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1/10. Polyarthritis as a complication of intravesical bacillus Calmette-Guerin immunotherapy for bladder cancer.

    bacillus Calmette-Guerin (BCG) is the most effective agent currently available for the treatment of superficial bladder cancer. However, this form of treatment is associated with some complications, including arthritis. In this report, we present a 69-year-old woman who developed inflammatory polyarthritis following BCG treatment for superficial bladder cancer. The arthritis resolved following treatment with a non-steroidal anti-inflammatory drug and chloroquinine.
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2/10. The dangerous ureter.

    Seven patients with recurring transitional cell carcinoma of the urinary bladder were treated with repeated transurethral resections of these tumors and were given adjuvant intravesical chemotherapy or bacillus-Calmette Guerin (BCG) vaccine. Carcinoma either in the ureters or renal pelves subsequently developed in these patients. Unfortunately, 2 patients had inoperable tumors when the diagnosis was confirmed. When treating patients with recurring carcinoma of the urinary bladder, the possibility of upper urinary tract tumors developing must always be considered. Hence, the necessity of frequent urinary and ureteral cytology examinations proceeding to excretory urography, retrograde pyelograms, computerized tomography (CT) scans of the upper tracts, or ureteroscopy as may be necessary to locate small tumors or to diagnose carcinoma in situ.
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keywords = bacillus
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3/10. Transient anuria requiring nephrostomy after intravesical bacillus Calmette-Guerin instillations for superficial bladder cancer.

    A 76-year-old man received intravesical bacillus Calmette-Guerin (BCG) instillations for recurrent superficial bladder cancer. He had undergone right nephroureterectomy for right renal pelvic cancer 9 months previously. He presented with anuria and left hydronephrosis after the fourth instillation, with serum creatinine increasing up to 15.7 mg/dL. Percutaneous nephrostomy was indwelled, and antegrade pyelography showed left vesicoureteral obstruction. There was no sign of recurrent bladder cancer or ureteral cancer. He started spontaneous voiding on day 4 and the nephrostomy was removed on day 8. Most of the side-effects of intravesical BCG therapy are minor, and major adverse reactions are rare. life-threatening ureteral obstruction would be a rare complication of BCG immunotherapy. Although BCG intravesical instillation after nephroureterectomy is a common practice, special care should be taken of renal function in patients with unilateral kidney during BCG therapy.
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ranking = 1.25
keywords = bacillus
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4/10. Management of panurothelial disease in superficial bladder cancer.

    BACKGROUND: A 59-year-old female presented with a history of recurrent superficial bladder cancer. Since the initial diagnosis 12 years earlier, she had had 12 recurrences, all treated with transurethral resection with adjuvant bacillus Calmette-Guerin and mitomycin C. pathology samples had always shown Ta grade 1 transitional-cell carcinoma. At the last recurrence, she presented with several papillary lesions throughout the bladder, discovered on control cystoscopy. Transurethral resection revealed a papillary grade 3 transitional-cell carcinoma of the bladder. INVESTIGATIONS: Intravenous urography and ureteroscopy. diagnosis: Panurothelial superficial transitional-cell carcinoma. MANAGEMENT: Radical cystectomy with total right ureterectomy and distal left ureterectomy. Reconstruction of the urinary tract was performed with the distal ileum detubulized and rearranged in a U shape. A pyeloileal anastomosis and a proximal ureteroileal anastomosis were performed at the right and left sides respectively.
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keywords = bacillus
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5/10. Instillation of bacillus Calmette-Guerin into the renal pelvis of a solitary kidney for the treatment of transitional cell carcinoma.

    Intravesical bacillus Calmette-Guerin is effective in the treatment and prophylaxis of superficial urothelial cancer of the bladder. There have been few reports of its efficacy and toxicity when instilled into the upper urinary tract. We elected to use intracavitary bacillus Calmette-Guerin in a patient with recurrent high grade transitional cell carcinoma in the renal pelvis of a solitary autotransplanted kidney. The patient required hospitalization and triple-drug therapy after 5 instillations. She was free of tumor 1 year after bacillus Calmette-Guerin instillations.
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ranking = 1.75
keywords = bacillus
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6/10. Intralesional immune therapy: methanol extraction residue of BCG or purified protein derivative.

    6 patients with cutaneous malignant melanoma and multiple secondary cutaneous lesions were treated with intralesional methanol extraction residue of bacillus Calmette Guerin (MER-BCG). Separate lesions were injected with purified protein derivatives (PPD) in 5 of the study patients. 5 of the 6 MER-BCG injection lesions developed marked inflammation clinically. Excisional biopsy 7-14 days later demonstrated complete dissolution of tumor in 2 patients and was accompanied by infiltration with acute and chronic inflammatory cells; 3 lesions revealed necrosis with residual tumor, and in 1 patient there was no apparent host response. Clinical tumor regression was not observed with PPD applied intralesionally, although histopathologic analysis revealed a granulomatous inflammatory response in 3 of 5 patients. No patient demonstrated regression of uninjected cutaneous lesions (4 evaluable patients) or visceral lesions (2 patients). The critical determinants of tumor regression are the size, site and depth of the lesion in relationship to the cutaneous surface. The mechanism of tumor eradication may be related to 'innocent bystander' necrosis secondary to nonspecific inflammation rather than immunologically mediated via host sensitization.
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7/10. Bladder cancer immunotherapy.

    A randomized controlled prospective evaluation of intravesical and percutaneous bacillus Calmette-Guerin immunotherapy was done in 57 patients with transitional cell carcinoma of the bladder. In addition, 9 patients at high risk for tumor recurrence were treated with bacillus Calmette-Guerin produced a self-limited cystitis and 1 complication (hydronephrosis) of immunotherapy was observed. Of the 57 randomized patients 54 were followed for 3 to 30 months. Tumor recurrence was documented in 13 of 26 controls (50 per cent) and only 6 of 28 patients (21 per cent) treated with bacillus Calmette-Guerin (p equals 0.027, chi-square). The interval free of disease was prolonged significantly with bacillus Calmette-Guerin treatment (p equals 0.014, generalized Wilcoxon test). Importantly, a simple purified protein derivative skin test distinguished those patients who responded to bacillus Calmette-Guerin immunotherapy from those who did not. Only 1 of 17 treated patients (6 per cent) whose purified protein derivative test converted from negative to positive had tumor recurrence compared to 5 recurrences (38 per cent) among the 13 patients whose test remained negative or had been positive before treatment (p equals 0.022, chi-square). bacillus Calmette-Guerin was given to 10 patients with stage B transitional cell carcinoma who were not candidates for cystectomy and 7 are free of disease. Of 5 patients with carcinoma in situ 3 remain free of tumor after bacillus Calmette-Guerin treatment and 5 of 6 who had multiple recurrences after intravesical chemotherapy responded favorably to bacillus Calmette-Guerin immunotherapy.
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ranking = 1.75
keywords = bacillus
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8/10. bacillus Calmette-Guerin immunotherapy of superficial bladder cancer.

    Thirty-seven patients were enrolled in a randomized prospective study to compare standard surgical therapy for superficial bladder cancer to standard therapy plus bacillus Calmette-Guerin (BCG). Side effects of BCG have been tolerated well and include dysuria in 95 per cent of the patients, urinary frequency in 83 per cent, hematuria in 39 per cent, fever in 22 per cent and nausea in 22 per cent. Of 19 control patients 8 (42 per cent) had recurrent tumors in the followup period, compared to 3 of 18 patients (17 per cent) treated with BCG. One patient treated wih BCG had 2 recurrences, yielding a recurrence rate of 22 per cent in the group receiving BCG compared to 42 per cent in controls. When the incidence of recurrent tumors in matched intervals before and after entry into the protocol is compared, no change in the rate of tumor recurrence (p equals 0.726 chi-square) occurred in controls, whereas tumor recurrences were reduced significantly in the group treated with BCG (p equals 0.010 chi-square). The reduction in tumor recurrence in patients treated with BCG compared to controls is statistically significant (p equals 0.029 chi-square). Of 4 patients who presented with new bladder tumors remain free of tumor after BCG therapy, while 2 of 5 comparable control patients developed recurrent tumors. Intravesical and percutaneous BCG immunotherapy appears to decrease the rate of tumor recurrence in patients followed for 1 year.
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keywords = bacillus
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9/10. Treatment of invasive or metastatic thymoma: report of eleven cases.

    The clinical presentation and therapeutic modalities of 11 patients with invasive or metastatic thymoma are presented. Two patients had myasthenia gravis, and five had extrathoracic metastases. survival exceeded five years in five patients, and four patients remain free of recurrence between 2.1 and 9.0 years after diagnosis. Surgery, with an attempt at complete resection, is the first step of therapy. A second thoracotomy for local relapse or attempt at curative resection was carried out in four patients. radiotherapy to the mediastinum and/or metastatic sites was given to ten patients with doses ranging from 3600-6000 rads (median = 4500 rads) in the nine nonmyasthenic patients. Inclusion of supraclavicular fossae in the radiotherapy field is recommended because it was a site of relapse in two patients. Systemic therapies were given to eight patients. Objective responses were seen with two of various chemotherapeutic regimens. A combination of bleomycin, Adriamycin, cisplatin, and prednisone ("BAPP") produced a partial remission in two of five patients, during 12 and 4 months, respectively. Two of three patients responded to maytansine as a single agent after failure of other agents. immunotherapy with intravenous corynebacterium parvum or intradermal methanol-Extraction Residue of bacillus Calmette-Guerin (MER-BCG) was ineffective in one patient each. The importance of combined modalities in the management of the disease is emphasized.
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ranking = 0.25
keywords = bacillus
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10/10. tuberculosis of the nasopharynx following radiotherapy.

    We report the case history of a patient who was treated with radiotherapy for nasopharyngeal carcinoma. During follow-up, she showed signs, symptoms and radiological evidence of disease recurrence and progression. However, repeated biopsies of the posterior nasal space (PNS) failed to demonstrate malignancy. A diagnosis of nasopharyngeal tuberculosis was finally made when tissue from a PNS biopsy stained positive for acid-fast bacillus. The patient responded to antituberculous chemotherapy.
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ranking = 0.25
keywords = bacillus
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