[Radiotherapy volume delineation based on (18F)-fluorodeoxyglucose positron emission tomography for locally advanced or inoperable oesophageal cancer]. / Intérêt de la tomographie par émission de positons au (18F)-fluorodésoxyglucose pour la planification de la radiothérapie des cancers de l'œsophage localement évolués ou inopérables.

PURPOSE: To study the impact on radiotherapy planning of an automatically segmented target volume delineation based on (18F)-fluorodeoxy-D-glucose (FDG)-hybrid positron emission tomography-computed tomography (PET-CT) compared to a manually delineation based on computed tomography (CT) in oesophageal carcinoma patients. METHODS AND MATERIALS: Fifty-eight patients diagnosed with oesophageal cancer between September 2009 and November 2014 were included. The majority had squamous cell carcinoma (84.5 %), and advanced stage (37.9 % were stade IIIA) and 44.8 % had middle oesophageal lesion. Gross tumour volumes were retrospectively defined based either manually on CT or automatically on coregistered PET/CT images using three different threshold methods: standard-uptake value (SUV) of 2.5, 40 % of maximum intensity and signal-to-background ratio. Target volumes were compared in length, volume and using the index of conformality. Radiotherapy plans to the dose of 50Gy and 66Gy using intensity-modulated radiotherapy were generated and compared for both data sets. Planification target volume coverage and doses delivered to organs at risk (heart, lung and spinal cord) were compared. RESULTS: The gross tumour volume based manually on CT was significantly longer than that automatically based on signal-to-background ratio (6.4cm versus 5.3cm; P<0.008). Doses to the lungs (V20, Dmean), heart (V40), and spinal cord (Dmax) were significantly lower on plans using the PTVSBR. The PTVSBR coverage was statistically better than the PTVCT coverage on both plans. (50Gy: P<0.0004 and 66Gy: P<0.0006). CONCLUSION: The automatic PET segmentation algorithm based on the signal-to-background ratio method for the delineation of oesophageal tumours is interesting, and results in better target volume coverage and decreased dose to organs at risk. This may allow dose escalation up to 66Gy to the gross tumour volume.

Cytokine concentrations in bronchoalveolar lavage fluid from horses with neutrophilic inflammatory airway disease.

BACKGROUND: Multiple cytological patterns occur in bronchoalveolar lavage fluid (BALF) of horses with inflammatory airway disease (IAD). Only few data on BALF cytokine profiles are available for horses with IAD, and are limited to mRNA expression. HYPOTHESIS/OBJECTIVE: Cytological profiles of IAD are associated with different BALF immunological pathways. To investigate BALF cytokine concentrations in a large number of horses with neutrophilic IAD. ANIMALS: One hundred and thirty-eight client-owned Standardbred racehorses in active training. METHODS: Prospective observational study. BALF samples were obtained from left and right lungs. Interleukin (IL)-4, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α concentrations were determined by ELISA. RESULTS: Fourteen horses had normal BALF cytological profiles and 56 exhibited evidence of bilateral neutrophilic IAD. Twenty-four horses showed BALF with, respectively, IAD- and CTL consistent cytology and were excluded; as were 44 horses because of evidence of pulmonary hemorrhage. TNF-α (56 ± 115 pg/mL; P = .034) and IFN-γ concentrations (104 ± 247 pg/mL; P = .044) were significantly higher for IAD horses, compared with controls (respectively 19 ± 41 and 80 ± 116 pg/mL). Horses with 'neutrophil' subtype had significantly higher IFN-γ concentrations (110 ± 154 pg/mL), than 'neutrophil/metachromatic' (56 ± 54 pg/mL; P = .028) and 'neutrophil/metachromatic/eosinophil' subtypes (44 ± 23 pg/mL; P = .012). CONCLUSIONS AND CLINICAL IMPORTANCE: Cytokine concentrations in BALF suggested that neutrophilic IAD is associated with activation of the innate immune system and a possible T-helper (Th)-1 polarized response. This study also suggested that immunological pathways vary according to cytological IAD subtypes.

Impact of manual lymphatic drainage on hemodynamic parameters in patients with heart failure and lower limb edema.

Manual lymphatic drainage (MLD), intermittent sequential pneumatic therapy (ISPT), multilayered bandages (MLB), and compression garments are main techniques in conservative treatment of peripheral lymphedema. Since 1990, it has been thought that ISPT applied to both lower limbs simultaneously should not be used for patients with heart failure because right atrial, pulmonary arterial, and pulmonary wedge pressures may increase to a critical point. In 2005, these same results were observed in patients with heart failure wearing MLB. For these reasons, MLB and ISPT have been contraindicated during lymphedema treatment in cardiac patients. The aim of this study was to determine if we may continue the treatment of lower limb lymphedema using MLD in patients with heart failure. We evaluated hemodynamic parameters using echography during MLD in patients with cardiac disease and obtained circumferential measurements of the edematous limb before and after treatment. MLD treatment significantly decreased the limbs as expected. The heart rate also decreased following MLD in contrast with all other hemodynamic parameters which were not affected by MLD. The findings suggest that there is no contraindication to use MLD in patients with heart failure and lower limb edema.

Morphological, haemato-biochemical and endocrine changes in young Standardbreds with 'maladaptation' to early training.

REASONS FOR PERFORMING STUDY: The demands in the Standardbred trotters industry require young, still growing horses, to be trained well above light exercise level. During that period, the risk of occurrence of energy imbalance and maladaptation to training is high. In man, the lack of energy homeostasis is considered as the basic problem in the development of chronic fatigue. OBJECTIVE: To find objective biomarkers of early maladaptation to training in young racehorses under field conditions. MATERIALS AND METHODS: Sixty-five 2-year-old Standardbreds were followed during their first 3 months of training in 5 different training centres. Monthly measurement of morphological variables (weight, height at withers, body condition score, body composition), basic haemato-biochemical variables and endocrine levels (testosterone, cortisol, thyroid hormones, leptin, IGF1, prolactin) were undertaken. Feeding levels and training programmes were also evaluated. At the end of the 3 month period, on the basis of an abnormal weight loss, 14 young horses were suspected of maladaptation to training (MT group). Morphological, haemato-biochemical, endocrine changes were compared between MT group (n = 14) and control group (C group, n = 40). Analysis of variance was calculated to study the effects of time and maladaptation to training. RESULTS: Compared to C group, MT group showed a significant higher weight loss in relation to a higher loss of fat mass and body condition score (P < 0.05). MT group presented higher GGT and white cell counts and lower red cell counts (P < 0.05). Finally, MT group showed significant lower levels of T4 (P = 0.03) than C group. CONCLUSION: Some young horses presented signs of energy imbalance which were also associated with haematobiochemical and endocrine changes. Those markers might be useful for identification of maladaptation to training.

Physiological measurements and prevalence of lower airway diseases in Trotters with dorsal displacement of the soft palate.

REASONS FOR PERFORMING STUDY: Dorsal displacement of the soft palate (DDSP) is one of the most common obstructive conditions of the upper respiratory tract in the racehorse. This condition has a complex aetiology which may be caused or exacerbated by pharyngeal inflammation. Additionally, lower respiratory airway diseases may be associated with DDSP thereby contributing to exercise intolerance in these horses. OBJECTIVE: The aim of this study was to measure physiological variables during a standardised exercise test and to assess the prevalence and consequences of lower respiratory airway disease in horses with DDSP. METHODS: A total of 46 horses were included in this study: 22 in the control and 24 in the DDSP groups. All horses performed a SET with measurement of heart rate (HR) and blood lactate concentration. One hour post exercise, respiratory samples were collected for cytological and bacteriological analysis. RESULTS: During exercise, the DDSP group had higher blood lactate concentration than the control group. According to BAL results, 50 and 63% of control and DDSP group horses, respectively, had evidence of inflammatory airway disease (IAD). In the DDSP group, 42% of horses had a syndrome of tracheal inflammation (STI) with 71% of this group having bacteria isolated at >10(5) CFU/ml. CONCLUSIONS: Horses with DDSP showed evidence of a high prevalence of IAD and STI with an associated positive bacteriology in 55% of the cases. Even if DDSP is treated by surgery, the authors' recommendation would be to investigate the possibility of lower respiratory airway problems which may also be impacting the horse's performance and/or surgery efficiency.

Oral supplementation with superoxide dismutase in Standardbred trotters in training: a double-blind placebo-controlled study.

REASONS FOR PERFORMING STUDY: Intense physical exercise produces an excess of reactive oxygen species which can disturb the antioxidant/oxidant balance of the horse in training. Several classes of antioxidant dietary compounds have been suggested to provide health benefits and there is evidence that consumption of these products leads to a reduction in the expression of various pro-inflammatory and/or oxidative stress biomarkers. The recent development of a new galenic system allows the oral delivery of the antioxidant enzyme: superoxide dismutase (SOD). This has been developed from a specific melon variety with a particularly high SOD activity. OBJECTIVES: To study the influence of an oral supplementation with an encapsulated melon rich in SOD on muscular and antioxidant balance variables in a population of Standardbreds in training. METHODS: Twenty-four Standardbreds in training were paired by age, sex and training level. They were randomly split into 2 groups: SOD group (520 iu/day) and placebo group. At the beginning of the study (T0) and after 30 days (T30) and 60 days (T60) of supplementation, physiological response during a standardised exercise test, plasma muscular enzymes at rest and post exercise (creatine kinase), oxidative stress markers (erythrocyte SOD) and blood resistance to haemolysis (KRL test) were assessed. Analysis of variance of time, treatment and interaction time x treatment was calculated. RESULTS: Between T0 and T60, in contrast with placebo group, a significant increase in the plasma resistance to haemolysis in the SOD group was observed and it was significantly higher (P < 0.05) in the SOD group than in the placebo group on T60. Between T0 and T60, resting CK remained constant in SOD group whereas a significant increase in plasma CK in the placebo group was observed. On T60, the CK level was significantly lower (P < 0.05) in SOD group than in the placebo group. CONCLUSIONS: These results suggest that oral SOD supplementation might increase blood resistance to haemolysis and reduce the increase in muscular membrane permeability induced by training.

Body composition in young standardbreds in training: relationships to body condition score, physiological and locomotor variables during exercise.

REASONS FOR PERFORMING STUDY: Body composition is an essential factor in athletic performance of human sprinters and long distance runners. However, in horses, many questions remain concerning relationships between body composition and performance in the different equine activities. OBJECTIVES: To determine relationships between body composition, body score, physiological and locomotor variables in a population of young Standardbreds in training. METHODS: Twenty-four 2-year-old Standardbreds were studied, body condition on a scale 0-5 and bodyweight recorded, and height at withers measured. Percentage of fat (%F), fat mass (FM) and fat free mass (FFM) were estimated echographically. During a standardised exercise test on the track, velocity, heart rate, respiratory frequency and blood lactate concentrations were measured. V4 and V200 (velocity for a blood lactate concentration of 4 mmol/l and velocity of 200 beats/min) calculated. Basic gait variables were measured at 3 different speeds with an accelerometric device. RESULTS: Body composition variables: %F and FM were significantly related to body condition score and physiological variables. Body score was highly correlated to %F (r = 0.64) and FM (r = 0.71). V4 was negatively correlated to %F (r = -0.59) and FM (r = -0.60), P<0.05. V200 was also negatively related to %F and FM, (r = -0.39 and r = -0.37, respectively, P<0.1). No relationships were found between body composition and gait characteristics. CONCLUSIONS: Body composition was closely related to indirect measurements of aerobic capacity, which is a major factor of athletic performance in middle distance running horses. POTENTIAL RELEVANCE: As in human athletes, trainers should take special note to evaluate optimal bodyweight and body composition of race horses to optimise performance.

Optimal active recovery intensity in standardbreds after submaximal work.

REASONS FOR PERFORMING STUDY: A retrospective study concerning spontaneous active recovery intensity, i.e. at a freely chosen speed, after a submaximal exercise in trotters showed that the mean intensity demanded by trainers corresponds to 40-50% of maximal heart rate (max HR; unpublished data). However, in human athletes, optimal active recovery intensity was found to be about 60-70% of max HR. Is the spontaneous recovery optimal after a submaximal exercise in trotters? OBJECTIVES: To compare different recovery intensities and define the most efficient one. METHODS: Thirty-seven trotters performed a standardised exercise test on the track. Horses were randomly divided into 4 groups of recovery: passive recovery (n = 10), 10 min walk recovery (n = 10, 100 m/min), 10 min slow trot recovery (n = 9, 250 m/min) and 10 min fast trot recovery (n = 8, 420 m/min). Before, during and 1 h after exercise, speed, heart rate, blood lactate concentration were measured as well as respiratory frequency and rectal temperature. Creatine kinase (CK) was measured 1, 3 and 5 h after exercise. RESULTS: Walk, slow trot and fast trot recovery corresponded respectively to 45-50%, 55-60% and 65-70% of max HR. Heart rate and blood lactate concentration were significantly lower after the 10 sec recovery with increasing intensity of recovery. CONCLUSION: The most efficient intensity of recovery was the 10 min fast trot recovery (65-70% max HR) as this type of recovery allows the optimal blood lactate disappearance. POTENTIAL RELEVANCE: Considering the usual habits of trainers or drivers, recovery intensity after trot races should be increased in intensity to optimise its efficiency.

Abnormal radiographic findings in 865 French standardbred trotters and their relationship to racing performance.

REASON FOR PERFORMING STUDY: Developmental orthopaedic lesions are commonly found in French Standardbred horses. One of the main questions asked by trainers, owners and veterinarians is what impact these lesions have on the racing career and racing performances of horses. OBJECTIVES: To study the prevalence and distribution of developmental orthopaedic lesions in young French Standardbred trotters and to relate them to racing performance. METHODS: Feet, fetlock, tarsus and stifle regions were radiographed in 865 two-year-old French Standardbred trotters. Abnormal radiographic findings (ARF) were evaluated for 12 anatomical sites identified in these areas, and a severity index given. Performance criteria were: success in qualification for racing, maximal and mean index of trot (ITR), an annual index calculated on the basis of the logarithm of earnings per starts, total earnings at 5 years, placed races compared to starts and longevity of the racing career. Analysis of variance were calculated to study the relationships between racing performance and the number of ARF or the severity index. RESULTS: A total of 363 horses (42.0%) showed ARF. Prevalence of ARF was 18.3% in the plantar aspect of the hind fetlock and 10.6% in the proximal tarsus. Among the total population, 833 horses were considered for performance evaluation, 478 of them were qualified for racing. The number of ARF significantly affected racing longevity. However, the number of ARF did not affect performance categories according to maximal ITR. Concerning distribution of ARF, the number of plantar lesions in the fetlock significantly affected mean ITR. The index of severity did not provide more information for prognosis than the number of ARF. CONCLUSION: Longevity is the only criteria affected by ARF. When evaluating different sites, only the plantar fetlock region showed a significant relationship with mean ITR. POTENTIAL RELEVANCE: Number of ARF and radiographic score (RS) affect mean ITR and longevity but do not affect maximal ITR. A horse with a good racing ability will be a good performer but might have a racing career shortened because of orthopaedic problems in relation to developmental orthopaedic lesions.

Harnessed vs. mounted standardbreds on the track: changes in gait and physiological variables.

REASONS FOR PERFORMING STUDY: It has become apparent through analysis of elite races over the past 20 years that mounted races are always slower than harnessed races when performed by the same horses over the same distances on the same tracks. OBJECTIVES: To investigate and compare physiological and gait variables in mounted and harnessed activities in trotters. METHODS: Ten trotters were taken at random in 2 standardised field exercise tests one week apart: a harnessed and a mounted test with standardised weight jockeys and drivers. Speed, heart rate (HR), respiratory frequency (RF), blood lactate concentration (La), stride characteristics (length, frequency [SF], symmetry, regularity, dorsoventral displacement of the sternum and vertical, longitudinal and lateral activities measuring the amount of deceleration and acceleration along the 3 axis) were measured. RESULTS: Paired t tests and an analysis of variance were calculated between the 2 conditions and revealed that V4 (speed for a La of 4 mmol/I), V200 (speed for a HR of 200 beats/min), stride length, trot symmetry, lateral activity were lower in the mounted condition. In contrast, RF, SF, dorsoventral displacement, vertical and longitudinal activities were significantly higher in mounted horses compared to harnessed horses. CONCLUSION: The significant physiological and biomechanical differences between pulling whilst harnessed and being ridden reflect an increase in the energy requirement of locomotion in the mounted condition compared to the harnessed condition. Trotting mounted at maximal speed is more demanding for the horse than harnessed as reflected by the lower V4 and V200 and some gait variables change in relation to this phenomenon. POTENTIAL RELEVANCE: This study demonstrates that trotting mounted at sub-maximum and maximum speed is more demanding for the horse when ridden and that it modifies some gait variables, either as a result or even as a possible cause.

Factors influencing variation in locomotor-respiratory coupling in standardbred trotters in the field.

REASONS FOR PERFORMING STUDY: A close relationship between limb and respiratory rhythms has been shown in clinically healthy galloping horses due to mechanical constraints in the thoracic region. This synchronisation leads to a 1/1 ratio between stride frequency (SF) and respiratory frequency (RF) during galloping. Very little is known about locomotor-respiratory coupling (LRC) during fast trot. OBJECTIVES: To investigate stride and respiratory rates during a standardised exercise test on the track in Standardbred Trotters. METHODS: Forty-four French trotters age 2-10 years performed a standardised exercise test consisting of three 3 min steps at constant speeds. Speed (V) of exercise varied between 500 and 750 m/min. Variables measured during exercise: SF, heart rate, RF using a microphone between the nostrils, blood lactate concentration. Physiological variables V4 and V200 were calculated and race performance index recorded. RESULTS: There was no age-related difference in RF or in LRC. Two LRC strategies were found: around 1/1 ratio and 3/2 ratio between SF and RF, respectively. A relationship between SF/RF ratio and physiological parameters showed a higher LRC in good performers because of a lower RF during submaximal and maximal exercise. CONCLUSION: RF is significantly lower and LRC significantly higher in good compared to poor performers. POTENTIAL RELEVANCE: Investigation is required to ensure that the breathing techniques of trotters may be used in the selection process of racehorses.

Relationships between physiological variables and race performance in French standardbred trotters.

The relationships between V4 (the velocity for a blood lactate concentration of 4 mmol/litre) and V200 (the velocity for a heart rate of 200 bpm) and the performance indices of 223 healthy French trotters were analysed. They were divided into four age groups of three, four, five and six years and over, and into three performance groups (good, intermediate and poor performers) defined by the index of trot (ITR), an annual index of performance calculated by the national stud. V4 and V200 were assessed during the performance of a three-step standardised field exercise test, and four performance indexes (ITR, earnings, best time and the number of starts) were calculated for each group. An analysis of variance showed that V4 and V200 were highly correlated with the horses' age and level of performance (P<0.05). The correlation between the physiological variables and ITR was better for the three- and four-year-old horses than for the older horses.

Reproducibility of a locomotor test for trotter horses.

Locomotion analysis is increasingly used to assess the gait of horses in the selection and training of equine athletes. We have developed a specific locomotor test for fast trotting harnessed horses that uses an accelerometric device. We describe here the reproducibility of the locomotor test and the validation of its use to analyse trotters on the racetrack. We measured the performance of eight horses under the same conditions three times in a single week. We then tested the influence of five tracks on the variables measured using eight different trotters every two days. The horses trotted at three or four velocities (8.3, 10, 11.7 m/s and at maximal velocity) in a straight line for 20 s. The short-term reproducibility of the test was very good for 23/25 variables, with no significant difference in the 23 variables for the three measurements. The two less reproducible variables reflected human error. The different tracks did not alter the stride variables measured. We conclude that the test is an easy, accurate method for analysing gait, as it provides reproducible stride variables for trotting harness horse under field conditions.

Analysis of trotter gait on the track by accelerometry and image analysis.

The aim of this study was to describe the correlation between the phases of the limb cycle of trotters on the track and specific points on the acceleration curves obtained from a new gait analysis system. We compared kinematic data obtained by video image analysis and 3-dimensional acceleration recordings made on 3 French trotters in training. They trotted on a race track at speeds of 8.33, 10 and 11.66 m/s, with a final stretch at maximum speed. Their locomotion was recorded with a synchronised video camera at a frame frequency of 200 Hz and with the Equimétrix gait analysis system. The gait variables were calculated using 3-dimension acceleration data recorded at the sternum (dorso-ventral, longitudinal and lateral axes) at a sampling rate of 100 Hz. Three phases of the stride were clearly identified on the dorsoventral acceleration signal: hoof-landing, midstance phase and toe-off. Braking and propulsion phases were identified on the corresponding longitudinal acceleration signal. The weight-bearing diagonal was identified by observing the lateral signal. The stride temporal variables (stride, stance, braking and propulsion durations for both diagonals), measured by video analysis and by acceleration signal analysis, were not significantly different (P>0.05). The identification of specific points on the acceleration pattern allowed an accurate temporal analysis of the stride. Potential applications could be the determination of locomotor factors related to racing performance or assessment of locomotor disorders at high speed.

[Malignant granuloma of the face and angiocentric T-cell lymphoma. A review of the literature apropos of a case]. / Granulome malin de la face et lymphome T angiocentrique. Une revue de la littérature à propos d'une observation.

The authors report the observation of a lethal midline granuloma in a 43 years old man, at first seen with repeated left sinusitis disease, the histo-pathological study of a biopsy of the external middle third of the left side of the nose made the diagnosis of midline lethal granuloma, classically called Stewart granuloma by french authors. General Medical Investigations to find some peripheral extension, done in specialized services were negative, Epstein Barr DNA was not found by the immuno-histochemical investigations and so don't prove the filiation of this case with angiocentric T cell immunoproliferative lesion. By the light of this observation and of a literature review, the authors debate about the difficulty of diagnosis and about the relations with the other granulomatosis lesions of the face, non Hodgkins' lymphoma and angiocentric T cell immuno-proliferative lesions.

Immunohistochemical markers defined by monoclonal antibodies and response to bacillus Calmette-Guérin endovesical immunotherapy for superficial bladder tumors.

As bacillus Calmette-Guérin (BCG) immunotherapy is highly effective for most but not all superficial bladder tumors, there is a need to define predictors of response to this mode of treatment. We have investigated a panel of markers defined by monoclonal antibodies, directed against tumor-associated transitional cell carcinoma antigen (G4 and E7), epidermal growth factor receptor, cytokeratin (CK) 18 and blood group antigens A, B and H, using an indirect immunoperoxidase staining on paraffin sections. Twenty superficial bladder tumors (T1) treated with intravesical BCG therapy (10 responders and 10 nonresponders) were tested with this panel. Among the responders, expression of CK18 antigen was positive in 7 and negative in 3, whereas in the nonresponder group it was positive in 2 and negative in 8. The difference was statistically significant (p less than 0.05). Loss of expression of CK18 antigenicity was associated with recurrence or progression of superficial bladder tumors following BCG therapy, indicating that changes in CK patterns should be investigated as potential predictive markers for response to BCG.

Bladder tumors invading the lamina propria (stage A/T1): influence of endovesical bacillus Calmette-Guérin therapy on recurrence and progression.

47 patients with transitional cell bladder carcinoma invading the lamina propria (stage A/T1) were treated from 1984 to 1986 by complete transurethral resection followed by 1-3 cycles of endovesical bacillus Calmette-Guérin instillations, and followed 14-64 months by cytology, endoscopy and bladder biopsies, 64% achieved a complete response, 36% recurred (recurrence rate/100 months/patient 2.2), 21% progressed to muscle invasion. Duration of treatment, tumor size or type (solid vs. papillary), presence of carcinoma in situ bore no relation to the final result. The preceding history of T1 bladder tumor appeared associated with a higher risk of progression although not reaching statistical significance. The results were compared to those obtained by transurethral resection in a similar group of 50 patients treated from 1982 to 1984 and followed up 12-100 months, 90% recurred and 34% progressed to muscle invasion with a recurrence rate/100 months/patient of 9.22. Keeping in mind the limits of a nonrandomized historical comparison, it appears that endovesical bacillus Calmette-Guérin therapy alters favorably the recurrence pattern of T1 bladder cancer.

Systemic bacillus Calmette-Guérin infection, 'BCGitis', in patients treated by intravesical bacillus Calmette-Guérin therapy for bladder cancer.

Among 169 patients treated for supeficial bladder tumor with 150 mg Pasteur-strain bacillus Calmette-Guérin (BCG) intravesical instillation, 5 cases of 'BCGitis' were observed, i.e. a severe systemic BCG infection with bronchopulmonary lesions and granulomatous hepatitis. In 4 cases, the complications appeared at the early stage of treatment (after the 3rd, 6th, 6th and 8th instillations, respectively). In 1 case, treated with monthly maintenance therapy for 2 years, BCGitis appeared 6 months after treatment had been completed and, in addition to pulmonary basal infiltrate and granulomatous hepatitis, intramedullary granulomatosis was observed. In 3 patients, trauma must be taken into consideration as BCGitis appeared after traumatic instillation with bleeding. All patients were cured by treatment with rifampicin, isoniazid and prednisone.

Systemic bacillus Calmette-Guerin infection in patients treated by intravesical BCG therapy for superficial bladder cancer.

Among 169 patients treated for superficial bladder tumors with intravesical instillations of 150 mg BCG-Pasteur, five developed BCG-itis--a severe systemic infection with bronchopulmonary lesions and granulomatous hepatitis. In four cases, the complication appeared early during treatment (after three, six, six and eight instillations respectively). In one case, BCG-itis appeared 6 months after completion of 2 years monthly maintenance therapy. In addition to pulmonary basal infiltration and granulomatous hepatitis, intramedullary granulomatosis was observed. In three patients, the role of trauma has to be considered, as BCG-itis appeared after a traumatic instillation with bleeding. All patients were cured by combined treatment with Rifampicin, Isoniazid and Prednisolone.