Adjuvant treatment with a vitamin A analogue (etretinate) after transurethral resection of superficial bladder tumors. Final analysis of a prospective, randomized multicenter trial in Switzerland.

Vitamin A and its derivatives, the retinoids, have antiproliferative effects and may induce cellular differentiation. Etretinate, a synthetic retinoid, has a more favorable therapeutic index experimentally than all-trans-retinoic acid or 13-cis-retinoic acid. Ninety patients with superficial papillary bladder tumors stages Ta and T1 entered a prospective randomized double-blind multicenter trial in Switzerland. Seventy-nine of the patients were eligible and received either 25 mg of etretinate or a placebo orally each day. The early withdrawal of a significantly greater number of patients in the placebo group for treatment failure during the first year of the study resulted in a secondary positive selection in this group. High-risk patients were removed and low-risk patients remained. In those patients who had tumor recurrences after randomization, the time to first recurrence was similar in both groups with 13.5 and 13.6 months in the placebo and etretinate groups, respectively. However, the mean interval to subsequent tumor recurrence was significantly longer in the etretinate group. The mean interval between recurrences in these subgroups was 12.7 months in the placebo arm and 20.3 months in the etretinate arm (p = 0.006). Consequently, the number of transurethral resections per patient-year was also reduced significantly in the etretinate group (p < 0.001). In patients with more than one transurethral resection of papillary tumors before randomization, the annual transurethral resection rate in the two treatment groups dropped from 1.7 to 1.3 in the 30 patients in the placebo group (NS, p = 0.1) and from 2.1 to 0.95 in the 25 patients in the etretinate group (p < 0.001). The side effects of etretinate (cheilitis, dryness of mucous membranes and skin) were acceptable to most patients. The relationship of the 3 myocardial infarcts observed in the etretinate group to the retinoid is not clear. Despite their significant effect on the recurrence rate of superficial papillary bladder tumors, retinoids should only be used in well-controlled prospective trials until more is known about their dosage-toxicity profiles.

Double-blind report on the efficacy of lactic acid-producing Enterococcus SF68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea.

A multicentre double-blind, placebo-controlled clinical trial, involving 123 patients at 10 centres, was carried out to assess the efficacy of a preparation of lactic acid-producing Enterococcus SF 68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea. In the prevention study, 45 patients being treated with antibiotics were given, concurrently, one capsule twice daily of either Enterococcus SF68 or placebo. Acute diarrhoea was present in 78 patients who were given the same treatment but three times daily. All treatments were continued for 7 days. Enterococcus SF 68 was shown to be effective in reducing the incidence of antibiotic-associated diarrhoea in comparison with placebo (8.7% compared with 27.2%, respectively). Patients with acute enteritis showed a significantly faster resolution of bowel abnormalities during treatment with Enterococcus SF68 compared with placebo.

Prevention of recurrent superficial bladder tumors by oral etretinate: preliminary results of a randomized, double blind multicenter trial in Switzerland.

Retinoids influence the proliferation and differentiation of epithelial tissues. Preliminary results of a double-blind randomized trial in the prevention of recurrent superficial bladder tumors are promising. Patients treated with an oral etretinate tend to have less tumor recurrences and transurethral resections. The number of multifocal recurrences after 12 months of treatment is significantly lower (p less than 0.02). There also are less dropouts owing to inefficacy of treatment (p less than 0.036).

[The Laferma reflux family, a case of multiple familial reflux]. / Reflux-Familie "Laferma", ein Fall von gehäuften familiärem Reflux.

We substantiate that five of total seven examined members of a family including the mother showed a reflux disease. Two of them had a monolateral, three a bilateral, two a vesicoureteral and three a vesicorenal reflux. Three of the examined members suffered from enuresis nocturna. All of the reflux-positive members of the family endoscopically showed gaping ostia of the ureter at the reflux-positive side. We found no criteria for an intravesical obstruction. All reflux-positive members showed a low-pressure reflux. Interestingly, only the female members exhibited a reflux. We don't know whether this case of an increased incidence of reflux disease within one family will represent a known hereditary pattern.