Cardnogenesis vol.12 no.5 pp.943-946, 1991
SHORT COMMUNICATION
Increased ermary mtorosamme excretion in paraplegic patnemlts
A.R.Tricker, D.J.Stickler1, J.C.Chawla2 and R.Preussmann Institute of Toxicology and Chemotherapy, German Cancer Research Center, Im Neuenheimer Feld 280, D-6900 Heidelberg, FRG, 'School of Pure and Applied Biology, UWIST, Cardiff CF1 3XF and 2Spinal Injuries Unit, Department of Rehabilitation Medicine, Rookwood Hospital, Cardiff, Wales
Table I. Bacterial status of paraplegic patients and control volunteers Paraplegic patients
Control group
30
10
2 13 9 5 1
10 0 0 0 0
1 15 5 7
0 0 0 0
8 5 2 1 3 7 5 5 4 4 2 2 2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Epidemiological studies suggest that bacterial infections of the urinary tract may be a risk factor for cancer of the bladder (1,2). The bacterial reduction of nitrate to nitrite and catalysis of in vivo A'-nitrosamine formation has been suggested as an etiological factor for the increased risk of bladder cancer in patients with urinary tract infections (3), chronic and repeated cystitis (4) and Schistosoma infected bilharzia patients (5). More recent studies suggest that in vivo nitrosamine formation in patients with urointestinal diversions may also be a risk factor for colon carcinogenesis in this patient group (6). Several investigations report an increased risk of bladder cancer in spine-injured patients with paraplegia (7-9) undergoing long-term urological management by intermittent urethral catheterization, supra-pubic catheterization and external condom drainage to preserve renal function. Nearly all patients undergoing chronic catheterization develop urinary tract infections (10) with complex mixed bacterial flora of drug resistant Gram-negative bacilli including several nitrate-reducing strains of Proteus mirabilis, KkbsieUa and Escherichia coti (11). A similar bacterial profile has been identified in the urine of bilharzia patients (12) and patients with urinary diversions (6). In vitro studies show that several strains of bacteria can mediate nitrosation reactions between secondary amines and nitrate under physiological pH conditions normally encountered in the urinary bladder (13). Furthermore, nearly 90% of urine samples collected from patients
Number of urines examined Range of different organisms Sterile 1 organism 2 organisms 3 - 4 organisms > 4 organisms Colony forming unit 104 105 106 107 Organisms isolated: Escherichia cot? Proteus mirabilis* fdebsieUa pneumoniae* tOebsiella oxytoca' Pseudomonas aeruginosa* Providencia stuartii Staphylococcus epidermidis Streptococcus faecalis Candida Acinetobacter cakoaceticus Enterobacter cloacae Gtrobacter diversus Diphtheroids Pseudomonas sp.
•Abbreviations: NPRO, N-nitrosoproline; NDMA, N-nitrosodimethylamine.
*Bacteria with known nitrosating activity.
Oxford University Press
943
Downloaded from http://carcin.oxfordjournals.org/ at National Central University Library on May 10, 2015
An increased risk of bladder cancer is a recognized complication in spine-injured patients undergoing long-term urethral catheterization to preserve renal function. Aerobic cultures from 28 of 30 paraplegic patients showed complex bacterial flora containing nitrate-reducing organisms (Escherichia coti, Proteus and KkbskUa spp.). Urine samples from 29 parapkgk patients were also found to contain volatile nitrosamines. Mean A'-nhrosamine excretion levels were 0.65 ± 0.69/xg/day A'-nitrosodimethylamine, 0.25 ± 0.44 /
SHORT COMMUNICATION
Increased ermary mtorosamme excretion in paraplegic patnemlts
A.R.Tricker, D.J.Stickler1, J.C.Chawla2 and R.Preussmann Institute of Toxicology and Chemotherapy, German Cancer Research Center, Im Neuenheimer Feld 280, D-6900 Heidelberg, FRG, 'School of Pure and Applied Biology, UWIST, Cardiff CF1 3XF and 2Spinal Injuries Unit, Department of Rehabilitation Medicine, Rookwood Hospital, Cardiff, Wales
Table I. Bacterial status of paraplegic patients and control volunteers Paraplegic patients
Control group
30
10
2 13 9 5 1
10 0 0 0 0
1 15 5 7
0 0 0 0
8 5 2 1 3 7 5 5 4 4 2 2 2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Epidemiological studies suggest that bacterial infections of the urinary tract may be a risk factor for cancer of the bladder (1,2). The bacterial reduction of nitrate to nitrite and catalysis of in vivo A'-nitrosamine formation has been suggested as an etiological factor for the increased risk of bladder cancer in patients with urinary tract infections (3), chronic and repeated cystitis (4) and Schistosoma infected bilharzia patients (5). More recent studies suggest that in vivo nitrosamine formation in patients with urointestinal diversions may also be a risk factor for colon carcinogenesis in this patient group (6). Several investigations report an increased risk of bladder cancer in spine-injured patients with paraplegia (7-9) undergoing long-term urological management by intermittent urethral catheterization, supra-pubic catheterization and external condom drainage to preserve renal function. Nearly all patients undergoing chronic catheterization develop urinary tract infections (10) with complex mixed bacterial flora of drug resistant Gram-negative bacilli including several nitrate-reducing strains of Proteus mirabilis, KkbsieUa and Escherichia coti (11). A similar bacterial profile has been identified in the urine of bilharzia patients (12) and patients with urinary diversions (6). In vitro studies show that several strains of bacteria can mediate nitrosation reactions between secondary amines and nitrate under physiological pH conditions normally encountered in the urinary bladder (13). Furthermore, nearly 90% of urine samples collected from patients
Number of urines examined Range of different organisms Sterile 1 organism 2 organisms 3 - 4 organisms > 4 organisms Colony forming unit 104 105 106 107 Organisms isolated: Escherichia cot? Proteus mirabilis* fdebsieUa pneumoniae* tOebsiella oxytoca' Pseudomonas aeruginosa* Providencia stuartii Staphylococcus epidermidis Streptococcus faecalis Candida Acinetobacter cakoaceticus Enterobacter cloacae Gtrobacter diversus Diphtheroids Pseudomonas sp.
•Abbreviations: NPRO, N-nitrosoproline; NDMA, N-nitrosodimethylamine.
*Bacteria with known nitrosating activity.
Oxford University Press
943
Downloaded from http://carcin.oxfordjournals.org/ at National Central University Library on May 10, 2015
An increased risk of bladder cancer is a recognized complication in spine-injured patients undergoing long-term urethral catheterization to preserve renal function. Aerobic cultures from 28 of 30 paraplegic patients showed complex bacterial flora containing nitrate-reducing organisms (Escherichia coti, Proteus and KkbskUa spp.). Urine samples from 29 parapkgk patients were also found to contain volatile nitrosamines. Mean A'-nhrosamine excretion levels were 0.65 ± 0.69/xg/day A'-nitrosodimethylamine, 0.25 ± 0.44 /
