Formalin Instillation Research Articles

Lexipafant (BB-882), a platelet activating factor receptor antagonist, ameliorates mucosal inflammation in an animal model of colitis.

To assess the anti-inflammatory action of lexipafant (BB-882), a platelet activating factor antagonist, in an animal model of acute colitis. An animal intervention study. Following the rectal instillation of formalin 0.75% into male New Zealand White (NZW) rabbits, 0.85 ml of aggregated immunoglobulin was administered i.v. Treatment groups (0.8 mg/kg, n = 6; 2.4 mg/kg, n = 13; 3.2 mg/kg, n = 10) were given bolus doses of BB-882 two-hourly i.v. (control group, n = 25). Rectal dialysis was performed before induction of colitis and sacrifice. Dialysate leukotriene B4 (LTB4), prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) levels were determined. Tissue was saved for histology and measurement of myeloperoxidase content. There was a dose-dependent improvement in macroscopic scores (2.4 and 3.2 mg/kg: P < 0.02, P < 0.001) and myeloperoxidase levels (3.2 mg/kg: P < 0.04). Dialysate LTB4 levels fell (2.4 and 3.2 mg/kg: P < 0.03, P < 0.02) as did PGE2 levels. TXB2 concentrations remained unaffected. The PAF receptor antagonist BB-882 shows efficacy in treating inflammation in an animal model of acute colitis as evidenced by a dose-dependent fall in macroscopic mucosal damage, neutrophil infiltration and reduced generation of inflammatory mediators.

Formalin instillation for refractory radiation-induced hemorrhagic proctitis

Our goal was to evaluate use of topical (4 percent) formalin in management of radiation-induced hemorrhagic proctitis, refractory to other methods of treatment. Specifically, we wished to determine its safety, ability to stop bleeding, and complications associated with therapy. Sixteen patients with radiation-induced hemorrhagic proctitis were treated with topical (4 percent) formalin. All had been previously treated with conservative regimens such as cautery, topical steroids, or laser, but these had failed. Five-hundred milliliters (ml) of a 4 percent formalin solution was instilled into the rectum in 50-ml aliquots. Each aliquot was kept in contact with rectal mucosa for approximately 30 seconds. Treatments were performed under local anesthesia in nine patients, sedation only in four, spinal in two, and general in one patient. In 12 patients, bleeding stopped after a single formalin instillation; in 3, bleeding was considerably reduced but continued sporadically. One patient required three treatments before bleeding stopped. Four patients developed postoperative anal pain, of which one also had significant tenesmus and reduced capacity. Of these four patients, only two had significant anal pain and fissures that lasted longer than one month. Topical (4 percent) formalin is safe and effective in treatment of radiation-induced hemorrhagic proctitis. A single treatment will stop bleeding in 75 percent of patients.

Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation

Objectives To determine the minimal active dose and extent of activity of intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Methods Twenty-four adults with grade 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-transplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 24 hours until a dose of 1.0 mg/dL was reached unless a response was achieved. Thirteen additional patients were treated at an initial dose of 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the absence of a response. Results Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62% with doses at or above 0.8 mg/dL and 18% at lower doses. All but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients were salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms developed during treatment with carboprost, but were not sufficiently severe to discontinue therapy. Conclusions Intravesicular carboprost at 1.0 mg/dL every 6 hours for no more than 7 days should be considered or a randomized study for treatment of refractory hemorrhagic cystitis. Cystoscopic examination and evacuation of clots prior to therapy may be required to achieve the full benefit of this treatment.

Urologic complications of high-dose chemotherapy and bone marrow transplantation

Objective. This study reviews the incidence and management of cyclophosphamide-induced hemorrhagic cystitis in a group of patients who received high-dose chemotherapy and bone marrow transplantation. Methods. The records of 217 consecutive patients undergoing bone marrow transplantation were reviewed. The incidence, degree, and management of hematuria in this group of pancytopenic and immunocompromised patients were recorded. Results. Despite prophylaxis, cystitis developed in 58 of these 217 patients (27%) . In 12 patients (6%) the cystitis was severe. These patients had gross hematuria, clot retention, and drop in hematocrit necessitating blood transfusion. These patients were managed with continuous bladder irrigation, alum irrigation, and when less aggressive approach was unsuccessful, with intravesical formalin instillation. Alum irrigation was used in 5 patients, and was successful in only 1 patient. Six patients required intravesical formalin instillation to control the hematuria. Formalin solution 2–5% was instilled initially. When lower-concentration formalin failed, 5–10% formalin was used progressively. Conclusions. Patients with bone marrow transplantation in whom severe hemorrhagic cystitis develops should be managed aggressively early. Intravesical formalin appears to be the most effective regimen in controlling profuse, persistent hematuria.

Intravesical formalin for hemorrhagic cystitis following irradiation of cancer of the cervix

OBJECTIVE: To determine the effectiveness of intravesical formalin instillation in hemorrhagic cystitis following irradiation of cancer of the cervix. METHOD: Records were reviewed for 35 patients with hemorrhagic radiation cystitis who underwent treatment with 1% (n = 22), 2% (n = 10), and 4% formalin (n = 4), using Fair's technique. RESULT: Complete response was seen in 31 patients (89%) and partial response in 3 patients (8%) after a single instillation. Minor complications were seen in 19 patients (54%). Major complications occurred in 11 patients (31%), with 5 cases requiring subsequent urinary diversion. One patient died of persistent bleeding and probable formalin toxicity. Hematuria recurred in 7 patients achieving complete response at a mean period of 8 months after treatment. A 1% solution was as effective in controlling hematuria as higher concentrations and was associated with significantly less morbidity. CONCLUSION: Intravesical instillation of 1% formalin is an effective treatment for intractable hematuria secondary to radiation cystitis.

Intra‐operative pulmonary embolism after intravesical instillation of formalin

Intra-operative pulmonary embolism is a rare and severe complication which is difficult to diagnose. A case is reported in which this condition occurred after intravesical instillation of formalin during radical cystectomy under general anaesthesia. Formalin may be related to formation of intravascular thrombi and result in pulmonary embolism.

Whole-abdominal radiotherapy for patients with minimal residual epithelial ovarian cancer

Sixteen patients with advanced epithelial ovarian cancer who were treated with cytoreductive surgery followed by multiagent chemotherapy were found to have residual tumor masses less than 2 cm in greatest diameter at reexploration and were treated with whole-abdominal radiation (19–31 Gy). Thirteen patients also received pelvic boosts to a total pelvic dose of 41–53.7 Gy. Radiotherapy was completed in all but 2 patients after treatment delays in 7 patients. Early treatment complications included myelosuppression in 11 patients, diarrhea in 3, and a self-limited small bowel obstruction in one. Delayed complications were severe and included 9 patients with radiation enterocolitis, 8 of whom required intestinal resection or diversion. One additional patient with radiation cystitis required instillation of formalin to control bleeding. Two patients are without evidence of disease 28 and 30 months following radiotherapy, while the remaining 14 patients have recurred after a median progression-free interval of 9 months (range 1–30 months). All patients who recurred failed within the treatment field and died of cancer after a median interval of 19 months following radiotherapy and 9 months after documentation of progression. These data suggest that few patients with persistent ovarian cancer following surgery and chemotherapy will be salvaged with radiotherapy.

Intravesical Formalin for the Treatment of Massive Hemorrhagic Cystitis: Retrospective Review of 25 Cases

Between 1980 and 1988 25 patients with massive bladder hemorrhage were treated with intravesical instillation of 4% formalin in 19 cases and 10% in the remaining 6 cases; the contact time was 15 min in 20 cases. The etiology of the hemorrhage was cyclophosphamide therapy (1 case), pelvic radiotherapy (15 cases) and infiltrating bladder cancer in the remaining 9 cases. In 10 cases, the instillation of formalin was performed in bladders with a prior supravesical diversion. Complications included 1 case of vesicorectal fistula, 1 case of uretero-hydronephrosis and 1 case of vesical extravasation of formalin when a concentration of 10% was used at a volume superior to 50 ml. The only complication seen with 4% formalin was 1 case of upper urinary tract dilatation. Good results were obtained in 88% of cases, who achieved correct hemostasis during a mean of 4 months.

Biliary sclerosis following formalin instillation into hydatid cysts

International Journal of Clinical PracticeVolume 42, Issue 5 p. 214-217 Case Report Biliary sclerosis following formalin instillation into hydatid cysts J A Pain FRCS, Corresponding Author J A Pain FRCS Surgical Registrar n/[email protected] Pancreato-biliary Unit, St George's and St James' Hospitals, LondonAddress correspondence to Mr J A Pain, Dept of Surgery, Mayday Hospital, Mayday Road, Thornton Heath, London CR4 7YE.Search for more papers by this authorP J Reddy FRCS, P J Reddy FRCS Surgical Research Fellow Pancreato-biliary Unit, St George's and St James' Hospitals, LondonSearch for more papers by this authorM J Knight FRCS, M J Knight FRCS Consultant Surgeon Pancreato-biliary Unit, St George's and St James' Hospitals, LondonSearch for more papers by this author J A Pain FRCS, Corresponding Author J A Pain FRCS Surgical Registrar n/[email protected] Pancreato-biliary Unit, St George's and St James' Hospitals, LondonAddress correspondence to Mr J A Pain, Dept of Surgery, Mayday Hospital, Mayday Road, Thornton Heath, London CR4 7YE.Search for more papers by this authorP J Reddy FRCS, P J Reddy FRCS Surgical Research Fellow Pancreato-biliary Unit, St George's and St James' Hospitals, LondonSearch for more papers by this authorM J Knight FRCS, M J Knight FRCS Consultant Surgeon Pancreato-biliary Unit, St George's and St James' Hospitals, LondonSearch for more papers by this author First published: 01 May 1988 https://doi.org/10.1111/j.1742-1241.1988.tb08562.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume42, Issue5May 1988Pages 214-217 RelatedInformation

Effect of Submucosal Formalin Injection on Bladder Wall in Rats

The effect of intravesical formalin instillation as a therapeutic modality for intractable bladder hemorrhage is well known. And despite clear evidence of therapeutic efficacy of intravesical cytotoxic drugs and/or BCG immunotherapy, there have been substantial recurrences during followup after transurethral resection for superficial bladder tumor. If formalin injected at the bed of superficial bladder tumor is able to coagulate and necrotize the tumor, it will be greatly helpful to the patients With recurrent bladder tumor developed during followup. Since this technique is applicable on outpatient basis, an economical as well as a psychological burden of the patients can be reduced considerably. The purpose of this study is to evaluate the effect of submucosal formalin injection on rat bladder wall, 36 healthy adult male Sprague-Dawley rats (weighing 350gm in average) were divided into 3 groups: In Group I (control group), 0.01ml of normal saline was injected submucosally at the left posterolateral wall of the bladder opened under intraperitoneal Nembutal anesthesia ; In Group II and III, 0.01 ml of 10% and 4% formalin, respectively, were administered at the same site as in the Group I, two rats in each group were sacrificed at day 1, 2, and 3, and week 1, 2 and 4 after injection, respectively. Gross and microscopic examination of the cystectomized specimen were done in each group. In the Group II, bladder stones were formed at week I, and in both the Group I and III, stones were seen at week 2 post injection. There was no significant difference III histologic findings of the bladder between the group II and III. Mucosal ulcer and/or prominent mucosal disruption was observed at 24 hours after injection in both Group II and III. Epithelial regeneration began at day 2, and was marked at day 3, and epithelial lining was almost normalized one week after injection. Subepithelial edema, telangiectasia and inflammatory reaction were prominent at 24 hours post formalin injection. Subepithelial edema persisted in moderate degree for 1 week. Telangiectasia and inflammatory reaction were noted for 4 weeks. Mild degree of these findings also appeared In the control group. Fibroblastic proliferation appeared at day 2 and persisted in moderate degree for 4 weeks. There has been no mortality or bladder perforation. These results suggest that clinical application of this technique is feasible for the selected cases of recurrent, solitary superficial bladder tumor. However, optimal dosage of formalin in relation to the size of the lesion remains to be investigated.

Transient and Persistent Hyperplasia in Heterotopically Transplanted Rat Urinary Bladders Induced by Formalin and Foreign Bodies

The effects of formalin instillation or teflon bead insertion on heterotopically transplanted rat urinary bladders (HTBs) were investigated. A single instillation of 0.3 per cent formalin dissolved in 0.9 per cent NaCl into HTBs induced multifocal superficial ulcers which were quickly repaired by lateral spreading of regenerating cells migrating from the adjacent mucosa. This was associated with a sharp increase in labeling index (10-30 per cent) on days 1 and 2, followed by focal mild (up to five cell layers) simple hyperplasia (SH) on days 4 and 7. Repeated weekly instillation of formalin for 30 weeks induced only focal mild epithelial hyperplasia. Six weekly instillations of urine one day after formalin administration slightly enhanced the formalin-induced rise in labeling index. Insertion of teflon beads caused extensive diffuse remarkable changes, especially in the presence of urine: multifocal to diffuse SH (four to eight cell layers) and multifocal papillary or nodular hyperplasia was observed by six weeks.The results indicate that responses to formalin instillation are acute and transient, while reactions to bead insertion are persistent. In both cases, presence of urine appeared to enhance hyperplastic changes. These models of bladder injury, by inducing two different types of reactions in the bladder, may be useful in examining the role of trauma in bladder carcinogenesis.

Renal and urinary tract complications following the intravesical instillation of formalin

The case is reported of a 10-yr-old girl who developed intractable hematuria from hemorrhagic cystitis following chemotherapy for a malignant lymphoma. Following the intravesical instillation of formalin, which controlled the hematuria, she developed oliguria attributable to ureteric stenosis and fibrotic contraction of the renal pelves. Bilateral nephrostomies were constructed, but recurrent pyelonephritis and further renal pelvic obstruction developed. A series of renal biopsies and ultimately bilateral nephrectomy revealed severe, chronic interstitial nephritis, massive renal interstitial accumulation of deposits probably containing Tamm-Horsfall protein and, in the left nephrectomy specimen, a florid interstitial chronic granulomatous inflammatory reaction. Although ureterohydronephrosis has been described by others as a complication of the intravesical instillation of formalin, fibrotic contraction of the upper urinary tract and the florid interstitial nephritis with granulomata as described herein have not previously been reported. It is proposed that vesicoureteric reflux of formalin, perhaps accompanied by intrarenal reflux, caused or contributed to these pathological changes.

Intractable Hematuria and Formalin

AbstractMassive hematuria, which is most frequently caused by radiation for pelvic malignancies, after treatment with cyclophosphamide or secondary to aggressive anticoagulation, represents a vexing problem for the practicing urologist. The existence of numerous therapeutic approaches results from the lack of an effective therapeutic modality. Lately, formalin seems to offer a new hope for the treatment of intractable hematuria.Analysis of published results after treatment with formalin revealed generally excellent results regarding control of hematuria. Nevertheless, the complication rate of formalin application is surprisingly high, including vesicoureteral reflux and hydroureteronephrosis as local reactions and systemically tubular necrosis with anuria. Our series of patients is presented with a detailed description of a patient who was afflicted with a vesicovaginal fistula following formalin instillation. Formalin can serve as excellent therapy for massive hematuria. If attention is paid to the concentration and to the technical details of its instillation the noxious side effects can be minimized or prevented in the majority of cases.

Intravesical instillation of Formalin for hemorrhagic cystitis secondary to radiation for gynecologic malignancies

Our experience with the use of Formalin instillation in interactable gross hematuria secondary to radiation cystitis in patients with gynecological malignancies is reported. This study indicates coagulative effect of low concentration of Formalin with minimal side effects as a method to control hemorrhage.

Intraperitoneal spillage of formalin after intravesical instillation

Intravesical instillation of formalin appears to be a method of choice in the control of massive hematuria following radiation cystitis. It is generally described as a safe, cheap, effective procedure. We report a case of intraperitoneal spillage of formalin and describe the metabolic and extensive medical problems encountered in the four-week period following the incident before the patient's death.

Surgical problems following irradiation therapy: urology (author's transl)

Late complications involving the bladder and ureter occasionally occur following irradiation to the minor pelvis. Intermittent light bleeding from the bladder can be contained by nonspecific installation therapy. With life-threatening hemorrhage, silver nitrate or formalin instillation is effective. The treatment of irradiation ulcers, irradiation contracted bladder, vesicovaginal fistulae, and late irradiation reactions of the ureter are discussed in incurable bladder contractions and vesicovaginal fistulae, a supravesicle urinary diversion is necessary.

Open instillation of formalin for hemorrhagic cystitis in a child

A child with massive hematuria was treated with open instillation of formalin in his bladder. Insertion of Fogarty catheters in both ureters was used to prevent vesicoureteral reflux, demonstrated on a previous cystogram.

Sudden Death during Instillation of Formalin into the Urinary Bladder

Sudden Death during Instillation of Formalin into the Urinary Bladder

Ureteral Complications after Intravesical Formalin Instillation

Results of formalin therapy for hemorrhage owing to post-radiation cystitis have been studied with special reference to the frequency and severity of ureteral complications. Gross bleeding stopped in 25 of 27 patients within 48 hours. However, 5 patients became anuric immediately after the instillation and in another 7 patients a transient increase in the serum creatinine level was observed. Urinary diversion was necessary in 11 of the 27 patients. The complication rate in the present study is considerably higher than reported previously. Complications may be explained by vesicoureteral reflux of a too strong formalin-alcohol solution. To avoid future complications we suggest that 1) a high diuresis should be induced peroperatively, 2) a 1 to 2 per cent formalin solution without alcohol should be used and 3) the instillation pressure should not exceed 15cm. water.

The role of primary prostaglandins in ocular inflammation as demonstrated by the effects of MK-447 in the rabbit eye

MK-447 (2-aminomethyl-4-t-butyl-6-iodophenol) has been reported to increase the overall production of the primary prostaglandins (PGE1, PGE2, PGF2α) and to act as an anti-inflammatory agent in extraocular tissues. The present studies demonstrate that, in the rabbit eye, MK-447 acts as an inflammatory rather than an anti-inflammatory agent. Repeated ocular instillation or subconjunctival injection of MK-447 induced significant conjunctival edema and/or iris hyperemia as well as disruption of the blood aqueous barrier as indicated by elevation of the protein content of the aqueous humor. The effects of subconjunctival injection of MK-447 were greatly reduced by the instillation of indomethacin but only mildly altered by dexamethasone, pyrilamine or soya bean trypsin inhibitor. Dose levels of MK-447, which were without effect when instilled alone into the eye, also markedly enhanced the ocular inflammatory responses to instillation of arachidonic acid (A.A.), formalin and PGE1. Administered intravenously, MK-447 both enhanced the ocular inflammation induced by instillation of A.A. and reduced the inflammatory skin reaction to intradermal injection of A.A. in the same rabbits. The results indicate MK-447 produces ocular inflammation and enhances the ocular inflammatory responses to other agents possibly by its unique action upon PG synthetic mechanisms and that the primary mediators of inflammation in the eye may differ from those in some extraocular tissues.