Prognostic impact of Bacillus Calmette-Guérin interruption at the time of induction and consolidation.

CONTEXT: Intravesical Bacillus Calmette-Guérin (BCG) is a cause of bladder and systemic toxicity that is difficult to prevent and is responsible for treatment drop out in bladder cancer patients. More recently, BCG shortage has become the main cause of incomplete treatment. AIMS: The aim of this study was to examine the impact on long-term prognosis of bladder cancer patients following discontinuation of BCG instillations. SETTINGS AND DESIGN: In this retrospective study, data were examined from 333 consecutive nonmuscle invasive bladder cancer patients treated from 2005 to 2015 by transurethral resection (TUR) and had undergone adjuvant BCG therapy after TUR. SUBJECTS AND METHODS: Rate of complete cure, the reason for the interruption, toxicity, and the associations between discontinuance of BCG therapy, tumor characteristics, association with carcinoma in situ and tumor recurrence or progression were analyzed. STATISTICAL ANALYSIS USED: Recurrence and progression-free survival rate curves were estimated using the Kaplan-Meier method and were compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Differences among groups were considered as statistically significant when P < 0.05. RESULTS: Overall, 303 patients were eligible for analysis. Median follow up was 36 (confidence interval: 7-120) months. A total of 55 (18.1%) had <6 installations (Group I); 87 (28.7%) completed induction and 1-year maintenance (Group III); and 161 (53.1%) completed the induction course, but not the 1-year maintenance (Group II). Grade III-IV toxicity rates were significantly higher in Group I than Group II and III. Interruption for BCG shortage was the main cause of interrupting BCG in Group II. Multivariate analysis showed that discontinuation of BCG induction therapy was an independent predictor for tumor recurrence (P < 0.001) and 1-year BCG maintenance therapy for tumor progression (P = 0.005). CONCLUSIONS: Discontinuation of BCG therapy has a significantly deleterious effect on tumor recurrence and progression rates. Although BCG toxicity is a major cause of drop out, BCG shortage became a major cause of discontinuation. All effort must be done today to restore normal production of BCG worldwide.

Traumatic aneurysm of the bifurcation of the abdominal aorta in an infant. A case report.

Post-traumatic aneurysms are extremely rare in the infant population. We report a case of delayed abdominal aortic aneurysm that appeared in a 5-year-old female, admitted 5 months previously with contusions to the abdomen.

[Pediatric priapism associated with pulmonary infection]. / Priapisme et infection pulmonaire chez l'enfant.

Priapism is a rare urologic emergency in pediatric population. It is usually a consequence of sickle cell disease. Leukemia is another important cause of priapism in children. We present a case of priapism associated with an acute pulmonary infection. To our knowledge, this is the second case describing this association. In the other reported case, pulmonary infection was related to Mycoplasma Pneumoniae. The hypothesis is that infection with Mycoplasma Pneumoniae can produce a hypercoagulable state, especially in selected areas of the circulation.

Bladder exstrophy associated with complete urethral duplication: a rare malformation with excellent prognosis.

PURPOSE: We report the association of complete urethral duplication and bladder exstrophy in 5 males, and describe the main characteristics to achieve diagnosis. MATERIALS AND METHODS: From 1983 to 2000, 5 males with single bladder exstrophy and complete urethral duplication were seen at 3 institutions. Although bladder exstrophy was obvious at birth, only 1 patient had the preoperative diagnosis of associated urethral duplication. All patients were evaluated with abdominal ultrasound, voiding cystourethrogram after bladder closure and cystoscopy. RESULTS: All patients were totally incontinent, including 4 after primary bladder exstrophy closure. Although it was initially unnoticed by the urologist, most patients had leakage from the tip of the penis during the Valsalva maneuver. In all cases bladder exstrophy was single and deeply situated in the pelvis with excellent elasticity. All patients had a normal sized penis with less severe dorsal chordee and conical shaped glans. The duplicate epispadiac urethra did not have a verumontanum. Only 1 of the 5 patients had the correct diagnosis made before primary closure of bladder exstrophy, while in the other 4 diagnosis of a duplicate ventral urethra was made at the time of epispadias or fistula repair. There were no other associated malformations. In all cases the dorsal epispadiac urethral plate was excised and bladder emptying occurred through the ventral urethra, which at cystoscopy had a normal verumontanum. Postoperatively, all patients became continent and voided with good flow through the ventral urethra and, as opposed to many cases of exstrophy and epispadias, had normal size and excellent cosmesis of the penis. CONCLUSIONS: Complete urethral duplication is a rare variant of the exstrophy-epispadias complex. Patients with this anomaly present with a larger and more deeply situated bladder plate than classical exstrophy and a larger penis. A high index of suspicion is necessary to make a preoperative diagnosis. Excision of the dorsal urethral plate and maintenance of the ventral urethra are the treatment of choice, resulting in a continence and normal voiding.

[Use of the immunoenzyme test ELISA-NS3 to distinguish horses infected by African horsesickness virus from vaccinated horses]. / Utilisation de l'épreuve immuno-enzymatique ELISA-NS3 pour différencier les chevaux infectés par le virus de la peste équine des chevaux vaccinés.

A vaccination protocol involving three horses, with five repeated injections of inactivated serotype 4 African horse sickness virus, was undertaken to determine a possible threshold for the appearance of antibodies against the non-structural protein NS3. Using an indirect enzyme-linked immunosorbent assay, with the recombinant NS3 protein as an antigen, the authors detected a response to NS3 as of the second injection for the first horse and after four injections for the second horse. No response to NS3 was detected for the third horse. The results show that the inactivated vaccine is insufficiently purified to eliminate the non-structural protein NS3. Therefore using the NS3 protein as a marker did not enable differentiation between vaccinated and infected horses.

Clinical, virological and immune responses of normal and immunosuppressed donkeys (Equus asinus africanus) after inoculation with African horse sickness virus.

To elucidate the role that donkeys may play in African horse sickness virus (AHSV) persistence during inter-epizootic periods we looked for clinical signs of infection and studied the viraemia and neutralising antibody kinetics in 3 immunocompetent and 3 immunosuppressed donkeys inoculated with AHSV-4. None of the donkeys developed signs of AHS. However infectious AHSV was isolated from the blood of the immunocompetent donkeys for up to 17 days post infection (dpi) and viral antigens were detected for up to 28 dpi. Immune cells also increased significantly from 35 to 60 dpi. There was no evidence of a recrudescence of viraemia following immunosuppression of these donkeys at 90 dpi despite a decrease in the numbers of immune cells. Infectious virus was not isolated from the blood of donkeys that had been immunosuppressed, prior to AHSV inoculation. However viral antigens were detected for up to 35 dpi. The titres of AHSV-specific neutralising antibodies and the number of immune cells were also significantly lower than in immunocompetent animals. Our findings suggest that donkeys may be able to play a role in the epidemiology of AHS but the ability of vectors to become infected by feeding upon viraemic donkeys needs to be assessed before the significance of that role can be fully understood.

Western immunoblotting as a method for the detection of African horse sickness virus protein-specific antibodies: differentiation between infected and vaccinated horses.

A Western immunoblotting procedure has been developed for the detection of African horse sickness virus (AHSV) protein-specific antibody responses. This assay readily identifies antibodies specific for at least 4 distinct, AHSV proteins, including VP5, NS1, NS2 and NS3/NS3a. By using the AHSV non-structural proteins as 'markers', the Western blotting procedure could be employed to provide a reliable means of discriminating between animals vaccinated with a purified, inactivated AHSV vaccine and those either naturally infected or vaccinated with a live, attenuated AHSV vaccine.

[Surgical complications of intestinal ascariasis]. / Les complications chirurgicales de l'ascaridiose intestinale.

Ascaridiosis is a usually benign disease caused by the parasite Ascaris lumbricoides. Medical treatment is usually sufficient. Prevalence in tropical zones is high, sometimes leading to severe surgical complications requiring treatment and having a high morbidity and mortality. Codified treatments are needed to reduce the incidence of ascaridiosis. Large scale prevention is needed, especially in endemic zones.

[Rectal prolapse in children. Review of 260 cases]. / Le prolapsus rectal de l'enfant. Revue de 260 cas.

Rectal prolapse is mostly seen in constipated children after prolonged straining at stool. In Morocco, it will occur in children suffering from digestive parasitosis or hypotrophic children following episodes of acute diarrhea. In order to evaluate the respective role of these factors and consequently adapt the management of this condition, a prospective study of 260 cases was conducted between 1979 and 1986 bearing on etiologic factors on the one hand and with a view to assessing the efficacy of medical treatment and of sclerosing injections on the other hand. As regards etiology, diarrhea in connection with digestive parasitosis appears as a predominating factor (62%). A deficient condition was also noted in 67 out of 160 children (42%). Medical treatment was successful only in 28% of cases, whereas 98% of our patients were cured by sclerosing injections without need for surgical treatment.

[Mycoplasma bovis infection: epidemiological and clinical survey of dairy cattle farms in Morocco]. / Infection à Mycoplasma bovis: suivi épidémiologique et clinique dans des élevages bovins laitiers au Maroc.

An epidemiological survey of M bovis infection in dairy cattle was performed in 10 herds of the Gharb's region, by sampling the animals three times with a two-month interval, between November 1985 and May 1986. M bovis was isolated in six herds with calf enzootic bronchopneumonia with a total frequency of 39% during the first visit, then 25 and 13% after two and four months, respectively. The severity of the symptoms seems closely related to the age of the animals: the youngest being the most susceptible. On the other hand, M bovis was isolated in two herds from 11% of cows suffering from clinical and subclinical mastitis. The isolation occurs at any lactation stage and the infection lasted more than four months in 40% of the animals. These results suggest that mycoplasma are important bovine pathogens in Morocco.

[Epidemiology of diarrhea caused by Escherichia coli and rotavirus in calves and lambs in Morocco]. / Epidèmiologie des diarrhées à Escherichia coli et à rotavirus chez le veau et l'agneau au Maroc.

An epidemiological survey on E coli and rotavirus associated diarrheas in one to twenty five days old calves and lambs was made in three regions: Rabat-Kenitra, Marrakech and Agadir. Isolated E coli K99 stains have been studied of a biochemical, serotypical (O antigen) and antibiotypical point of view. The identification of rotavirus was made by ELISA test. Persistence of K99 antigen and heat stable toxin A was examined after a conservation of 5 weeks at - 18 degrees C. The frequency of E coli K99 or rotavirus associated diarrheas is respectively 26.9% and 29.7% in calf, 10% and 30% in lamb. This incidence considerably decreases from the 20th day in calf and from the 11th day in lamb. It must be observed that 34.8% of cases of diarrheas in calf and 55% in lamb cannot be ascribed to investigated agents. Only 12 out of 42 E coli K99 strains belong to serogroups O101, O8 and O9. Preservation of strains to - 18 degrees C comes with the loss of K99 antigen. These strains are not toxinogens. Among the strains having kept this antigen, 29% are toxinogens. Surveyings of antibiotics resistance was discussed.

[The treatment of Pott's disease in children. Apropos of 100 cases]. / Le traitement du mal de pott de l'enfant. A propos de 100 cas.

Between 1976 and 1984, 100 children aged 13 months to 15 years were treated for tuberculosis of the spine. 29 patients seen at an early stage and presenting limited lesions healed completely with mild or moderate residual kyphosis after orthopaedic treatment associating antibiotherapy and strict immobilization in plaster shells. 71 patients having extensive vertebral destruction or after failure of the orthopaedic treatment underwent surgery for excision and anterior spine fusion. A supplementary posterior spine fusion was performed in 48 patients. This procedure, in conjunction with preoperative traction, obtained stabilization of the spine and healing of vertebral lesions in most cases with excellent correction of recent kyphosis. In view of these results, it seems possible to determine which treatment is best adapted according to: the extent, severity and level of the lesions, the degree and age of kyphosis, the existence or not of paraplegia. The possibility to reduce fixed severe kyphosis (6 cases) and the indication for a supplementary posterior fusion are evaluated.

[Pyelo-ureteral duplication and vesico-ureteral reflux]. / Duplicité pyélo-urétérale et reflux vésico-urétéral.

106 children (76 girls and 30 boys) were treated for vesico-ureteric reflux in double upper urinary tracts. The results of different treatment protocols are discussed. Medical treatment is rarely successful. Partial or total nephrectomy is sometimes necessary because of very poor renal function. Cohen's technique for the "en bloc" ureterocystoneostomy of the two ureters seems to provide the best conservative treatment. But the results, which are good as far as the reflux is concerned, are often unsatisfactory because of the scarring of the renal parenchyma, especially as regards the inferior pole, and because of persistent urinary infection.

[Experimental study of postvaccinal immunity to sheep-pox]. / Etude expérimentale de l'immunité anticlaveleuse post-vaccinale.

Two live virus sheep-pox vaccines have been prepared on lamb testicular cells from strains Perego and RM65. Inocuity and activity have been compared to those of a commercial vaccine on a small number of lambs. Immunogenicity has been studied through neutralizing and precipitating antibodies, and through challenge resistance (strain Held), using a protective index. Results show that Perego vaccine titrated at 10(4) DICT50 gives a reliable immunity and does not provoke severe reaction post-inoculation. RM65 vaccine of which protection index is lower, only avoid infection to generalize. Although some correlation exists between seroneutralizing titers and protective index, virulent challenge appears and seems to give better data with regards to the level of protection conferred.

[Prevention of caustic stenoses of the esophagus with an intraesophageal mold]. / La prévention des sténoses caustiques de l'oesophage par moule endo-oesophagien.

The various methods for the management of full-thickness caustic burns of the esophagus, whether by early bougienage or by corticosteroïd treatment and/or use of an intraluminal catheter, have proved unsuccessful to this date. The use of an intraluminal splint kept in place during 3 weeks, as advocated by Reyes, slows down the growth of exuberant granulation tissue and prevents the formation of synechia and stricture during the healing process. Reyes's method was modified as follows: after a delay of 4 or 5 days, an esophagoscopy is performed along with a histologic study in order to ascertain the extent of the burn. Then, a Blackmore catheter is introduced in the esophagus to serve as a splint. No corticosteroids are used. The authors report 3 cases of deep caustic burns of the esophagus as attested by endoscopic and histologic studies, which have been successfully treated.