Intravesical Gemcitabine for Treatment of Superficial Bladder Cancer not Responding to Bacillus Calmette-Guerin Vaccine

Objectives: Intravesical Bacillus Calmette-Guerin (BCG) vaccine is the mainstay of treatment and prophylaxis in superficial bladder cancer (SBC) as it reduces tumor recurrence and disease progression. About one-third of patients do not respond to BCG. The aim of this study was to determine the efficacy of intravesical gemcitabine in patients with BCG-refractory SBC. Methods: Twenty three patients with SBC; TaG3; T1G2-G3 or carcinoma in situ (CIS); refractory (after at least 2 courses of intravesical BCG) or intolerant to intravesical BCG therapy were included. Two weeks after complete tumor resection; patients received intravesical gemcitabine twice weekly at a dose of 2.000 mg/100 ml normal saline for 6 consecutive weeks. Two months after the last dose; recurrence-free patients underwent cystoscopy; urinary cytology and 6 random bladder biopsies. Thereafter; patients were evaluated by the same measures every 3 months; as long as there was no recurrence. Patients with complete response (negative cytology and random biopsies) at the first follow-up cystoscopy received a similar maintenance dose once weekly for another 6 weeks. Results: Twenty one patients completed the study: 15 males and 6 females with a mean age of 48.1 (38-72) years. The follow-up was 15 months (range 2-19 months). Thirteen (61.9) patients were recurrence-free after a mean of 17 months. Superficial recurrences were detected in 6 (28.6) patients and progression by stage in 2 patients (9.5). During follow-up; 8 patients had tumor recurrences and 2 had progression to a higher stage. The median recurrence-free time was 14.7 months (5-19 months). The drug was well tolerated and side-effects were mild in all patients; except two: one had easily controlled hematuria and the other had leucopenia. Conclusion: In properly selected patients; gemcitabine seems to be a promising option in the management of high-risk BCG-refractory SBC; especially in those who refuse or are unfit for cystectomy. Long-term efficacy and the role of maintenance therapy have to be properly studied

Efficacy of BCG vaccine against leprosy and tuberculosis in northern Malawi

Protection afforded BCG vaccines against tuberculosis and leprosy varies widely between different populations. In the only controlled trial which assessed protective efficacy of BCG (Danish and Pasteur strains) against both diseases; there was slightly more protection against leprosy than against tuberculosis. Protection was estimated at 50 percent or greater against leprosy; and there was no evidence for lower protection against multibacillary than against paucibacillary disease. There was no statistically significant protection by BCG against tuberculosis in this population

Absence of bacteremia with Mycobacterium avium-intracellulare in Ugandan patients with AIDS

Disseminated infection with Mycobacterium avium-intracellulare is the most common systemic bacterial infection in American patients with the acquired immunodeficiency syndrome. Blood cultures for mycobacteria were obtained from 50 severely ill Ugandan patients fulfilling the World Health Organization criteria for AIDS and considered late in the course of their illness; 98pc had antibody to HIV by ELISA. All blood cultures were negative. These data suggest that disseminated infection with M. avium-intracellulare is infrequent in Ugandan patients with AIDS; if it occurs at all

Protective efficacy of BCG against leprosy in Northern Malawi

The effectiveness of a BCG vaccination programme in protecting against leprosy was assessed by case-control and cohort analyses of data from the Lepra Evaluation Project in Karonga District; Northern Malawi. Results indicate that BCG provides at least 50 percent protection against leprosy in this population and that protection is independent of age; sex; schooling status; or location within the project area. Agreement between these findings and those from a controlled trial in Uganda indicates that BCG is sufficiently effective against leprosy in East and Central Africa to be considered an important element of leprosy control in that region

Ten years' leprosy control work in Malawi: methods and outcome after treatment

This report describes the organizational structure of the British Leprosy Relief Association [LEPRA] Control Project in Malawi as it has evolved since 1973. It would seem that only 3-5 percent of the cohort study group did not benefit from the antileprosy treatment offered. A decline in detection rates points to a decline in incidence

BCG Case-Control Study in HIV-infected women

A case-control study was conducted to investigate the effect of HIV infection on the protective effect of BCG vaccination for tuberculosis in Uganda. A variety of reports have suggested that HIV infection may interfere with the protective efficacy of BCG vaccination by suppressing the immune system of an individual leading to reactivation of latent TB infection. The study was conducted in Mulago Hospital; the National Referral Hospital situated in Kampala