[Comparative studies of the efficacy, safety and usefulness of S6472, cefaclor and cephalexin on complicated urinary tract infection by the double-blind method]

To objectively evaluated the usefulness of the standard formulation of cefaclor (CCL) and the long-acting formulation of cefaclor (S6472) in noncatheterized complicated urinary tract infection (UTI), a double-blind comparison study was carried out using cephalexin (CEX) as a control. Patients were orally treated with either 500 mg of CCL 3 times/day, 750 mg of S6472 2 times/day, or 500 mg of CEX 4 times/day for 14 days. Overall clinical effect was evaluated on days 5 and 14 in accordance with the UTI therapeutic evaluation standard, with check for recurrence on day 21. There was no demographic difference between the groups. There was no difference in the effective rate on day 5 among the 3 treatment groups: 58.1% in S6472 group, 66.0% in CCL group and 61.9% in CEX group. Nor on day 14, was there any significant difference in the effective rate among the 3 groups: 70.8% in S6472 group, 63.4% in CCL group and 61.8% in CEX group. Stratification analyses (by UTI group, infection site, in- or out-patient, time of starting treatment, pretreatment severity of pyuria, total number of bacteria before treatment) revealed no significant difference among the 3 groups. Therapeutic effect evaluated by physicians in charge was not significantly different among the 3 groups on day 5 or day 14. In terms of overall therapeutic effect, all 3 products were very effective in patients infected with sensitive bacteria: On day 5, 85.4% in S6472 group, 84.4% in CCL group, and 83.7% in CEX group. There was no significant difference among the 3 groups on either day. The incidence of side effects was not significantly different among the 3 groups: 4 out of 129 patients treated with S6472 (3.1%), 2 of 131 treated with CCL (1.5%) and 2 of 128 with CEX (1.6%). Clinical laboratory tests revealed 4 abnormal findings in 4 patients treated with S6472, 6 findings in 4 treated with CCL, and 4 findings in 2 treated with CEX, showing no significant difference in incidence among the 3 groups. Both side effects and abnormal clinical laboratory findings were mild and reversible. Physicians in charge judged the usefulness of the 3 drugs on days 5 and 14, taking efficacy and safety into consideration. Significant difference was not observed. The presence of recurrence was examined 7 days after drug withdrawal in patients regarded as remarkable responders to 14-day treatment by overall therapeutic effect evaluation.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative study of chemosensitivity tests of human urogenital tumors between a clonogenic assay and a novel dye exclusion test]

There is a need for chemosensitivity tests of human tumors to become simpler and to have a better correspondence with their therapeutical record. We examined and compared two chemosensitivity tests in vitro. One was a clonogenic assay performed using a double agar system and the other was a novel dye exclusion method that was a modification of the traditional dye exclusion method of Weisenthal. Cultured cells and surgical speciners of urogenital tumors were used for the present experiments. Comparison of chemosensitivity between the clonogenic assay and the novel dye exclusion test resulted in a similar dose response for each, and both tests were suitable not only for cultured cells but also surgical speciners. Among surgical speciners, 17 of 25 cases (68%) tested by clonogenic assay and 8 of 11 cases (73%) tested by novel dye exclusion test were successful in detecting drug sensitivity. Renal cell carcinomas had higher plating efficiency and showed a higher success rate in the clonogenic assay than any other urogenital tumors. On the other hand, the novel dye exclusion method depended on tumor cell growth in suspension culture. Among 11 cases on which both the clonogenic assay and the novel dye exclusion method were performed, only in one case was there failure to estimate drug sensitivity. Therefore, more successful results in examining the chemosensitivity of urogenital tumors might be expected by using both the clonogenic assay and the novel dye exclusion method.

[Statistics on operations in the Department of Urology, Kobe University School of Medicine (January, 1976 to December, 1980)]

Statistical observations on operations performed in our department from 1976 to 1980 were reviewed, especially in comparison with the statistics for the preceding 10 years. Operations on the kidney were the most frequent, as they were in the preceding 10 years, but operations on the bladder have increased remarkably, in 1980 accounting for more than those on the kidney. During this period, operations for benign diseases such as lithotomy of the upper urinary tract and prostatectomy tended to decrease. On the other hand, operations for malignant diseases of kidney, bladder and scrotal contents steadily increased. Transurethral operations are still increasing, especially for bladder tumors. It has been established that bladder tumors should be treated by either TUR-BT or total cystectomy and not by partial cystectomy. As to urinary diversion, ileal conduit was the main procedure used during this 5-year period instead of cutaneous ureterostomy.

Giant seminoma of undescended testis in Down syndrome

A giant seminoma of undescended testis in a forty-one-year-old Japanese male with Down syndrome is reported as is a review of the literature. The relationship between Down syndrome and testicular cancer are discussed. To our knowledge this is the largest seminoma of undescended testis (weight 3,500 Gm) so far recorded.

[A case of leiomyosarcoma of the inferior vena cava]

A case of primary leiomyosarcoma of the inferior vena cava was reported. The patient, a 74-year-old man, consulted our hospital with complaints of back pain and abdominal mass in right flank. Probe laparotomy revealed a tumor situated in the retroperitoneum and multiple metastatic nodules in the liver. Biopsy was performed and diagnosed as leiomyosarcoma. He was intensively treated with antineoplastic chemotherapy, but his condition gradually aggravated. He died 4 months after admission. The autopsy revealed a right retroperitoneal mass (17 X 12 X 18 cm in size, 1,340 g in weight) that showed a yellowish appearance. There was also a thumb-tip sized tumor with a stalk in the lumen of inferior vena cava. Both tumors grew in continuity with each other through the wall of inferior vena cava. The tumors were diagnosed as leiomyosarcoma, which derived from inferior vena cava.

[A case of primary malignant lymphoma of the urinary bladder]

This paper presents an autopsy case of primary malignant lymphoma of the urinary bladder. The patient, a 63-year-old man, consulted us because of macroscopic hematuria. Cystoscopy revealed a bladder tumor, which was diagnosed as an anaplastic cell carcinoma by transurethral punch biopsy. The tumor progressively increased in size, despite treatment with preoperative antineoplastic chemotherapy consisting of CDDP. Only ureterocutaneostomy and biopsy were performed at the operation although total cystectomy and ileal conduit had been planned, because the tumor had invaded into the perivesicular tissue. Biopsy revealed B cell lymphoma, which was characterized by specific staining with IgG by the PAP method. Although antineoplastic chemotherapy was performed again after operation, the patient gradually weakened and died 5 months after admission. At autopsy, a hen-egg sized, non-papillary tumor which invading into the perivesicular tissue was found at the anterior wall of the urinary bladder. There were many metastatic nodules in the thraco-lumbar vertebral columns, para-aortic lymphnodes and mesenteric lymphnodes. Lungs and liver were free from metastatic tumors.

[Two cases of spontaneous fistula between urinary tract and gastrointestinal tract]

This is a report of two cases of a fistula between the urinary and gastrointestinal tracts. One case was a 56-year-old female patient with a right pyeloduodenal fistula, and the other was a 38-year-old female with a left ureterodescending colon fistula. The chief complaint was right lumbago in the first case, and fever and left lumbago in the second case. Both cases were diagnosed by retrograde pyelography. In both cases, the ailing kidney appeared to be non-functioning, and the former was operated by nephrectomy, fistulectomy, and duodenectomy in the cuneate form, while the latter was operated by nephrectomy and fistulectomy. The cause of the formation of the fistula was considered to be chronic pyelonephritis accompanied by renal stones in the first case, and rupture of the colon diverticulitis in the second case. Postoperative prognosis was satisfactory in both cases.

[A case of ectopia testis transversa]

A case of ectopia testis transversa was reported. A patient, 35-year-old male, was admitted to our hospital with swelling of left scrotal contents. At operation, two testes were situated in the left scrotal half, but the right half was empty. Including our case, 66 cases of ectopia testis transversa have been reported in Japan.

Urinary diversion: anastomosis of the ureters into a sigmoid pouch and end-to-side sigmoidorectostomy

From 1978 to 1982 bilateral ureterorectostomy and end-to-side sigmoidorectostomy were done following cystectomy for carcinoma of the bladder in 7 patients. No patient had recurrent pyelonephritis or ureterointestinal obstruction. Rectography showed the absence of rectoureteral reflux of contrast medium but rectosigmoid reflux appeared after injection of more than 150 ml. opaque solution. Adequate alkali therapy was performed in 2 patients with hyperchloremic acidosis. While there were some problems concerning the quality of urinary and fecal control achieved in our patients they were no worse than those of ordinary ureterosigmoidostomy. This operation might be recommended for patients in whom a collection appliance is unacceptable. However, before this surgical procedure can be performed the fact that the end result in terms of fecal urinary continence is unpredictable must be explained thoroughly to the patient.

[Studies on antibiotics distribution in the post-operative cavity]

In 17 post-operative patients, serum and operation cavity exudate levels after 2 g administration of various cephems (CZX, LMOX, CTX, and CPZ) by one hour drip infusion were evaluated. Drug concentration in exudate (actual levels) was corrected by using an equation for the purpose of excluding blood contamination. After 2 hours from the start of infusion, theoretical levels generally were similar to actual levels. CZX: Peak exudate level was 38.9 micrograms/ml at 4 hours. Maximum exudate level/maximum serum level (E/S) was 0.31. LMOX: Peak in exudate was 41.4 micrograms/ml at 4 hours. E/S was 0.59. CTX: Exudate peak level was 30.8 micrograms/ml at 2 hours, and E/S was 0.53. CPZ: Peak level in exudate was 74.0 micrograms/ml at 4 hours. E/S was 0.36. Generally, peaks occurred at 4 hours (3 hours later than serum peaks), and their range was between 30 and 80 micrograms/ml. At 8 hours, drug levels in exudate were 10 approximately 60 micrograms/ml, and they were higher than the corresponding serum level at that time.

A rare case of adenocarcinoma of bladder following augmentation enterocystoplasty

This is a report of a case of poorly differentiated adenocarcinoma found 20 years after bladder augmentation ileoplasty. The origin of this tumor was proved to be the ileal part of bladder augmentation. Autopsy revealed metastatic lesions in the stoma (sigmoid conduit), lungs, liver, left femur, adrenal glands and lymph nodes. A review of the literature revealed only one other such case. This is a rare case of adenocarcinoma in the ileal part of bladder augmentation.

[Male infertility with chromosomal abnormalities. I. XYY syndrome]

Chromosomal abnormalities are found in a considerably high percentage of cases of male infertility, in particular azoospermia. We report a case of the XYY syndrome and review the literature. A 36-year-old man, a factory hand, presented with infertility. He was safely delivered at term as a fourth child when his father was 41 years old and his mother 38. He had no delinquent or criminal record. His height was 179 cm, weight 75 kg and distance of extended hands 184 cm. No gynecomastia was noticed. Both testes were 8ml in size and growth of pubic hair and penis were normal. Severe oligozoospermia was identified in semen analysis. Seminal vesiculography showed pathological dilatation of the seminal vas end. The testicular biopsy specimens revealed spermatogenic arrest for the most part. Chromosomal analysis showed 47, XYY karyotype; and, two Y-chromatin was revealed in cultured lymphocytes. Though plasma gonadotropin levels were high, testosterone, estradiol, prolactin, TSH, GH, T3 and T4 levels were within normal limits. Pituitary reserve function for secreting gonadotropins and Leydig cell reserve function to secrete testosterone have been found to be almost normal.

[In vitro antibacterial activity of various cephems against clinical isolates from complicated urinary tract infections]

In vitro antibacterial activity of several cephems (CEZ as the first generation (group A); CTM and CMZ as the second generation (group B); CMX, CPZ, LMOX, CTX and CZX as the third generation (group C)) against 8 species, each of 54 strains, of Gram-negative clinical isolates from complicated urinary tract infection was compared by determination of the MICs. The following results were obtained: The most sensitive drugs against each species in MIC80; CTX (MIC80 0.20 microgram/ml) against E. coli, CMX (1.56 microgram/ml) against K. pneumoniae, LMOX (0.39 microgram/ml) against P. mirabilis, LMOX (0.78 microgram/ml) against Indole (+) Proteus, CMX and CPZ (50 micrograms/ml) against E. cloacae, CMX and LMOX (50 micrograms/ml) against C. freundii, CMX (3.13 micrograms/ml) against S. marcescens and CPZ (25 micrograms/ml) against P. aeruginosa The most sensitive drugs against each species in MICS100; CMX (MIC100 3.13 micrograms/ml) against E. coli, CMX (6.25 micrograms/ml) against K. pneumoniae, CTX (0.78 microgram/ml) against P. mirabilis, LMOX (1.56 microgram/ml) against Indole (+) Proteus, CPZ (100 micrograms/ml) against E. cloacae, CMX (100 micrograms/ml) against C. freundii, CMX (12.5 microgram/ml) against S. marcescens and CPZ (50 micrograms/ml) against P. aeruginosa. In each species, the group C were most sensitive followed by those of the group B. Many isolates were highly resistant to the group A (especially in C. freundii, S. marcescens and P. aeruginosa).

[A study on Ureaplasma urealyticum and sperm. Comparison of sperm morphology before and after chemotherapy]

Spermiogram (morphology of sperm heads and tails) was evaluated in 21 men visiting our infertility clinic before and after the eradication of genital infection with Ureaplasma urealyticum. The percentage of coiled tails and fuzzy granular tails were decreased after eradication of Ureaplasma but there were no significant changes in the morphologic characteristics of sperm heads. Spermiogram was also analysed in 5 men who were unsuccessfully treated for genital Ureaplasma infection. In this group there were no significant changes in the morphologic characteristics of sperm heads and tails before and after chemotherapy.

[A case of renal cell carcinoma of horseshoe kidney that produced AFP and caused hypercalcemia]

A very rare case of renal cell carcinoma of the horseshoe kidney that produced AFP and caused hypercalcemia is reported. The relationship between this renal cell carcinoma and hypercalcemia was obvious, but the mechanism of hypercalcemia was not revealed. The presence of AFP in cancer cells was demonstrated using the "ABC" method.

A new method for rapid spermatozoal concentration and motility: a multiple-exposure photography system using the Polaroid camera

A multiple exposure photography (MEP) system using the Polaroid camera PM-CP (Olympus, Tokyo, Japan) has been developed to accurately estimate the concentration and motility of spermatozoa in routine clinical work for the treatment of infertility. This Polaroid-MEP system is equipped with a xenon stroboscope MS-230 (Sugawara Laboratories Inc., Tokyo, Japan), and Makler's Counting Chamber (Sefi-Medical Instruments, Haifa, Israel). The system immediately produces printed images of spermatozoal tracks at the laboratory of the outpatient clinic, providing objective and exact information about the concentration and the motility of spermatozoa.

[Clinical studies on recurrence of acute uncomplicated cystitis]

Recurrence rate and symptoms after chemotherapy against acute uncomplicated cystitis (AUC) were studied. Upon completion of a 7-day treatment with two regimens, one of CEX alone (Group C) and the other of a combination of CEX with Lysozyme (Neuzym) (Group L), at a dose of 1 g CEX daily, efficacy of the drugs was assessed according to the criteria established by the UTI Study Group. The forty one cases in Group C and 38 cases in Group L showing an excellent response were evaluated for recurrence. The rates of recurrence were 12.2% in Group C and 21.1% in Group L during the first 7 days after treatment. In recurrent cases, bacteriuria was seen in 84.6% (11/13), pyuria in 53.8% (7/13) and miction pain in 30.8% (4/13). Thus, bacteriuria and pyuria should be the items of the criteria for AUC recurrence.

Vesicocolic fistula formed by "collision" tumor between transitional cell carcinoma of urinary bladder and adenocarcinoma of the sigmoid colon

A patient with vesicosigmoid fistula due to "collision" tumor between adenocarcinoma of the sigmoid colon and transitional cell carcinoma of the urinary bladder is presented. Resection of the sigmoid colon and partial cystectomy were performed. The clinical symptoms, diagnostic procedures and treatments are discussed.

New preoperative chemotherapy for bladder cancer using combination hemodialysis and direct hemoperfusion: preliminary report

Preoperative chemotherapy and subsequent cystectomy were performed on 11 patients with locally invasive bladder cancer. Three chemotherapy regimens were tested: 1) 2 to 3 mg. per kg. doxorubicin in 5 patients, 2) 1 mg. per kg. mitomycin C in 3 and 3) 0.6 mg. per kg. mitomycin C with 70 mg. systemic bleomycin in 3. Doxorubicin and mitomycin C were infused once preoperatively into the hypogastric arteries or the aortic bifurcation, with simultaneous hemodialysis and direct hemoperfusion to remove as much extra-regional infusate as possible and, thus, reduce the systemic toxicity of the drug. Objective responses were obtained in 4 of 7 patients with measurable tumor (57 per cent). Downstaging was obtained in 7 of 11 patients (64 per cent). All patients given doxorubicin had leukocytopenia (500 to 1,900 per mm.3) and moderate patchy alopecia, and 1 patient given mitomycin C and bleomycin had thrombocytopenia (44,000 per mm.3). However, these side effects were observed comparatively less in the patients given mitomycin C only.

[Combination of intra-arterial administration of anticancer agent and hemocarboperfusion in treatment of advanced cancer]

Nineteen patients with malignant tumors were treated with a combination of bolus administration of mitomycin C with direct hemoperfusion over charcoal, and 15 patients were valuable. Mitomycin C of 1 mg/kg was administered via a catheter placed into the regional artery. Seven out of 14 patients with genitourinary cancers: 4 out of 9 patients with urinary bladder, 2 of 4 patients with renal and one prostate responded to the therapy. There were 4 responders out of 8 in the one-shot administration group, on the other hand, 7 cases receiving continuous infusion of 60 to 120 minutes responded. In both the one-shot group and the continuous group nausea and vomiting were observed in 21% and 11% respectively. Three patients receiving continuous administration of mitomycin C had local ulcerations. Myelosuppressions such as leukocytopenia and thrombocytopenia were observed in 37% of the both groups.

[Comparative double-blind study of cefroxadine and cephalexin in the treatment of complicated urinary tract infection]

To evaluate the efficacy, safety, and utility of cefroxadine (CXD) for the treatment of complicated urinary tract infections, a double blind study comparing CXD with cephalexin (CEX) was carried out. Patient received either 1,500 mg/day of CXD 3 times a day, or 2,000 mg/day of CEX 4 times a day for 5 days by oral route, and the following results were obtained. Of the 305 patients, clinical efficacies were evaluated in 220 cases (CXD 105 cases, CEX 115 cases) except that excluded or dropped out. Side effect was evaluated in 301 cases (CXD 150 cases, CEX 151 cases). There was no statistically significant difference in the back ground characteristics between the 2 groups. Overall clinical assessment by the committee according to the "Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on Urinary Tract Infection" patients evaluated as better than "good" were 64 of 105 (61.0%) for CXD and 75 of 115 (65.2%) for CEX. The difference between the 2 groups was not statistically significant. In effect on pyuria, patients evaluated as better than "decreased" were 58 of 105 (55.2%) for CXD and 69 of 115 (60.0%) for CEX. The difference between the 2 groups was not statistically significant. In effect of bacteriuria, patients evaluated as better than "decreased" were 57 of 105 (54.3%) for CXD and 69 of 115 (60.0%) for CEX. The difference between the 2 groups was not statistically significant. Analyses were stratified according to classification by the type of infection, diagnosis, degree of pyuria before treatment, and bacterial count before treatment. There were no statistically significant differences between the 2 treatment groups as to any item. In evaluation by attending physician, patients evaluated as better than "good" were 81 of 140 (57.9%) for CXD, and 85 of 141 (60.3%) for CEX. Statistically significant difference was not observed between the 2 groups. In drug usefulness by attending physician, patients evaluated as better than "usefulness" were 106 of 140 (75.7%) for CXD, and 109 of 141 (77.3%) for CEX. The difference between the 2 groups was not statistically significant. In evaluation of the infections with sensitive species to both CXD and CEX by the committee according to "Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on Urinary Tract Infections, overall clinical efficacies were evaluated in 102 (CXD 48 cases, CEX 54 cases) which were infected with sensitive species. There was no statistically significant difference in the back ground characteristics between the 2 treatment groups.(ABSTRACT TRUNCATED AT 400 WORDS)