Evaluation of microsatellite analysis in urine sediment for diagnosis of bladder cancer.

Alterations at microsatellite DNA markers in cells exfoliated in urine have been correlated to the presence of bladder cancer. To check the feasibility of such noninvasive analysis to routinely diagnose bladder cancers, we have developed a highly sensitive method using fluorescent PCR to search for DNA microsatellite alterations in urine sediment compared with a blood paired sample. One hundred eighty-three patients were included in our study. This population comprised 103 bladder cancers (64 pTa stages), the complement representing controls and other benign or malignant diseases. Results of the analysis at 17 loci in a blinded study were compared with cystoscopy and/or pathology. The high reproducibility of this technique and the analysis of 26 control patients allowed us to determine for each microsatellite a cutoff characterizing a significant allelic imbalance. For bladder cancer detection, the overall sensitivity of the test was 84%. Using this procedure, we identified alterations in 81%, 84%, 91%, and 100% of pTa, pT1, pT2, and >pT2 stages, respectively. This corresponds to 79%, 82%, and 96% sensitivity for grades I, II, and III, respectively. Interestingly, for routine purposes, we observed an overall sensitivity of 80% (76% for pTa stages) when only the eight most rearranged microsatellites were considered. In conclusion, the noninvasive feature combined with the rapidity of this fluorescent and highly sensitive technique for the detection of early stages provides us with a useful help for the diagnosis of bladder cancer.

[Evaluation of the delays in treatment of myocardial infarction. Results of a survey in Alsace]. / Evaluation des délais de prise en charge de l'infarctus du myocarde. Résultats d'une enquête en Alsace.

In order to assess the conditions of access to emergency care of acute myocardial infarction in Alsace, the authors carried out a survey in all hospitals and medical clinics in the region. All subjects admitted for acute myocardial infarction in the region between 3rd December 1995 and 3rd April 1996 were included. The study population comprised 405 persons. The onset of symptoms usually occurred at the patient's home (85% of cases). The first call was made to the general practitioner in 65% of cases. The emergency ambulance transported 40% of patients. The median time to hospital admission was 5 h 15 (average 21 h); the delay was greater in patients over 65 years of age (6 h 42 versus 3 h 51, p < 0.01). This mainly resulted from a delay in calling the doctor by the patients. Thirty nine per cent of patients underwent a myocardial revascularisation procedure (thrombolysis: 27%, direct coronary angioplasty: 12%). Therefore, ten years after a similar study, this survey shows that the delay to hospital admission has not improved and is still too long for effective emergency therapy to be given. In a region where ischaemic heart disease accounts for 10% of all deaths, a multidisciplinary approach is required to elaborate a regional policy for optimising the management of acute myocardial infarction.