The effect of isoniazid on BCG-induced toxicity in patients with superficial bladder cancer.

The use of bacillus Calmette-Guérin in the treatment of transitional cell cancer of the bladder has caused concern because of its associated adverse effects. We conducted a randomized prospective, double-blind, multicentre study to determine whether isoniazid prophylaxis could reduce BCG-induced toxicity without compromising its immunotherapeutic effects. Patients (n = 160) with histologically documented urothelial cancer (pTa-T1, pTis, G1-3) were treated with 6 weekly instillations of BCG Connaught strain, 81 mg, administered concomitantly with a 3-day course of isoniazid (300 mg o.d.) or placebo. Side-effects were recorded with each treatment and at follow-up. Of the patients treated with isoniazid, 19% remained free from side-effects, compared with 16% of the placebo group. Local side-effects confined to the bladder were significantly lower among those receiving isoniazid (35% vs. 48%, p < 0.01). Local side-effects together with systemic adverse effects such as fever, nausea or skin rash were experienced by 30% of patients in each arm. There were no differences in tumour recurrence between the two patient groups. Concomitant isoniazid reduces the local, but not the systemic side-effects of topically applied BCG without compromising the antitumour effect on superficial, transitional cell cancer of the bladder during a follow-up period that now exceeds 2 years.

Cytogenetic analysis of upper urinary tract transitional cell carcinomas.

Ten primary (nine regular and one post-radiation) upper urinary tract transitional cell carcinomas (TCC), i.e., tumors of the renal pelvis and ureter, were obtained from 10 patients following nephroureterectomy and processed for cytogenetic analysis after short-term culturing. Clonal chromosomal aberrations were found in eight tumors. While 10 karyotypically related and/or unrelated clones were detected in the post-radiation tumor, cytogenetic monoclonality was seen in all other tumors. With the exception of two tumors with loss of the Y chromosome as the only change, chromosome 9 was invariably involved, either with loss of the entire chromosome or with partial loss from the short arm. Our findings indicate that the karyotypic profile of upper urinary tract TCC is identical to that of bladder TCC, an indication that the same pathogenetic mechanisms are at work in both regions.

Long-term study of Crohn's disease.

Nineteen children and 160 adults with Crohn's disease were examined. The children had been under treatment between 1972 and 1974. There were 11 boys and 8 girls. Their main symptoms were general malaise, diarrhea, abdominal pains, anemia and weight loss. Clinical examination showed pallor, malnutrition, and abdominal tenderness on palpation. In 7 of 19 cases, rectosigmoidoscopy showed pathological changes. Radiologically, the most frequent site of the disease was observed to be in the ileocecal area. Since conservative therapy is associated with the risk of grave local and general complications, resection of the affected intestinal segment was the method of choice. Resection must be carried out through healthy tissues. Although the intestinal absorption of B12, fat and bile acids deteriorated after resection of the ileum, the general state of health of the patient improved. Body weight, serum albumin, serum iron concentration and the total iron binding capacity increased and the patient developed normally. Relapses occurred in 8 of the 19 cases. From the large number of adult patients who were studied, it could be shown that the risk of a relapse was greater in the ileal and ileocolic disease than in disease restricted to colon.