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1/12. Miliary mycobacterium bovis induced by intravesical bacille Calmette-Guerin immunotherapy.

    Intravesical instillation of bacille Calmette-Guerin (BCG), an attenuated strain of mycobacterium bovis, is the treatment of choice for many patients with bladder cancer. In a small percentage, this therapy is associated with systemic side effects including pneumonitis. It is uncertain whether these systemic manifestations are due to dissemination of infection or due to hypersensitivity, an etiologic distinction that has important therapeutic implications. We report the first case in which miliary M. bovis was proven to be the responsible mechanism, by culture of M. bovis biovar BCG from a transbronchial lung biopsy and complete resolution on anti-tuberculous chemotherapy.
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2/12. Mycotic aneurysm of the popliteal artery as a complication of intravesical BCG therapy for superficial bladder cancer. Case report and literature review.

    A 67-year-old man was treated with maintenance intravesical BCG for superficial bladder cancer. As a culture-proven complication of this therapy, he developed general malaise, high fever, granulomatous hepatitis and a mycotic aneurysm in his left knee. All complications were treated successfully with antituberculous therapy. No vascular surgery was necessary. This case report again stresses the necessity to recognise complications of BCG treatment and to start adequate therapy as soon as possible.
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3/12. trichosporon asahii fungemia in a patient with non-hematological malignancy.

    trichosporon fungemia is usually seen in neutropenic patients with underlying hematological malignancies. In this report we describe a fatal case of trichosporon asahii fungemia in a non-neutropenic patient with a non-hematological malignancy. For 1 week the patient exhibited hematuria, weakness, easy fatigability and headaches. At admission she had anemia, renal failure and evidence of right hydronephrosis and bladder wall masses as detected by CT scan. She did not have a history of tobacco abuse, contact with urinary carcinogens or schistosoma infestation; her clinical picture was suggestive of bladder cancer. After some investigations the patient underwent radical cystectomy and ileal conduit surgery because of transitional cell carcinoma in the urinary bladder. After an initial uneventful improvement postoperatively the patient deteriorated and died of septic shock despite all reanimation efforts and antibiotherapy including fluconazole. The blood culture obtained 4 days before the patient died revealed T. asahii, which was isolated on the day she died and found to be resistant to fluconazole and caspofungin. This report suggests that clinicians remain aware that T. asahii fungemia may develop in clinically deteriorated patients even if they do not have a hematological malignancy.
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4/12. Successful culturing of infectious, oncogenic adenovirus from the stimulated lymphocytes of a patient with bladder tumour.

    During their attempts at culturing viruses from tumour cells and circulating lymphocytes, authors obtained oncogenic type 18 infectious adenovirus from the phytohaemagglutinin-stimulated, peripheral T lymphocytes of a patient with bladder tumour. They found that the lymphocytes of other patients with urogenital tumour often show sensibility to the viral antigens. The successful culturing of the virus proves that patients with urogenital tumour carry the functioning genomes of the ontogenic virus, not only in their tumour cells but also in their circulating lymphocytes. It is assumed that these genomes jointly with the immune system impaired by other DNS viruses might have a role in tumour development. It is known that the tumour cells and circulating lymphocytes of patients with malignant urogenital tumour may carry viral components, latent viruses. However, infectious virus--in the mentioned cases--could not be isolated. In the present study attempt was made to culture infectious virus from the tumour cells and the in vitro stimulated circulating T lymphocytes of patients with urogenital tumour.
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5/12. centromere splitting in bladder cancer.

    Cytogenetic studies on a bladder carcinoma, carried out using short time cultures, showed centromere splitting (CS) mainly affecting chromosomes 22, 13, 14, 21, 15, 20, 12, 7, 17, and 18. Clonal trisomies and monosomies were also detected. Our case is the first description of CS in bladder tumor cells. Our results suggest that CS is an early phenomenon in the karyotypic evolution of this case; it can be considered a primary, yet unspecific, chromosome change related to aneuploidy in bladder cancer.
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6/12. Establishment and characterization of a new cell line from human bladder cancer (JMSU1).

    A new human bladder cancer cell line designated JMSU1 has been established from malignant ascitic fluid of a 75-year-old Japanese man with bladder cancer, and maintained in culture for more than 7 years and over 240 passages. Inverted phase-contrast microscopy revealed that JMSU1 was composed of morphologically distinct cells (polygonal to spindle-shaped cells), showing morphological heterogeneity in vitro. Histological examination of xenografts showed poorly differentiated transitional cell carcinoma, resembling the original tumor. Immunohistochemical staining for cytokeratin and electron microscopic examination suggested that JMSU1 was of epithelial origin. Chromosome analysis gave a modal number of 69 with no y chromosome. Isozyme analysis (LDH, G6PD, and NP) showed the mobility pattern of human type B. dna fingerprint analysis demonstrated that there was no cross-culture contamination of JMSU1 during the passages. In conclusion, a newly established and well-characterized cell line, JMSU1, offers promising material for the investigation of the biological properties of bladder cancer.
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7/12. The persistence of bacille Calmette-Guerin in the bladder after intravesical treatment for bladder cancer.

    OBJECTIVE: To determine the incidence of bacille Calmette-Guerin (BCG) bacilli persisting in the urinary tract of patients treated previously with intravesical BCG for carcinoma in situ or multiple Ta.T1 transitional cell carcinoma. patients AND methods: One-hundred and twenty-five patients were treated at the Freeman Hospital, Newcastle upon Tyne, UK over an 8-year period, 90 of whom submitted early morning urine samples for culture for acid-fast bacilli at varying intervals following BCG treatment. The records of all patients were reviewed to determine the incidence of caseating granulomata containing acid-fast bacilli together with the incidence of toxicity and the outcome of treatment. RESULTS: Five patients were found to have persisting acid-fast mycobacteria in their urine or bladder up to 16.5 months after completing intravesical instillations of BCG. In one patient this probably accounted for bladder symptoms that required palliative cystectomy. In four patients the 'infection' was not severe. Two patients were treated with antituberculous chemotherapy without complication. Three years after intravesical BCG therapy 36 of 69 patients (52%) had remained tumour free. CONCLUSION: BCG organisms can persist in the urinary tract for at least 16.5 months after the completion of intravesical BCG instillation therapy.
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8/12. Molecular confirmation of bacillus Calmette-Guerin as the cause of pulmonary infection following urinary tract instillation.

    Instillation into the urinary tract of the bacillus Calmette-Guerin (BCG), a strain of mycobacterium bovis, is associated only rarely with severe side effects. We report here two cases of culture-proven pulmonary infection due to therapy with BCG. The first patient, who was seropositive for the human immunodeficiency virus, developed bilateral interstitial pneumonitis after instillation of BCG into the bladder. The second patient developed a right-lower-lobe infiltrate and empyema after instillation of BCG into the right renal pelvis. The clinical isolates from these two patients and from a third patient with a psoas abscess following intravesical instillation were analyzed with use of pulsed field gel electrophoresis (PFGE) to resolve chromosomal restriction fragment polymorphisms. The clinical isolates were confirmed to be BCG by comparison with known vaccine strains that differed from M. bovis isolates. We conclude that the potential for subsequent dissemination be considered prior to the intravesical administration of BCG. Analysis with PFGE may be useful for identifying species of the mycobacterium tuberculosis complex.
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9/12. Disseminated infection after intravesical BCG immunotherapy. Detection of organisms in pulmonary tissue.

    A 57-year-old man undergoing intravesical immunotherapy with BCG for transitional cell bladder carcinoma presented with dyspnea, fever, hypoxemia, and a diffuse micronodular pattern on chest radiograph. Transbronchial biopsy specimen revealed widespread noncaseating granulomas, and acid-fast bacilli were identified in sputum as well as in the biopsy tissue. The patient's condition responded promptly to antituberculous antibiotics given in conjunction with corticosteroids. Although no growth was evident on TB culture of the specimens, the presence of organisms indicates a probable infectious cause of the pulmonary disease process.
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10/12. psoas abscess following intravesical bacillus Calmette-Guerin for bladder cancer: a case report.

    An 87-year-old man with an abdominal aortic aneurysm received intravesical bacillus Calmette-Guerin therapy for transitional cell carcinoma of the bladder. He presented 9 months later with a psoas abscess that mimicked a contained retroperitoneal abdominal aortic aneurysm rupture. The abscess cultures yielded mycobacterium bovis. Recent transurethral resection and high voiding pressures after instillations of bacillus Calmette-Guerin may have led to distant dissemination of the drug.
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