) or drug-induced (secondary). We present two cases of significant morbidity related to primary and secondary perforation of the bladder following two instillations of epirubicin. The patient with the primary perforation was managed conservatively, while the second was subjected to immediate surgical exploration. The two patients were finally released in good condition. Complications concerning a primary perforation of the bladder and instillation of chemotherapeutic drugs can be easily avoided by recognising the perforation intraoperatively. However, we postulate that a delayed perforation of the bladder might occur due to the cytotoxic effect to the bladder tissue of the instilled drugs

Iron deposits surrounding multiple sclerosis plaques.

Autopsy samples from cerebral areas of five brains from patients with multiple sclerosis (MS) and from six control brains were stained with Perls acid ferrocyanide to detect nonheme iron present as hemosiderin. Positive iron reactions were observed only in MS sections surrounding demyelinated plaques. Myelinated white matter near the lesion contained numerous iron-laden ovoid bodied and axons that stained positively for iron. Positive reactions were also found within blood vessels of gray matter near the lesion. A possible source of the iron was extravasated blood