Untargeted Metabolomics Profiling Reveals Exercise Intensity-Dependent Alterations in Thoroughbred Racehorses' Plasma after Routine Conditioning Sessions

Thoroughbred (TB) racehorses undergo rigorous conditioning programs to optimize their physical and mental capabilities through varied exercise sessions. While conventional investigations focus on limited hematological and biochemical parameters, this field study employed untargeted metabolomics to comprehensively assess metabolic responses triggered by exercise sessions routinely used in TB conditioning. Blood samples were collected pre- and post-exercise from ten racehorses, divided into two groups based on exercise intensity: high intensity (n = 6, gallop at ± 13.38 m/s, 1400 m) and moderate intensity (n = 4, soft canter at ± 7.63 m/s, 2500 m). Intensity was evaluated through monitoring of the speed, heart rate, and lactatemia. Resting and 30 min post-exercise plasma samples were analyzed using ultraperformance liquid chromatography coupled with high-resolution mass spectrometry. Unsupervised principal component analysis revealed exercise-induced metabolome changes, with high-intensity exercise inducing greater alterations. Following high-intensity exercise, 54 metabolites related to amino acid, fatty acid, nucleic acid, and vitamin metabolism were altered versus 23 metabolites, primarily linked to fatty acid and amino acid metabolism, following moderate-intensity exercise. Metabolomics confirmed energy metabolism changes reported by traditional biochemistry studies and highlighted the involvement of lipid and amino acid metabolism during routine exercise and recovery, aspects that had previously been overlooked in TB racehorses.

Effect of a blend of magnesium oxide on Equine Squamous Gastric Disease in young trotter horses under training

BACKGROUND

Equine squamous gastric disease (ESGD), as part of the equine gastric ulcer syndrome (EGUS), are common in racing horses. The use of buffering feed supplements to treat and/or prevent gastric ulcers is an option to control this condition.

OBJECTIVE

The purpose of this study was to evaluate the effect of a 30-day supplementation with a blend of magnesium oxide (MgO) on ESGD scores in trotters under training.

METHODS

Forty-two young trotters were submitted to a gastroscopic evaluation to assess their ESGD score and were randomly assigned in a group supplemented with MgO or in a control group. After 30 days, a second evaluation by gastroscopy was performed. The effect of the MgO supplementation was assessed by comparing the evolution of the ESGD score in supplemented and control groups between day 0 and day 30.

RESULTS

The results confirm the high prevalence of EGUS in young Trotters. The supplementation significantly decreased the ESGD scoring in the supplemented group whereas the control group remain unchanged.

CONCLUSION

The oral MgO supplementation was efficient to control ESGD in the population studied.

Determination of muscle mitochondrial respiratory capacity in Standardbred racehorses as an aid to predicting exertional rhabdomyolysis

This prospective cohort study evaluated the potential of high-resolution respirometry applied to permeabilized muscle fibers for fitness evaluation in French Standardbred racehorses. Fitness evaluation by means of respirometric parameters did not correlate with racing performance registered over the following racing season. However, altered mitochondrial energy metabolism was associated with higher risk of developing exertional rhabdomyolysis, a common cause of exercise intolerance in racehorses. These data represent a first step towards establishing reference values for muscle OXPHOS capacity in this breed.

Cytokine concentrations in bronchoalveolar lavage fluid from horses with neutrophilic inflammatory airway disease

Background

Multiple cytological patterns occur in bronchoalveolar lavage fluid (BALF) of horses with inflammatory airway disease (IAD). Only few data on BALF cytokine profiles are available for horses with IAD, and are limited to mRNA expression.

Hypothesis/Objective

Cytological profiles of IAD are associated with different BALF immunological pathways. To investigate BALF cytokine concentrations in a large number of horses with neutrophilic IAD.

Animals

One hundred and thirty‐eight client‐owned Standardbred racehorses in active training.

Methods

Prospective observational study. BALF samples were obtained from left and right lungs. Interleukin (IL)‐4, interferon (IFN)‐γ, and tumor necrosis factor (TNF)‐α concentrations were determined by ELISA.

Results

Fourteen horses had normal BALF cytological profiles and 56 exhibited evidence of bilateral neutrophilic IAD. Twenty‐four horses showed BALF with, respectively, IAD‐ and CTL consistent cytology and were excluded; as were 44 horses because of evidence of pulmonary hemorrhage. TNF‐α (56 ± 115 pg/mL; P = .034) and IFN‐γ concentrations (104 ± 247 pg/mL; P = .044) were significantly higher for IAD horses, compared with controls (respectively 19 ± 41 and 80 ± 116 pg/mL). Horses with ‘neutrophil’ subtype had significantly higher IFN‐γ concentrations (110 ± 154 pg/mL), than ‘neutrophil/metachromatic’ (56 ± 54 pg/mL; P = .028) and ‘neutrophil/metachromatic/eosinophil’ subtypes (44 ± 23 pg/mL; P = .012).

Conclusions and Clinical Importance

Cytokine concentrations in BALF suggested that neutrophilic IAD is associated with activation of the innate immune system and a possible T‐helper (Th)‐1 polarized response. This study also suggested that immunological pathways vary according to cytological IAD subtypes.

Oral supplementation with superoxide dismutase in Standardbred trotters in training: a double-blind placebo-controlled study

REASONS FOR PERFORMING STUDY

Intense physical exercise produces an excess of reactive oxygen species which can disturb the antioxidant/oxidant balance of the horse in training. Several classes of antioxidant dietary compounds have been suggested to provide health benefits and there is evidence that consumption of these products leads to a reduction in the expression of various pro-inflammatory and/or oxidative stress biomarkers. The recent development of a new galenic system allows the oral delivery of the antioxidant enzyme: superoxide dismutase (SOD). This has been developed from a specific melon variety with a particularly high SOD activity.

OBJECTIVES

To study the influence of an oral supplementation with an encapsulated melon rich in SOD on muscular and antioxidant balance variables in a population of Standardbreds in training.

METHODS

Twenty-four Standardbreds in training were paired by age, sex and training level. They were randomly split into 2 groups: SOD group (520 iu/day) and placebo group. At the beginning of the study (T0) and after 30 days (T30) and 60 days (T60) of supplementation, physiological response during a standardised exercise test, plasma muscular enzymes at rest and post exercise (creatine kinase), oxidative stress markers (erythrocyte SOD) and blood resistance to haemolysis (KRL test) were assessed. Analysis of variance of time, treatment and interaction time x treatment was calculated.

RESULTS

Between T0 and T60, in contrast with placebo group, a significant increase in the plasma resistance to haemolysis in the SOD group was observed and it was significantly higher (P < 0.05) in the SOD group than in the placebo group on T60. Between T0 and T60, resting CK remained constant in SOD group whereas a significant increase in plasma CK in the placebo group was observed. On T60, the CK level was significantly lower (P < 0.05) in SOD group than in the placebo group.

CONCLUSIONS

These results suggest that oral SOD supplementation might increase blood resistance to haemolysis and reduce the increase in muscular membrane permeability induced by training.

Physiological measurements and prevalence of lower airway diseases in Trotters with dorsal displacement of the soft palate

REASONS FOR PERFORMING STUDY

Dorsal displacement of the soft palate (DDSP) is one of the most common obstructive conditions of the upper respiratory tract in the racehorse. This condition has a complex aetiology which may be caused or exacerbated by pharyngeal inflammation. Additionally, lower respiratory airway diseases may be associated with DDSP thereby contributing to exercise intolerance in these horses.

OBJECTIVE

The aim of this study was to measure physiological variables during a standardised exercise test and to assess the prevalence and consequences of lower respiratory airway disease in horses with DDSP.

METHODS

A total of 46 horses were included in this study: 22 in the control and 24 in the DDSP groups. All horses performed a SET with measurement of heart rate (HR) and blood lactate concentration. One hour post exercise, respiratory samples were collected for cytological and bacteriological analysis.

RESULTS

During exercise, the DDSP group had higher blood lactate concentration than the control group. According to BAL results, 50 and 63% of control and DDSP group horses, respectively, had evidence of inflammatory airway disease (IAD). In the DDSP group, 42% of horses had a syndrome of tracheal inflammation (STI) with 71% of this group having bacteria isolated at >10(5) CFU/ml.

CONCLUSIONS

Horses with DDSP showed evidence of a high prevalence of IAD and STI with an associated positive bacteriology in 55% of the cases. Even if DDSP is treated by surgery, the authors' recommendation would be to investigate the possibility of lower respiratory airway problems which may also be impacting the horse's performance and/or surgery efficiency.

Impact of manual lymphatic drainage on hemodynamic parameters in patients with heart failure and lower limb edema

Manual lymphatic drainage (MLD), intermittent sequential pneumatic therapy (ISPT), multilayered bandages (MLB), and compression garments are main techniques in conservative treatment of peripheral lymphedema. Since 1990, it has been thought that ISPT applied to both lower limbs simultaneously should not be used for patients with heart failure because right atrial, pulmonary arterial, and pulmonary wedge pressures may increase to a critical point. In 2005, these same results were observed in patients with heart failure wearing MLB. For these reasons, MLB and ISPT have been contraindicated during lymphedema treatment in cardiac patients. The aim of this study was to determine if we may continue the treatment of lower limb lymphedema using MLD in patients with heart failure. We evaluated hemodynamic parameters using echography during MLD in patients with cardiac disease and obtained circumferential measurements of the edematous limb before and after treatment. MLD treatment significantly decreased the limbs as expected. The heart rate also decreased following MLD in contrast with all other hemodynamic parameters which were not affected by MLD. The findings suggest that there is no contraindication to use MLD in patients with heart failure and lower limb edema.

Body composition in young Standardbreds in training: relationships to body condition score, physiological and locomotor variables during exercise

REASONS FOR PERFORMING STUDY

Body composition is an essential factor in athletic performance of human sprinters and long distance runners. However, in horses, many questions remain concerning relationships between body composition and performance in the different equine activities.

OBJECTIVES

To determine relationships between body composition, body score, physiological and locomotor variables in a population of young Standardbreds in training.

METHODS

Twenty-four 2-year-old Standardbreds were studied, body condition on a scale 0-5 and bodyweight recorded, and height at withers measured. Percentage of fat (%F), fat mass (FM) and fat free mass (FFM) were estimated echographically. During a standardised exercise test on the track, velocity, heart rate, respiratory frequency and blood lactate concentrations were measured. V4 and V200 (velocity for a blood lactate concentration of 4 mmol/l and velocity of 200 beats/min) calculated. Basic gait variables were measured at 3 different speeds with an accelerometric device.

RESULTS

Body composition variables: %F and FM were significantly related to body condition score and physiological variables. Body score was highly correlated to %F (r = 0.64) and FM (r = 0.71). V4 was negatively correlated to %F (r = -0.59) and FM (r = -0.60), P<0.05. V200 was also negatively related to %F and FM, (r = -0.39 and r = -0.37, respectively, P<0.1). No relationships were found between body composition and gait characteristics.

CONCLUSIONS

Body composition was closely related to indirect measurements of aerobic capacity, which is a major factor of athletic performance in middle distance running horses.

POTENTIAL RELEVANCE

As in human athletes, trainers should take special note to evaluate optimal bodyweight and body composition of race horses to optimise performance.

Factors influencing variation in locomotor-respiratory coupling in Standardbred Trotters in the field

REASONS FOR PERFORMING STUDY

A close relationship between limb and respiratory rhythms has been shown in clinically healthy galloping horses due to mechanical constraints in the thoracic region. This synchronisation leads to a 1/1 ratio between stride frequency (SF) and respiratory frequency (RF) during galloping. Very little is known about locomotor-respiratory coupling (LRC) during fast trot.

OBJECTIVES

To investigate stride and respiratory rates during a standardised exercise test on the track in Standardbred Trotters.

METHODS

Forty-four French trotters age 2-10 years performed a standardised exercise test consisting of three 3 min steps at constant speeds. Speed (V) of exercise varied between 500 and 750 m/min. Variables measured during exercise: SF, heart rate, RF using a microphone between the nostrils, blood lactate concentration. Physiological variables V4 and V200 were calculated and race performance index recorded.

RESULTS

There was no age-related difference in RF or in LRC. Two LRC strategies were found: around 1/1 ratio and 3/2 ratio between SF and RF, respectively. A relationship between SF/RF ratio and physiological parameters showed a higher LRC in good performers because of a lower RF during submaximal and maximal exercise.

CONCLUSION

RF is significantly lower and LRC significantly higher in good compared to poor performers.

POTENTIAL RELEVANCE

Investigation is required to ensure that the breathing techniques of trotters may be used in the selection process of racehorses.

Abnormal radiographic findings in 865 French Standardbred trotters and their relationship to racing performance

REASON FOR PERFORMING STUDY

Developmental orthopaedic lesions are commonly found in French Standardbred horses. One of the main questions asked by trainers, owners and veterinarians is what impact these lesions have on the racing career and racing performances of horses.

OBJECTIVES

To study the prevalence and distribution of developmental orthopaedic lesions in young French Standardbred trotters and to relate them to racing performance.

METHODS

Feet, fetlock, tarsus and stifle regions were radiographed in 865 two-year-old French Standardbred trotters. Abnormal radiographic findings (ARF) were evaluated for 12 anatomical sites identified in these areas, and a severity index given. Performance criteria were: success in qualification for racing, maximal and mean index of trot (ITR), an annual index calculated on the basis of the logarithm of earnings per starts, total earnings at 5 years, placed races compared to starts and longevity of the racing career. Analysis of variance were calculated to study the relationships between racing performance and the number of ARF or the severity index.

RESULTS

A total of 363 horses (42.0%) showed ARF. Prevalence of ARF was 18.3% in the plantar aspect of the hind fetlock and 10.6% in the proximal tarsus. Among the total population, 833 horses were considered for performance evaluation, 478 of them were qualified for racing. The number of ARF significantly affected racing longevity. However, the number of ARF did not affect performance categories according to maximal ITR. Concerning distribution of ARF, the number of plantar lesions in the fetlock significantly affected mean ITR. The index of severity did not provide more information for prognosis than the number of ARF.

CONCLUSION

Longevity is the only criteria affected by ARF. When evaluating different sites, only the plantar fetlock region showed a significant relationship with mean ITR.

POTENTIAL RELEVANCE

Number of ARF and radiographic score (RS) affect mean ITR and longevity but do not affect maximal ITR. A horse with a good racing ability will be a good performer but might have a racing career shortened because of orthopaedic problems in relation to developmental orthopaedic lesions.

Harnessed vs. mounted standardbreds on the track: changes in gait and physiological variables

REASONS FOR PERFORMING STUDY

It has become apparent through analysis of elite races over the past 20 years that mounted races are always slower than harnessed races when performed by the same horses over the same distances on the same tracks.

OBJECTIVES

To investigate and compare physiological and gait variables in mounted and harnessed activities in trotters.

METHODS

Ten trotters were taken at random in 2 standardised field exercise tests one week apart: a harnessed and a mounted test with standardised weight jockeys and drivers. Speed, heart rate (HR), respiratory frequency (RF), blood lactate concentration (La), stride characteristics (length, frequency [SF], symmetry, regularity, dorsoventral displacement of the sternum and vertical, longitudinal and lateral activities measuring the amount of deceleration and acceleration along the 3 axis) were measured.

RESULTS

Paired t tests and an analysis of variance were calculated between the 2 conditions and revealed that V4 (speed for a La of 4 mmol/I), V200 (speed for a HR of 200 beats/min), stride length, trot symmetry, lateral activity were lower in the mounted condition. In contrast, RF, SF, dorsoventral displacement, vertical and longitudinal activities were significantly higher in mounted horses compared to harnessed horses.

CONCLUSION

The significant physiological and biomechanical differences between pulling whilst harnessed and being ridden reflect an increase in the energy requirement of locomotion in the mounted condition compared to the harnessed condition. Trotting mounted at maximal speed is more demanding for the horse than harnessed as reflected by the lower V4 and V200 and some gait variables change in relation to this phenomenon.

POTENTIAL RELEVANCE

This study demonstrates that trotting mounted at sub-maximum and maximum speed is more demanding for the horse when ridden and that it modifies some gait variables, either as a result or even as a possible cause.

Optimal active recovery intensity in standardbreds after submaximal work

REASONS FOR PERFORMING STUDY

A retrospective study concerning spontaneous active recovery intensity, i.e. at a freely chosen speed, after a submaximal exercise in trotters showed that the mean intensity demanded by trainers corresponds to 40-50% of maximal heart rate (max HR; unpublished data). However, in human athletes, optimal active recovery intensity was found to be about 60-70% of max HR. Is the spontaneous recovery optimal after a submaximal exercise in trotters?

OBJECTIVES

To compare different recovery intensities and define the most efficient one.

METHODS

Thirty-seven trotters performed a standardised exercise test on the track. Horses were randomly divided into 4 groups of recovery: passive recovery (n = 10), 10 min walk recovery (n = 10, 100 m/min), 10 min slow trot recovery (n = 9, 250 m/min) and 10 min fast trot recovery (n = 8, 420 m/min). Before, during and 1 h after exercise, speed, heart rate, blood lactate concentration were measured as well as respiratory frequency and rectal temperature. Creatine kinase (CK) was measured 1, 3 and 5 h after exercise.

RESULTS

Walk, slow trot and fast trot recovery corresponded respectively to 45-50%, 55-60% and 65-70% of max HR. Heart rate and blood lactate concentration were significantly lower after the 10 sec recovery with increasing intensity of recovery.

CONCLUSION

The most efficient intensity of recovery was the 10 min fast trot recovery (65-70% max HR) as this type of recovery allows the optimal blood lactate disappearance.

POTENTIAL RELEVANCE

Considering the usual habits of trainers or drivers, recovery intensity after trot races should be increased in intensity to optimise its efficiency.

Effect of age on locomotion of Standardbred trotters in training

In Standardbreds, the main aim of early training (begun during the growth period) is the mechanization of athletes leading to a particular gait called the ‘flying trot’. The present cross-sectional study was undertaken to investigate the biomechanical and physiological factors involved in this gait change, and aimed to analyse the effect of age on gait and energetic variables in a population of Standardbred horses under training. One hundred and forty-three horses aged from two to seven years were tested on a track at three speeds (8.5, 10 and 11.6 m s−1) with a gait-analysis system. Gait variables (temporal and linear variables, symmetry, regularity, two-beat rhythm, dorso-ventral, longitudinal and lateral activities) were compared between four age groups (two-, three-, four-, and five-year-olds and above). After a standardized exercise test, two energetic variables (V4 and V200) were also compared between these groups. Most variables were influenced by age/training status. The results indicated that, from young to mature racehorses, stride length and duration increase; and gait becomes more symmetric and more regular. We also observed a decrease in dorso-ventral, longitudinal and lateral activities, i.e. a decrease of thoracic displacements. These differences could be elucidated at slow speed and were still obvious at high speed. V4 and V200 also increased significantly with age/training status. All of these results indicate an improvement in co-ordination and a decrease in metabolic cost with increasing age/training status. Thus gait acquisition could be related to an improvement in trotting efficiency.

Relationships between physiological variables and race performance in French standardbred trotters

The relationships between V4 (the velocity for a blood lactate concentration of 4 mmol/litre) and V200 (the velocity for a heart rate of 200 bpm) and the performance indices of 223 healthy French trotters were analysed. They were divided into four age groups of three, four, five and six years and over, and into three performance groups (good, intermediate and poor performers) defined by the index of trot (ITR), an annual index of performance calculated by the national stud. V4 and V200 were assessed during the performance of a three-step standardised field exercise test, and four performance indexes (ITR, earnings, best time and the number of starts) were calculated for each group. An analysis of variance showed that V4 and V200 were highly correlated with the horses' age and level of performance (P<0.05). The correlation between the physiological variables and ITR was better for the three- and four-year-old horses than for the older horses.

Reproducibility of a locomotor test for trotter horses

Locomotion analysis is increasingly used to assess the gait of horses in the selection and training of equine athletes. We have developed a specific locomotor test for fast trotting harnessed horses that uses an accelerometric device. We describe here the reproducibility of the locomotor test and the validation of its use to analyse trotters on the racetrack. We measured the performance of eight horses under the same conditions three times in a single week. We then tested the influence of five tracks on the variables measured using eight different trotters every two days. The horses trotted at three or four velocities (8.3, 10, 11.7 m/s and at maximal velocity) in a straight line for 20 s. The short-term reproducibility of the test was very good for 23/25 variables, with no significant difference in the 23 variables for the three measurements. The two less reproducible variables reflected human error. The different tracks did not alter the stride variables measured. We conclude that the test is an easy, accurate method for analysing gait, as it provides reproducible stride variables for trotting harness horse under field conditions.

Analysis of trotter gait on the track by accelerometry and image analysis

The aim of this study was to describe the correlation between the phases of the limb cycle of trotters on the track and specific points on the acceleration curves obtained from a new gait analysis system. We compared kinematic data obtained by video image analysis and 3-dimensional acceleration recordings made on 3 French trotters in training. They trotted on a race track at speeds of 8.33, 10 and 11.66 m/s, with a final stretch at maximum speed. Their locomotion was recorded with a synchronised video camera at a frame frequency of 200 Hz and with the Equimétrix gait analysis system. The gait variables were calculated using 3-dimension acceleration data recorded at the sternum (dorso-ventral, longitudinal and lateral axes) at a sampling rate of 100 Hz. Three phases of the stride were clearly identified on the dorsoventral acceleration signal: hoof-landing, midstance phase and toe-off. Braking and propulsion phases were identified on the corresponding longitudinal acceleration signal. The weight-bearing diagonal was identified by observing the lateral signal. The stride temporal variables (stride, stance, braking and propulsion durations for both diagonals), measured by video analysis and by acceleration signal analysis, were not significantly different (P>0.05). The identification of specific points on the acceleration pattern allowed an accurate temporal analysis of the stride. Potential applications could be the determination of locomotor factors related to racing performance or assessment of locomotor disorders at high speed.

Immunohistochemical markers defined by monoclonal antibodies and response to bacillus Calmette-Guérin endovesical immunotherapy for superficial bladder tumors

As bacillus Calmette-Guérin (BCG) immunotherapy is highly effective for most but not all superficial bladder tumors, there is a need to define predictors of response to this mode of treatment. We have investigated a panel of markers defined by monoclonal antibodies, directed against tumor-associated transitional cell carcinoma antigen (G4 and E7), epidermal growth factor receptor, cytokeratin (CK) 18 and blood group antigens A, B and H, using an indirect immunoperoxidase staining on paraffin sections. Twenty superficial bladder tumors (T1) treated with intravesical BCG therapy (10 responders and 10 nonresponders) were tested with this panel. Among the responders, expression of CK18 antigen was positive in 7 and negative in 3, whereas in the nonresponder group it was positive in 2 and negative in 8. The difference was statistically significant (p less than 0.05). Loss of expression of CK18 antigenicity was associated with recurrence or progression of superficial bladder tumors following BCG therapy, indicating that changes in CK patterns should be investigated as potential predictive markers for response to BCG.

Systemic bacillus Calmette-Guérin infection, 'BCGitis', in patients treated by intravesical bacillus Calmette-Guérin therapy for bladder cancer

Among 169 patients treated for supeficial bladder tumor with 150 mg Pasteur-strain bacillus Calmette-Guérin (BCG) intravesical instillation, 5 cases of 'BCGitis' were observed, i.e. a severe systemic BCG infection with bronchopulmonary lesions and granulomatous hepatitis. In 4 cases, the complications appeared at the early stage of treatment (after the 3rd, 6th, 6th and 8th instillations, respectively). In 1 case, treated with monthly maintenance therapy for 2 years, BCGitis appeared 6 months after treatment had been completed and, in addition to pulmonary basal infiltrate and granulomatous hepatitis, intramedullary granulomatosis was observed. In 3 patients, trauma must be taken into consideration as BCGitis appeared after traumatic instillation with bleeding. All patients were cured by treatment with rifampicin, isoniazid and prednisone.

Bladder tumors invading the lamina propria (stage A/T1): influence of endovesical bacillus Calmette-Guérin therapy on recurrence and progression

47 patients with transitional cell bladder carcinoma invading the lamina propria (stage A/T1) were treated from 1984 to 1986 by complete transurethral resection followed by 1-3 cycles of endovesical bacillus Calmette-Guérin instillations, and followed 14-64 months by cytology, endoscopy and bladder biopsies, 64% achieved a complete response, 36% recurred (recurrence rate/100 months/patient 2.2), 21% progressed to muscle invasion. Duration of treatment, tumor size or type (solid vs. papillary), presence of carcinoma in situ bore no relation to the final result. The preceding history of T1 bladder tumor appeared associated with a higher risk of progression although not reaching statistical significance. The results were compared to those obtained by transurethral resection in a similar group of 50 patients treated from 1982 to 1984 and followed up 12-100 months, 90% recurred and 34% progressed to muscle invasion with a recurrence rate/100 months/patient of 9.22. Keeping in mind the limits of a nonrandomized historical comparison, it appears that endovesical bacillus Calmette-Guérin therapy alters favorably the recurrence pattern of T1 bladder cancer.

[Wilson's disease with liver copper in normal concentration]

The cases of 2 children with Wilson's disease revealed by persistent hypertransaminasemia are reported. Blood ceruloplasmin concentration was low but the liver content of copper was lower than usually seen in presymptomatic forms of the disease. The apparently low liver copper concentration could be explained by an unusually important steatosis.

[Malakoplakia]

Malakoplakia is a fairly rare disease, normally found in women (four out of every five cases). It mainly attacks the urinary system, but may spread to the other viscera. The symptoms are not clinically specific. The main interest of the disease is its pathogenesis, from which its treatment is derived. It is in fact an immunological dysfunction of the phagocytes, leading to chemical disorders in the macrophages. Its treatment is based on the use of cholinergic agonists and vitamin C therapy.

Salvage cystectomy: the case for a combined abdominoperineal approach

Salvage cystectomy, after failed radical radiotherapy for infiltrating bladder cancer, is a major procedure in which rectal laceration can lead to life-threatening complications. The advantages of a combined abdominoperineal approach are emphasized in a series of 14 patients.