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Structural basis of voiding dysfunction in megacystis microcolon intestinal hypoperistalsis syndrome.
[megacystis-microcolon-intestinal hypoperistalsis syndrome]
Megacystis
microcolon
intestinal
hypoperistalsis
syndrome
(
MMIHS
)
is
a
rare
,
congenital
and
usually
fatal
condition
of
unknown
etiology
.
It
is
characterized
by
abdominal
distension
caused
by
a
distended
,
non-obstructed
urinary
bladder
and
intestinal
hypoperistalsis
with
functional
intestinal
obstruction
.
Previous
studies
reported
vacuolar
degenerative
changes
in
the
smooth
muscle
cells
of
bowel
and
bladder
suggesting
that
MMIHS
may
be
due
to
a
visceral
myopathy
.
The
aim
of
this
study
was
to
examine
the
expression
of
contractile
,
cytoskeletal
and
extracellular
matrix
proteins
in
the
detrusor
muscle
of
MMIHS
patients
.
Bladder
specimens
were
obtained
from
six
MMIHS
patients
.
Normal
bladder
specimens
were
obtained
during
partial
cystectomy
and
served
as
controls
.
Single
fluorescence
immunohistochemistry
for
alpha-smooth
muscle
actin
(
SMA
)
,
desmin
,
dystrophin
,
vinculin
and
collagen
types
I
and
III
was
carried
out
.
Specific
connective
tissue
stains
(
trichrome
Masson
,
van
Gieson
)
and
electron
microscopical
investigations
were
also
performed
.
Trichrome
Masson
and
van
Gieson
staining
demonstrated
markedly
increased
dense
connective
tissue
between
the
layers
of
the
detrusor
muscle
in
MMIHS
compared
to
controls
.
Collagen
type
I
immunoreactivity
was
markedly
increased
and
SMA
,
desmin
and
dystrophin
immunoreactivity
was
markedly
reduced
in
the
bladder
muscle
of
MMIHS
compared
to
controls
.
Electron
microscopy
revealed
vacuolar
degenerative
changes
in
smooth
muscle
cells
and
an
abundance
of
connective
tissue
between
these
cells
.
These
data
suggest
that
the
detrusor
muscle
in
MMIHS
is
strikingly
abnormal
and
is
the
likely
cause
of
voiding
dysfunction
.
Diseases
Validation
Diseases presenting
"myopathy"
symptom
coats disease
cushing syndrome
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
familial mediterranean fever
focal myositis
homocystinuria without methylmalonic aciduria
inclusion body myositis
junctional epidermolysis bullosa
lymphangioleiomyomatosis
megacystis-microcolon-intestinal hypoperistalsis syndrome
pyruvate dehydrogenase deficiency
This symptom has already been validated