Comparison of the reactogenicity and immunogenicity of a split and a subunit-adjuvanted influenza vaccine in elderly subjects.

A randomised, open study was carried out among an elderly population in order to compare the reactogenicity and immunogenicity of an inactivated, split virion influenza vaccine (Vaxigrip, Aventis Pasteur MSD, Lyon, France) with that of an MF59-adjuvanted, subunit vaccine (Fluad, Chiron Vaccines, Siena, Italy). Both vaccines contained the three strains: A/Sydney/5/97 (H3N2), A/Beijing/262/95 (H1N1) and B/Beijing/184/93, recommended by the WHO for the 1998-1999 influenza season. A total of 2150 subjects were vaccinated and included in the reactogenicity analysis. A total of 1076 subjects received Vaxigrip (age 73.3 +/- 5.9 years, 49.6% men) and 1074 subjects received Fluad (age 73.4 +/- 5.9 years, 52.3% men). All subjects were kept under medical observation for 30 min after vaccination, in order to check any immediate local and/or systemic reaction. A self monitoring diary card was given to all subjects to collect any local and/or systemic reaction occurring during the 3 days following the vaccination, any adverse event occurring between vaccination day and 21st day post-vaccination and any medication taken during the study period. A total of 1186 subjects were included in the immunogenicity analysis. A total of 591 subjects received Vaxigrip (age 73.4 +/- 5.6 years, 52.3% men) and 595 subjects received Fluad (age 73.8 +/- 5.9 years, 55.8% men). Blood samples were collected pre- and 21 days post-vaccination and were analysed by the haemagglutination inhibition assay. In terms of reactogenicity both vaccines were generally well tolerated. The frequency of local reactions was lower in the group that received Vaxigrip. Pain at the injection site occurring from 30 min to 3 days after vaccination was also significantly less frequent (P = 0.005) in the Vaxigrip group. Fever > or =37.5 degrees C was reported in less than 1% of all vaccinated subjects. No serious adverse event was related to vaccine administration. In terms of immunogenicity both vaccines induced an effective immune response (anti-HI titre > or =40) against A/Sydney/5/97 (H3N2) and A/Beijing/262/95 (H1N1) strains in the entire population. Vaxigrip and Fluad induced similar seroprotection and seroconversion rates against the A/Sydney/5/97 (H3N2) strain. For both vaccines a lower percentage of subjects achieved a seroprotective titre > or =40 against the B/Beijing/184/93. A lower antibody response against the influenza B strain was also observed in other studies conducted during the same season. In subjects 75 years of age or older, Fluad was more immunogenic than Vaxigrip for all three virus strains.

Total bladder reconstruction after cystectomy.

A case of total bladder reconstruction after cystectomy for bladder cancer is reported. A combination of the Kock pouch and Camey procedure was used.

Evidence against a zinc binding peptide in pilocarpine-stimulated canine prostatic secretions.

Pilocarpine-stimulated canine prostatic secretions were subjected to gel filtration chromatography over Sephadex G-100 and Bio Gel P-4. Free zinc and the zinc in pilocarpine-stimulated canine prostatic secretions were observed to elute in the same fractions from the Sephadex G-100 column. In addition, Sephadex G-100 chromatography could not resolve free zinc from the small peptide bacitracin. However, a column packed with Bio Gel P-4 could resolve free zinc and bacitracin. When pilocarpine-stimulated canine prostatic secretions were chromatographed over the Bio Gel P-4 column, the major portion of the zinc eluted in the same fractions as did free zinc. No zinc was observed in the fractions where the small peptide bacitracin was found to elute. These results indicate that contrary to a previous report, zinc in pilocarpine-stimulated canine prostatic secretions was not bound to an eight amino acid peptide, but, rather, behaved chromatographically like free zinc.

Palliative urinary diversion.

With the development of nonsurgical methods of urinary diversion and the availability of new and more effective methods for treating cancer, an increasing number of patients will be candidates for palliative urinary diversion. Urinary diversion is clearly indicated to provide the time necessary to establish the correct diagnosis, to treat pain or sepsis, and to provide time for other treatments to control the underlying disease. When diversion is being considered solely for the purpose of treating uremia and the tumor has proved to be refractory to all known effective forms of treatment, the decision about whether to perform a diversion must be based on the individual circumstances of the patient including the age, type of tumor, and social and economic considerations. Methods of internal diversion such as ureteral stents are preferred when feasible. Percutaneous nephrectomy may be useful when internal diversion cannot be accomplished or when it can be anticipated that the diversion will be only temporary. When permanent diversion is required, loop cutaneous ureterostomy using the better kidney or bilateral cutaneous ureterostomy is effective only when the ureters are dilated. Diversion into an ileal segment is necessary when the ureters are of normal caliber.

Protection against sudden coronary occlusion by induced mild chronic volume hypertrophy in dogs.

A model of mild chronic volume hypertrophy in the dog has been described which consists of establishing a small arteriovenous (A-V) shunt. The model was utilized to evaluate the protection afforded by mild chronic volume hypertrophy against sudden coronary occlusion. Eight animals were studied, 4 with a single shunt (mean estimated 25% increase in cardiac output) and 4 with a double shunt (mean estimated 57% increase in cardiac output). The A-V shunt resulted in the expected volume hypertrophy by roentgenographic and cardiac weight criteria, but was small enough to produce no signs of exercise intolerance, cardiac failure, or definite electrocardiographic changes. After 6 months, the A-V fistulae were surgically closed and 2 weeks later, under normal hemodynamic conditions, the heart was challenged by sudden, permanent ligation of the left circumflex coronary artery at its origin. The time from ligation to death was measured and compared with 10 control animals without such fistulae. Death occurred in 2 to 13 min in the control animals; in contrast, 5 of the 8 animals with mild chronic volume hypertrophy survived longer than any control animal, and 2 were long-term survivors. The actuarial estimate of the difference in survival was significant (p=0.007) and indicated that the fistulae reduced the hazard of coronary ligation by a factor of 6. A single small shunt afforded protection similar to a double one. Therefore, mild chronic volume hypertrophy induced by a small A-V fistula in the normal dog protects against sudden coronary occlusion. We speculate that the procedure may have a role in the multifactorial prophylactic management of coronary artery disease in asymptomatic high risk subjects, instead of an inapplicable exercise program.

Embryonal rhabdomyosarcoma of the genitourinary organs.

We report on 14 patients with embryonal rhabdomyosarcoma of the genitourinary organs treated with combined modality therapy. Six patients with paratesticular lesions are free of tumor 7 to 72 months (mean 44) after diagnosis, while 6 of 8 with pelvic lesions are free of tumor 18 to 132 months (mean 61) following diagnosis. Two patients died of metastases. Over-all, 2-year survival free of relapse was obtained in 9 of 11 patients (81 per cent). Of 4 patients with pelvic lesions who were treated with primary radiation-chemotherapy without exenteration 3 were managed successfully but 1 required urinary diversion for vesical fibrosis. Current concepts in the management of embryonal rhabdomyosarcoma are discussed.

Unreliability of sentinel lymph node biopsy for staging penile carcinoma.

We present a patient in whom unresectable lymph node metastases developed within 6 months of negative bilateral sentinel lymph node biopsies. The management of regional lymph nodes of patients with carcinoma of the penis is discussed.

Percutaneous nephrostomy: indications, complications and clinical usefulness.

Our experience with percutaneous nephrostomy in 22 patients is presented. This procedure can be accomplished readily and is safe, reliable and effective for short and long-term urinary diversion in various urologic conditions in children and adults.