RESUMEN
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.
RESUMEN
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.
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Traumatismos Abdominales/complicaciones , Aneurisma de la Aorta Abdominal/etiología , Contusiones/complicaciones , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Preescolar , Femenino , Humanos , Politetrafluoroetileno , Factores de TiempoRESUMEN
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.
Asunto(s)
Neumonía por Mycoplasma/complicaciones , Priapismo/etiología , Niño , Humanos , Masculino , Pene/irrigación sanguínea , Priapismo/patología , Trombofilia/complicaciones , Trombofilia/etiologíaRESUMEN
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.
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Extrofia de la Vejiga/complicaciones , Uretra/anomalías , Adulto , Preescolar , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
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.
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Virus de la Enfermedad Equina Africana/inmunología , Enfermedad Equina Africana/inmunología , Anticuerpos Antivirales/sangre , Ensayo de Inmunoadsorción Enzimática/veterinaria , Vacunas Virales/inmunología , Enfermedad Equina Africana/diagnóstico , Enfermedad Equina Africana/prevención & control , Animales , Antígenos Virales/inmunología , Caballos , Pruebas de Neutralización/veterinaria , Proteínas Recombinantes/inmunología , Vacunación/veterinaria , Vacunas de Productos Inactivados/inmunología , Proteínas no Estructurales Virales/inmunologíaRESUMEN
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.
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Virus de la Enfermedad Equina Africana/fisiología , Enfermedad Equina Africana/inmunología , Equidae , Enfermedad Equina Africana/epidemiología , Enfermedad Equina Africana/virología , Virus de la Enfermedad Equina Africana/inmunología , Virus de la Enfermedad Equina Africana/aislamiento & purificación , Animales , Anticuerpos Antivirales/sangre , Línea Celular , Chlorocebus aethiops , Femenino , Técnica del Anticuerpo Fluorescente Directa/veterinaria , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Terapia de Inmunosupresión/veterinaria , Recuento de Leucocitos/veterinaria , Leucocitos Mononucleares/inmunología , Masculino , Marruecos/epidemiología , Pruebas de Neutralización/veterinaria , Reacción en Cadena de la Polimerasa/veterinaria , ARN Viral/sangre , Células Vero , Viremia/inmunología , Viremia/veterinaria , Viremia/virologíaRESUMEN
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.
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Virus de la Enfermedad Equina Africana/inmunología , Enfermedad Equina Africana/inmunología , Anticuerpos Antivirales/sangre , Western Blotting/veterinaria , Proteínas Virales/inmunología , Vacunas Virales/inmunología , Animales , Chlorocebus aethiops , Caballos , Vacunación/veterinaria , Vacunas Atenuadas/inmunología , Vacunas de Productos Inactivados/inmunología , Células VeroAsunto(s)
Cifosis/genética , Osteocondrodisplasias/genética , Escoliosis/genética , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/genética , Consanguinidad , Humanos , Lactante , Cifosis/diagnóstico , Masculino , Osteocondrodisplasias/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/genética , Escoliosis/diagnóstico , SíndromeRESUMEN
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.
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Ascariasis/complicaciones , Enfermedades del Íleon/etiología , Parasitosis Intestinales/complicaciones , Obstrucción Intestinal/etiología , Perforación Intestinal/etiología , Animales , Ascariasis/diagnóstico por imagen , Ascariasis/parasitología , Ascariasis/cirugía , Ascaris lumbricoides/aislamiento & purificación , Preescolar , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Parasitosis Intestinales/diagnóstico por imagen , Parasitosis Intestinales/parasitología , Parasitosis Intestinales/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Masculino , Marruecos , RadiografíaRESUMEN
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.
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Enfermedades de los Bovinos/epidemiología , Infecciones por Mycoplasma/veterinaria , Animales , Bovinos , Enfermedades de los Bovinos/microbiología , Femenino , Marruecos , Infecciones por Mycoplasma/epidemiologíaRESUMEN
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.
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Prolapso Rectal/etiología , Adolescente , Niño , Preescolar , Terapia Combinada , Estreñimiento/complicaciones , Diarrea/complicaciones , Femenino , Humanos , Parasitosis Intestinales/complicaciones , Masculino , Prolapso Rectal/terapia , Soluciones Esclerosantes/uso terapéuticoRESUMEN
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.
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Enfermedades de los Bovinos/epidemiología , Diarrea/veterinaria , Infecciones por Escherichia coli/veterinaria , Infecciones por Rotavirus/veterinaria , Enfermedades de las Ovejas/epidemiología , Animales , Animales Recién Nacidos , Bovinos , Enfermedades de los Bovinos/microbiología , Diarrea/epidemiología , Diarrea/microbiología , Infecciones por Escherichia coli/epidemiología , Marruecos , Infecciones por Rotavirus/epidemiología , Ovinos , Enfermedades de las Ovejas/microbiologíaRESUMEN
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.
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Cifosis/terapia , Tuberculosis de la Columna Vertebral/terapia , Adolescente , Antituberculosos/uso terapéutico , Moldes Quirúrgicos , Niño , Preescolar , Terapia Combinada , Femenino , Humanos , Lactante , Cifosis/etiología , Masculino , Radiografía , Fusión Vertebral/métodos , Tracción , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/diagnóstico por imagenRESUMEN
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.
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Pelvis Renal/anomalías , Uréter/anomalías , Reflujo Vesicoureteral/etiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Pelvis Renal/diagnóstico por imagen , Masculino , Radiografía , Uréter/diagnóstico por imagen , Uréter/cirugía , Derivación Urinaria/métodos , Reflujo Vesicoureteral/diagnóstico por imagen , Reflujo Vesicoureteral/cirugíaRESUMEN
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.
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Quemaduras Químicas/terapia , Estenosis Esofágica/prevención & control , Esófago/lesiones , Intubación , Quemaduras Químicas/complicaciones , Quemaduras Químicas/patología , Preescolar , Estenosis Esofágica/etiología , Esófago/patología , Humanos , Lactante , Masculino , Factores de TiempoRESUMEN
Brucellosis was diagnosed in a closed herd of approximately 200 Fresian cattle in February 1982. Diagnosis was based on positive serologic tests and abortions from which B. abortus was isolated. Initial efforts to control the disease were the isolation of all cows which were positive on the standard tube agglutination test. In addition all cows which calved or aborted were isolated. In August 1982 all cows which were negative to the standard tube agglutination test were vaccinated with a reduced dose of strain 19 vaccine (approximately 1 X 10(9) organisms). The herd was retested 60 days after vaccination and all animals which were positive on the rivanol supplemental test at a titer of 1:50 or greater were considered infected and removed from the herd. Subsequent to vaccination there were an additional 22 cows which aborted. These cows were removed from the herd. A calfhood vaccination programme utilizing the standard dose of strain 19 has been initiated in the herd. An increased effort was made to maintain all of the stables at a higher level of sanitation.