Antegrade perfusion with bacillus Calmette-Guérin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: who may benefit?

There is paucity of data on bacillus Calmette-Guérin (BCG) perfusion in patients with non-muscle-invasive urothelial carcinoma (NMIUC) of the upper urinary tract (UUT).

The prognostic value of cytology and fluorescence in situ hybridization in the follow-up of nonmuscle-invasive bladder cancer after intravesical Bacillus Calmette-Guérin therapy

Molecular markers reliably predicting failure or success of Bacillus Calmette-Guérin (BCG) in the treatment of nonmuscle-invasive urothelial bladder cancer (NMIBC) are lacking. The aim of our study was to evaluate the value of cytology and chromosomal aberrations detected by fluorescence in situ hybridization (FISH) in predicting failure to BCG therapy. Sixty-eight patients with NMIBC were prospectively recruited. Bladder washings collected before and after BCG instillation were analyzed by conventional cytology and by multitarget FISH assay (UroVysion, Abbott/Vysis, Des Plaines, IL) for aberrations of chromosomes 3, 7, 17 and 9p21. Persistent and recurrent bladder cancers were defined as positive events during follow-up. Twenty-six of 68 (38%) NMIBC failed to BCG. Both positive post-BCG cytology and positive post-BCG FISH were significantly associated with failure of BCG (hazard ratio (HR)= 5.1 and HR= 5.6, respectively; p < 0.001 each) when compared to those with negative results. In the subgroup of nondefinitive cytology (all except those with unequivocally positive cytology), FISH was superior to cytology as a marker of relapse (HR= 6.2 and 1.4, respectively). Cytology and FISH in post-BCG bladder washings are highly interrelated and a positive result predicts failure to BCG therapy in patients with NMIBC equally well. FISH is most useful in the diagnostically less certain cytology categories but does not provide additional information in clearly malignant cytology.

Bacillus Calmette-Guérin Failure in Patients with Non-Muscle-invasive Urothelial Carcinoma of the Bladder May Be Due to the Urologist's Failure to Detect Urothelial Carcinoma of the Upper Urinary Tract and Urethra

BACKGROUND: Various reasons exist for so-called bacillus Calmette-Guérin (BCG) failure in patients with non-muscle-invasive urothelial bladder carcinoma (NMIBC). OBJECTIVE: To explore whether urothelial carcinoma of the upper urinary tract (UUT) and/or prostatic urethra may be a cause for BCG failure. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 110 patients with high-risk NMIBC repeatedly treated with intravesical BCG, diagnosed with disease recurrence, and followed for a median time of 9.1 yr. INTERVENTION: Two or more intravesical BCG induction courses without maintenance. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was pattern of disease recurrence (BCG failure) within the urinary tract categorised into UUT and/or urethral carcinoma (with or without intravesical recurrence), and intravesical recurrence alone. Secondary outcome was survival. Predictors of UUT and/or urethral carcinoma and the effect of pattern of disease recurrence on cancer-specific survival were assessed with multivariable Cox regression analysis adjusting for multiple clinical and tumour characteristics. RESULTS AND LIMITATIONS: Of the 110 patients, 57 (52%) had UUT and/or urethral carcinoma (with or without intravesical recurrence), and 53 (48%) had intravesical recurrence alone. In patients with UUT and/or urethral carcinoma, bladder carcinoma in situ (Tis) before the first and second BCG course was present in 42 of 57 (74%) and 47 of 57 (82%) patients, respectively. On multivariable analysis, bladder Tis before the first and/or second BCG course was the only independent predictor of UUT and/or urethral carcinoma. Of the 110 patients, 69 (63%) were alive at last follow-up visit, 18 (16%) had died due to metastatic urothelial carcinoma, and 23 (21%) had died of other causes. Pattern of disease recurrence within the urinary tract was not an independent predictor of cancer-specific survival. Main study limitations were retrospective design and limited power for survival analysis. CONCLUSIONS: In our patients with high-risk NMIBC failing after two or more courses of intravesical BCG, UUT and/or urethral carcinoma was detected in >50% of the cases during follow-up. The vast majority of these patients had bladder Tis before the first and/or second BCG course. In patients experiencing the so-called BCG failure, a diagnostic work-up of UUT and prostatic urethra should always be performed to exclude urothelial carcinoma before additional intravesical therapy or even a radical cystectomy is considered.

Regierungs-Ausschreiben, wodurch der § 22. der Judenordnung vom 1ten Jan. 1749. so viel die Wechsel betrifft, erläutert, weniger nicht den Juden auf dem Lande das Hausiren in den Dörfern erlaubt wird : Cassel den 24. Aug. 1751

Fürstl. Hessische Regierung daselbsten

[Zusätze z. Judenordnung v. Jahre 1749] : ... obwohl i. d. Landtags-Abschiede vom Jahre 1731 u. ... 1739 u. 1749 ... Juden-Ordnungen gegen die zum größten Nachtheil Unserer anderen Unterthanen... ; ... Cassell den 7.ten April 1772, Friedrich L. z. Hessen

Sammelband: enthält 22 Hanauische Juden-Ordnungen; Exlibris von Gottlieb Schnapper-Arndt

[Erläuterung der Judenordnung v. Jahre 1749]

... Wir, Friedrich, Landgraf zu Hessen, Fürst zu Herßfeld ... Cassell den 25ten Junii 1779

Regierungs-Rescript, daß das in der Judenordnung vom 21ten Jan. 1749, § 1 enthaltene Verbott, wegen des Gewerbes der ausländischen Juden ausser den Jahrmärkten, keineswegs vom Einkauf zu verstehen

Unsern gnädigen und günstigen Gruß zuvor, Ehrsame, gute Gönner ... Cassel den 19ten Juli 1779

[Rescripte Wechsel, Darlehen u. Handel betr.] : Nachem des regirenden Herrn Landgrafen Hochfürstl. Durchlaucht ... Hessen-Kasselische Judenordnung vom 21. Jänner 1749 ... ältere und neuere, in den übrigen Hess. Staaten emanirte ... auch in der Grafschaft Hanau ...

gegeben Hanau den 12. SAept. 1796 aus Fürstl. Hessischer Regierung daselbst

[Zusätze u. Verbesserungen z. Judenordnung v. Jahre 1749 ... welche Contracte zu den wucherlichen gehören ...]

Wilhelm der Neunte, Landgraf zu Hessen ... so geschehen Wilhelmshöhe den 20ten August 1800