There were no substantial differences in technical results and clinical outcomes of the two treatment strategies both at short-term and long-term follow-up. Since angioplasty followed by selective stent placement is less expensive than direct placement of a stent, the former seems to be the treatment of choice for lifestyle-limiting intermittent claudication caused by iliac artery occlusive disease.

To study the local immunological effects of intravesical bacillus Calmette-Guérin (BCG) therapy in superficial bladder cancer patients, the production of interleukin-1 (IL-1), IL-2, IL-6, tumour necrosis factor alpha (TNF alpha), and interferon gamma (IFN gamma) was investigated in the urine. Urine specimens were collected during the six weekly BCG instillations, before instillation, and 2, 4, 6, 8, and 24 h thereafter. Results were standardized to urine creatinine. In general, the concentration of IL-1 increased markedly during the first three BCG instillations, reaching a plateau from instillations 3 to 6. IL-2 was not detected after the first BCG instillation, but from the second instillation onwards the mean IL-2 concentration increased rapidly. With respect to IL-6, patients had relatively high levels in the urine after the first BCG instillation. A relatively moderate increase of the IL-6 concentration was observed during the following weeks. Like IL-2, TNF alpha was only detected after repeated BCG instillations. Generally the highest TNF levels were found after BCG instillation 5. The presence of IFN gamma could not be demonstrated. With respect to the occurrence of the cytokines during the first 24 h after the BCG instillation, TNF, IL-2, and IL-6 were detectable 2 h after the instillation. In contrast, IL-1 seemed to appear later, i.e. from 4 h onwards. TNF decreased most rapidly; it was nearly absent in 6-h samples. Generally IL-2 was not detectable in the 8-h samples, whereas IL-1 and IL-6 were present up to 8 h after instillation of BCG. The presence of TNF was found less frequently than the presence of IL-1, IL-2, and IL-6. Neutralization experiments indicated that most of the IL-1 present in the urine after BCG treatment was IL-1 alpha. In conclusion, activation of BCG-specific T cells was indicated by the detection of IL-2. The presence of IL-1, IL-6, and TNF alpha might suggest activation of macrophages by intravesically administered BCG, although production by other cell types cannot be excluded. It is suggested that these cytokines, in combination with the leucocytes that are known to be recruited to the bladder in reaction to the BCG treatment, may play an important role in the antitumour activity of BCG against bladder cancer. For monitoring purposes, collection of urine might be performed during the first 6 h after BCG instillations 4-6.(ABSTRACT TRUNCATED AT 400 WORDS)

Background: Screening guidelines for women at familial risk of breast cancer without a known causative gene mutation differ internationally. To our knowledge, no randomised controlled MRI-screening trial has been performed. The FaMRIsc-study aims to assess the efficacy of MRI versus mammography screening for familial risk and furthermore assesses the influence of breast density. Methods: In 12 Dutch hospitals, 1355 women aged 30-55 years with a cumulative lifetime risk of ≥20% without a BRCA1/2 mutation were randomised with a web-based computer generated hospital sequence, concealed for participants, physicians and researchers, in either the MRI-group with yearly MRI, clinical breast examination and mammography biennially, or the Mammography-group with yearly mammography and clinical breast examination. Breastfeeding, pregnancy, previous screening and previous ductal carcinoma in situ were permitted, but no previous invasive cancer. Primary outcomes were number, size and nodal-stage of breast cancers. Secondary outcomes were sensitivity, specificity and positive predictive value. Results were also stratified by mammographic density (BI-RADS AD). Intention to screen analyses were performed. This trial was registered with the Netherlands Trial Register, NTR2789. Findings: Between Jan 1 2011, and Dec 31 2017 in the MRI-group (674 women) compared to the Mammographygroup (680 women) with a median follow-up of 5.2 years for both groups, more breast cancers were detected (40 versus 15, p<0•001), invasive cancers were smaller (median size 9 versus 17 mm, p=0•010) and less frequently node positive (4/24, 17% versus 5/8, 63%, p=0•023). In the MRI-group, specificity was significantly lower compared to the Mammography-group (83•8% versus 91•0%, p<0•001), while sensitivity hardly differed (97•5% versus 86.7%, p=0.18). Clinical breast examination contributed hardly to detection (1/55). In incident cancers, tumour stage was better in the MRI-group (p=0•035), with lower numbers of node positive and ≥T2 tumours, while specificity improved in both arms (MRI-group: 87•4%, Mammography-group: 92•6%, p<0•001). All tumours ≥T2 were in the two highest density categories. In BI-RADS density A-C MRI was most effective. Interpretation: The earlier detection by MRI screening and especially the fewer late-stage cancers in incident rounds, may reduce adjuvant chemotherapy and mortality. However, especially for women with the highest breast density at the cost of more false positive results.