[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1992). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 732 bacterial strains isolated from patients with urinary tract infections in 11 hospitals during the period of June 1992 to May 1993. Of the above total bacterial isolates, Gram-positive bacteria accounted for 35.4% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 64.6% and most of them were Escherichia coli. 1. Enterococcus faecalis Ampicillin (ABPC), imipenem (IPM) and vancomycin (VCM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC90S of them were 2 micrograms/ml. Piperacillin (PIPC) was also active with the MIC90 of 8 micrograms/ml. The others except chloramphenicol (CP) were not so active with the MIC90S of 32 micrograms/ml or above. 2. Staphylococcus aureus including MRSA VCM showed the highest activities against S. aureus isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The others were not so active with the MIC90S of 32 micrograms/ml or above. 3. Staphylococcus epidermidis ABK showed the highest activities against S. epidermidis isolated from patients with urinary tract infections. Its MIC90 was 0.5 microgram/ml. Cefotiam (CTM) and VCM were also active with the MIC90S of 2 micrograms/ml. Penicillins except ABPC, gentamicin (GM), clindamycin (CLDM) and quinolones were not so active with the MIC90S of 64 micrograms/ml or above. 4. Streptococcus agalactiae Most of the agents were active against S. agalactiae isolated from patients with urinary tract infections. Penicillins, cephems, erythromycin (EM), and CLDM showed the highest activities. The MIC90S of them were 0.25 microgram/ml or below. Amikacin (AMK) and minocycline (MINO) were not so active with the MIC90S of 32 micrograms/ml or above. 5. Citrobacter freundii IPM showed the highest activities against C. freundii isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml. Cefozopran (CZOP) and amikacin (AMK) were also active with the MIC90S of 4 micrograms/ml. Penicillins and cephems generally were not so active. 6. Enterobacter cloacae IPM and GM showed the highest activities against E. cloacae. The MIC90S of them were 0.5 microgram/ml. Ciprofloxacin (CPFX) and tosufloxacin (TFLX) were also active with the MIC90S of 4 micrograms/ml. Penicillins and cephems generally showed lower activities. 7. Escherichia coli Most of the agents were active against E. coli. Flomoxef (FMOX), cefmenoxime (CMX), CZOP, IPM, carumonam (CRMN), norfloxacin (NFLX), ofloxacin (OFLX), CPFX and TFLX showed the highest activities against E. coli. The MIC90S of them were 0.125 microgram/ml or below. Cefotiam (CTM), ceftazidime (CAZ), cefuzonam (CZON) and latamoxef (LMOX) were also active with the MIC90S of 0.25 microgram/ml. Penicillins were not so active with the MIC90S of 32 micrograms/ml or above. 8. Klebsiella pneumoniae Most of the agents were active against K. pneumoniae. FMOX, CMX, CZOP and CRMN showed the highest activities. The MIC90S of them were 0.125 microgram/ml or below. But ampicillin (ABPC) was not so active with the MIC90 of 128 micrograms/ml. 9. Proteus mirabilis Most of the agents were active against P. mirabilis. FMOX, CMX, CAZ, CZON, LMOX, CFIX, CPDX, CRMN, NFLX, CPFX and TFLX showed the highest activities against P. mirabilis isolated from patients with urinary tract infections. The MIC90S of them were 0.125 microgram/ml or below. ABPC and MINO were not so active with the MIC90S of 256 micrograms/ml or above. 10. Pseudomonas aeruginosa Most of the agents were not so active against P. aeruginosa. IPM showed MIC90 of 8 micrograms/ml. Cefclidin (CFCL) and AMK showed MIC90S o

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1993). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 657 bacterial strains isolated from patients with urinary tract infections in 10 hospitals during the period of June 1993 to May 1994. Of the above total bacterial isolates, Gram-positive bacteria accounted for 28.3% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 71.7% and most of them were Escherichia coli. 1. Enterococcus faecalis Ampicillin (ABPC), imipenem (IPM) and vancomycin (VCM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC90s of them were 2 micrograms/ml. Piperacillin (PIPC) was also active with the MIC90 of 8 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 2. Staphylococcus aureus including MRSA VCM showed the highest activities against S. aureus isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 3. Staphylococcus epidermidis VCM showed the strongest activity against S. epidermidis isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml. ABK was also active with the MIC90 of 4 micrograms/ml. The others except ABPC were not so active with the MIC90s of 32 micrograms/ml or above. 4. Streptococcus agalactiae Most of the agents were active against S. agalactiae isolated from patients with urinary tract infections. Penicillins, cephems, erythromycin (EM), and clindamycin (CLDM) showed the highest activities. The MIC90s of them were 0.25 microgram/ml or below. Amikacin (AMK) and minocycline (MINO) showed somewhat low activities with the MIC90s of 16 micrograms/ml. 5. Citrobacter freundii IPM showed the highest activities against C. freundii isolated from patients with urinary tract infections. Its MIC90 was 2 micrograms/ml. Cefozopran (CZOP) and gentamicin (GM) were also active with the MIC90s of 8 micrograms/ml. Penicillins and cephems generally were not so active. 6. Enterobacter cloacae IPM and GM showed the highest activities against E. cloacae. The MIC90s of them were 1 microgram/ml. CZOP and tosufloxacin (TFLX) were also active with the MIC90s of 8 micrograms/ml. Penicillins and cephems except CZOP showed lower activities with the MIC90s of 64 micrograms/ml or above. 7. Escherichia coli Most of antimicrobial agents were active against E. coli. Flomoxef (FMOX), CZOP, IPM, CPFX and TFLX showed the highest activities against E. coli. The MIC90s of them were 0.125 microgram/ml or below. Cefmenoxime (CMX), ceftazidime (CAZ), cefuzonam (CZON), latamoxef (LMOX), carumonam (CRMN), norfloxacin (NFLX) and ofloxacin (OFLX) were also active with the MIC90s of 0.25 microgram/ml. Penicillins and MINO were not so active with the MIC90s of 32 micrograms/ml or above. 8. Klebsiella pneumoniae CZOP, IPM and CRMN showed the highest activities against K. pneumoniae. The MIC90s of them were 0.125 microgram/ml or below. CAZ, CZON, CFIX, CPFX and TFLX were also active the MIC90s of 0.25 microgram/ml. Penicillins were not so active with the MIC90s of 128 micrograms/ml or above. 9. Proteus mirabilis P. mirabilis was susceptible to a majority of drugs. CMX, CAZ, CZON, LMOX, CFIX, CRMN and CPFX showed the highest activities against P. mirabilis isolated from patients with urinary tract infections. The MIC90s of them were 0.125 microgram/ml or below. MINO was not so active with the MIC90 of 256 micrograms/ml or above. 10. Pseudomonas aeruginosa Most of the agents were not so active against P. aeruginosa. IPM showed MIC90 of 8 micrograms/ml.

Tumor necrosis factor and coagulopathy in patients with prostate cancer

This study was undertaken to evaluate the relationship between serum tumor necrosis factor (TNF) and coagulopathy in patients with prostate cancer. TNF levels in 104 sera obtained from 101 prostate cancer patients were determined using an enzyme immunoassay. Serum levels of fibrin/fibrinogen degradation product E fragment (FDP) and plasma levels of fibrin degradation product D-dimer in patients with elevated serum TNF levels were 1221.95 +/- 375.94 ng/ml and 27.34 +/- 9.81 micrograms/ml, which were significantly higher than those (FDP, 94.35 +/- 13.17 ng/ml; D-dimer, 1.03 +/- 0.20 micrograms/ml) in patients with undetectable serum TNF levels (P < 0.01). In addition, patients with elevated serum TNF levels showed significant increases in plasma levels of thrombin-antithrombin-III complex and plasmin-alpha 2-antiplasmin inhibitor complex and a significantly higher incidence of positive plasma soluble fibrin monomer complex than did those with undetectable serum TNF levels. The percentage of prothrombin time was significantly decreased in the group with elevated serum levels of TNF. Serum levels of TNF were significantly elevated in patients with serum FDP levels of > or = 200 ng/ml than in those with serum FDP levels of < 200 ng/ml (3.91 +/- 0.45 versus 2.17 +/- 0.08 units/ml) and in patients with plasma D-dimer levels of > or = 2 micrograms/ml than in those with plasma D-dimer levels of < 2 micrograms/ml (3.82 +/- 0.48 versus 2.10 +/- 0.06 units/ml). These results suggest that TNF may be one of the pathogenetic factors that could explain the occurrence of coagulopathy in patients with prostate cancer.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1992). II. Background of patients]

Clinical background was investigated on 913 bacterial strains isolated from patients with urinary tract infections (UTIs) in 11 hospitals during the period from June, 1992 to May, 1993. 1. Distribution of sex, age and infections Among over forties males, the majority was taken by complicated urinary tract infections. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age. 2. Distribution of sex, age and pathogens isolated from UTIs IN uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age, and next CNS in under fifties. In complicated UTIs without indwelling catheter, E. coli and Enterococcus faecalis were isolated with a frequency of 12-28%, respectively. In complicated UTIs with indwelling catheter, Pseudomonas aeruginosa were most frequently isolated, and next E. faecalis. 3. Administration of antibiotics and pathogens isolated from UTIs In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 306 to 44 isolates. And also, pathogens of complicated UTIs without indwelling catheter, have decreased from 217 to 76 isolates. However, in complicated UTIs with indwelling catheter, pathogens after or before administration of antibiotics, were not revealed an obvious change. 4. Pathogens and UTIs with or without factor and operation In uncomplicated UTIs with or without factor and operation, E. coli was mainly detected. In complicated UTIs without indwelling catheter and with or without factor and operation, E. coli was mainly detected. In complicated UTIs with indwelling catheter and with factor and operation, P. aeruginosa and E. faecalis were detected, 19.6% and 16.0%, respectively. Without factor and operation, P. aeruginosa was detected, 28.9%, and next E. faecalis 13.3%. The distribution of pathogens after administration of antibiotics was similar.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1991). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 751 bacterial strains isolated from patients with urinary tract infections in 11 hospitals during the period of June 1991 to May 1992. Of the above total bacterial isolates, Gram-positive bacteria accounted for 28.6% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 71.4% and most of them were Escherichia coli. 1. Enterococcus faecalis Ampicillin (ABPC), imipenem (IPM) and vancomycin (VCM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC90s of them were 2 micrograms/ml. Piperacillin (PIPC) and chloramphenicol (CP) were also active with the MIC90s of 8 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 2. Staphylococcus aureus including MRSA Arbekacin (ABK) showed the highest activities against S. aureus isolated from patients with urinary tract infections. Its MIC90 was 0.5 microgram/ml. VCM was also active with its MIC90 of 1 microgram/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 3. Citrobacter freundii Ciprofloxacin (CPFX) showed the highest activities against C. freundii isolated from patients with urinary tract infections. Its MIC90 was 0.5 microgram/ml. IPM, gentamicin (GM), ABK and norfloxacin (NFLX) were also active with the MIC90s of 1 microgram/ml. Penicillins and cephems were not so active. 4. Enterobacter cloacae IPM showed the highest activities against E. cloacae isolated from patients with urinary tract infections. Its MIC90 was 0.5 microgram/ml. CPFX was also active with the MIC90 of 2 micrograms/ml. Aminoglycosides were active comparatively. The MIC90s of them were 4 micrograms/ml. Penicillins and cephems generally showed lower activities. 5. Escherichia coli IPM and ciprofloxacin (CPFX) showed the highest activities against E. coli isolated from patients with urinary tract infections. The MIC90s of them were 0.125 micrograms/ml or below. Flomoxef (FMOX), cefmenoxime (CMX), cefuzonam (CZON), latamoxef (LMOX), norfloxacin (NFLX) and ofloxacin (OFLX) were also active with the MIC90s of 0.25 microgram/ml. Penicillins except mecillinam (MPC) were not so active showing the MIC90s of 32 micrograms/ml or above. 6. Klebsiella pneumoniae IPM showed the highest activities against K. pneumoniae isolated from patients with urinary tract infections. Its MIC90 was 0.25 microgram/ml. Gentamicin (GM) and arbekacin (ABK) were also active with the MIC90s of 0.5 microgram/ml, respectively. But minocycline (MINO) and penicillins were not so active showing the MIC90s of 32 micrograms/ml or above. 7. Proteus mirabilis Most of the agents were active against P. mirabilis.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1991). II. Background of patients]

Clinical background was investigated on 632 bacterial strains isolated from patients with urinary tract infections (UTIs) in 11 hospitals during the period from June, 1991 to May, 1992. 1. Distribution of sex, age and infections Among over forties males, the majority was taken by complicated urinary tract infections. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age. 2. Distribution of sex, age and pathogens isolated from UTIs In uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age, and next Enterococcus faecalis in over fifties. In complicated UTIs without indwelling catheter, E. coli and E. faecalis were isolated with a frequency of 17.4-26.6%, respectively. In complicated UTIs with indwelling catheter, E. faecalis were most frequently isolated, and next Pseudomonas aeruginosa. 3. Administration of antibiotics and pathogens isolated from UTIs In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 319 to 34 isolates. And also, pathogens of complicated UTIs without indwelling catheter, have decreased from 122 to 49 isolates. However, in complicated UTIs with indwelling catheter, pathogens after or before administration of antibiotics, were not revealed an obvious change. 4. Pathogens and UTIs with or without factor and operation In uncomplicated UTIs with or without factor and operation, E. coli was mainly detected. In complicated UTIs without indwelling catheter and with or without factor and operation, E. faecalis and E. coli were mainly detected. In complicated UTIs with indwelling catheter and with factor and operation, E. faecalis and P. aeruginosa were detected, 24.3% and 22.9%, respectively. Without factor and operation, E. faecalis was detected 18.4%, and next Klebsiella spp. 15.8%. And the distribution of pathogens after administration of antibiotics was similar.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1990). II. Background of patients]

Clinical background was investigated on 861 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period from June, 1990 to May, 1991. 1. Distribution of sex, age and infections: Among over fifties males, the complicated urinary tract infections was most frequent. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age. 2. Distribution of sex, age and pathogens isolated from UTIs: In uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age. In complicated UTIs without indwelling catheter, E. coli and Enterococcus faecalis were isolated with a frequency of 20-30%, respectively. In complicated UTIs with indwelling catheter, Pseudomonas aeruginosa were most frequently isolated, and next E. faecalis. 3. Administration of antibiotics and pathogens isolated from UTIs: In uncomplicated UTIs and complicated UTIs without indwelling catheter, pathogens, after administration of antibiotics, isolated from patients have obviously decreased. In complicated UTIs with indwelling catheter, pathogens, before and after administration of antibiotics, isolated from patients were not decreased. And the distribution of pathogens after administration of antibiotics was similar.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1990). III. Secular changes in susceptibility]

Susceptibilities of Enterococcus faecalis, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa, Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1990 to May 1991 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis to minocycline (MINO) and ofloxacin (OFLX) has decreased. As for Citrobacter spp., Enterobacter spp. and P. mirabilis, which were detected very few in 1989 and 1990, their susceptibilities were not observed an obvious change. The susceptibilities of E. coli to MINO was observed a very clear alteration, that is, in uncomplicated UTIs and complicated UTIs, the susceptibilities has decreased. However, the susceptibilities of Klebsiella spp., P. aeruginosa and Serratia spp. were not observed an obvious variation.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1990). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 848 bacterial strains isolated from patients with urinary tract infections in 10 hospitals during the period of June 1990 to May 1991. Of the above total bacterial isolates, Gram-positive bacteria accounted for 23.9% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 76.1% and most of them were Escherichia coli. 1. Enterococcus faecalis: Ampicillin (ABPC), imipenem (IPM) and vancomycin (VCM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC90s of them were 2 micrograms/ml. Piperacillin (PIPC) was also active with the MIC90 of 4 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 2. Staphylococcus aureus: VCM and arbekacin (ABK) showed the highest activities against S. aureus isolated from patients with urinary tract infections. The MIC90s of them were 1 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 3. Escherichia coli: Cefozopran (CZOP), carumonam (CRMN) and ofloxacin (OFLX) showed the highest activities against E. coli isolated from patients with urinary tract infections. The MIC90s of them were of 0.125 microgram/ml or below. IPM, cefotiam (CTM) and cefmenoxime (CMX) were also active with the MIC90s of 0.25 micrograms/ml. Penicillins were not so active with the MIC90s of 32 micrograms/ml or above. 4. Klebsiella pneumoniae: Flomoxef (FMOX), cefixime (CFIX), CZOP and CRMN showed the highest activities against K. pneumoniae isolated from patients with urinary tract infections. The MIC90s of them were of 0.125 microgram/ml or below. IPM and gentamicin (GM) were also active with the MIC90s of 0.25 microgram/ml and 0.5 microgram/ml, respectively. All other cephems were also active with the MIC90s of 4 micrograms/ml or below. 5. Citrobacter freundii: GM and IPM showed the highest activities against C. freundii isolated from patients with urinary tract infections. The MIC90s of them were 1 microgram/ml. Amikacin (AMK) was also active with the MIC90 of 4 micrograms/ml. The others were not so active. 6. Enterobacter cloacae: IPM and GM showed the highest activities against E. cloacae isolated from patients with urinary tract infections. The MIC90s of them MIC90s of 0.5 microgram/ml. AMK and OFLX were also active with the MIC90s of 4 micrograms/ml. Penicillins and cephems generally showed lower activities. 7. Proteus mirabilis: Most of the agents were active against P. mirabilis. Cephems were generally active with the MIC90s in a range of < or = 0.125 microgram/ml-4 micrograms/ml.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1991). III. Secular changes in susceptibility]

Susceptibilities of Enterococcus faecalis, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June 1991 to May 1992 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis to cefmenoxime and amikacin has decreased. As for Citrobacter spp., Enterobacter spp., P. mirabilis and Serratia spp., which were detected very few in 1989, 1990 and 1991, their susceptibilities were not observed an obvious change. The susceptibilities of E. coli to minocycline was observed a very clear alteration, that is, in uncomplicated UTIs and complicated UTIs without indwelling catheter, the susceptibilities has decreased. However, the susceptibilities of Klebsiella spp. was not observed an obvious variation. The susceptibilities of P. aeruginosa to quinolones isolated from uncomplicated UTIs has clearly decreased. These data should be considered in clinical treatment of various urinary tract infections.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1989). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 1,032 bacterial strains isolated from patients with urinary tract infections in 10 hospitals during the period of June 1989 to May 1990. Of the above total bacterial isolates, Gram-positive bacteria accounted for 30.8% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 69.2% and most of them were Escherichia coli. 1. Enterococcus faecalis Imipenem (IPM) showed the highest activity against E. faecalis isolated from patients with urinary tract infections. The followings, ampicillin (ABPC) and vancomycin (VCM) showed potent activities, with the MIC90S of 2 micrograms/ml. Piperacillin (PIPC), minocycline (MINO) and chloramphenicol (CP) were also active with the MIC90S of 8 micrograms/ml. The others were not so active with the MIC90S of 32 micrograms/ml or above. 2. Staphylococcus aureus VCM showed the highest activity against S. aureus with MIC90 of 1 microgram/ml. Dicloxacillin (MDIPC) and arbekacin (ABK) were active with the MIC90S of 2 micrograms/ml. MINO showed the MIC90 of 4 micrograms/ml. All other agents except ciprofloxacin (CPFX) showed lower activity. 3. Staphylococcus epidermidis MINO showed the highest activity against S. epidermidis. Its MIC90 was 0.25 microgram/ml. The followings, ABK and VCM were also active with the MIC90S of 0.5 microgram/ml, 2 micrograms/ml, respectively. The others except CPFX were not so active. 4. Coagulase-negative staphylococci (CNS) Most of the agents were active against CNS. IPM, ABK and MINO showed the highest activities with the MIC90S of 0.125 microgram/ml or below. MDIPC, cefazolin (CEZ), cefotiam (CTM) and VCM were also active with the MIC90S of 1 microgram/ml. Clindamycin (CLDM) showed lower activity, with the MIC90 of 128 micrograms/ml. 5. Streptococcus agalactiae CEZ, cefuzonam (CZON), IPM and CLDM showed the potent activity, all strains were inhibited at the MIC of 0.125 microgram/ml or below. The followings, cefmenoxime (CMX) and erythromycin (EM) were active with the MIC90S of 0.125 microgram/ml or below. PIPC and VCM were also active with the MIC90S 0.25 microgram/ml and 0.5 microgram/ml, respectively Amikacin (AMK) showed lower activity. Escherichia coli IPM, CTM, flomoxef (FMOX), CMX, carumonam (CRMN), norfloxacin (NFLX), ofloxacin (OFLX) and CPFX showed the highest activities against E. coli. The MIC90S of them were .125 microgram/ml or below. ceftazidime (CAZ) and CZON were also active with the MIC90S of 0.25 microgram/ml. Penicillins except mecillinam (MPC) were not so active showing the MIC90S of 32 micrograms/ml or above. 7. Klebsiella pneuminiae FMOX, CMX, cefixime (CFIX), IPM, CRMN and NFLX showed the highest activities against K. pneumoniae.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1989). II. Background of patients]

Clinical background was investigated on 1,197 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period from June, 1989 to May, 1990. 1. Distribution of sex and age A majority of female patients with UTIs accounted for a twenties and thirties. The proportion of male patients with UTI has increased with age, accounting for majority in patients 70 years or older. 2. Distribution of infection types and age Most cases among twenties or thirties were uncomplicated UTIs. Fifties and older cases were most frequent in complicated UTIs. 3. Distribution of isolated bacteria and age Escherichia coli was most frequent on the whole, followed by Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus spp. and Klebsiella spp.. E. coli had declined with age, and on the other hand, E. faecalis and P. aeruginosa had increased with age. 4. Administration of antibiotics and pathogens isolated from UTIs. In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 439 to 4. Before an administration of antibiotics, E. coli was mainly detected, but after an administration of antibiotics, E. coli has decreased into two strains. After administration of antibiotics, pathogens of complicated UTIs, without indwelling catheter, have decreased from 324 to 19: E. coli has decreased from 86 to 2, but E. faecalis, Staphylococcus spp., Enterobacter spp. and P. aeruginosa have increased. Pathogens of complicated UTIs with indwelling catheter, have decreased from 156 to 14 after administration of antibiotics, and mainly isolated pathogens were E. faecalis and P. aeruginosa.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1989). III. Secular changes in susceptibility]

Susceptibilities of Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa, Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1989 to May 1990 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. As for Citrobacter spp., P. mirabilis and Serratia spp., which were detected very few in 1989, their susceptibilities were not observed an obvious change. As for Enterobacter spp., the susceptible strains to flomoxef, cefixime, cefuzonam and ceftazidime increased in complicated UTIs with indwelling catheter. The susceptibilities of E. coli to penicillins increased slightly in complicated UTIs with indwelling catheter. Against Klebsiella spp., a good activity of minocycline or cephems was found. The susceptibilities of P. aeruginosa to ciprofloxacin and new quinolones increased in uncomplicated UTIs. These data should be considered in clinical treatment of various urinary tract infections.

Complications in radical cystectomy and their prevention

We wish to dedicate this review article on radical cystectomy, its complications and their prevention to the memory of Prof. Luciano Giuliani. The article is based on a work written originally by Jim Montie and many other authors for the consensus meeting on bladder cancer held in Antwerp in 1994 and recently published in a booklet entitled “Global strategy for bladder cancer” (1). With the consent of Montie and the other co-authors, we have prepared on updated Italian version, inserting some parts (such as vascular complications) which were treated more superficially in the preliminary text.

Autocrine growth of transitional cell carcinoma of the bladder induced by granulocyte-colony stimulating factor

Granulocyte-colony stimulating factor (G-CSF) produced by nonhematopoietic malignant cells has been reported to be capable of inducing a leukemoid reaction in the host through intense stimulation of leukocyte production. Furthermore, this is frequently associated with aggressive tumor cell growth and a detrimental clinical outcome. In this study, we identified bladder cancer cells producing G-CSF with the expression of the functional receptor, which provides direct evidence of autocrine growth of bladder cancer cells induced by G-CSF. The cancer cells used in this study were obtained from a 76-year-old man who had a metastatic transitional cell carcinoma of the bladder and who demonstrated marked leukocytosis, his peripheral blood leukocyte count was 94,900 leukocytes/mm3, and his serum G-CSF level was 103 pg/ml. The culture medium in which the cancer cells were grown exclusively contained a significant amount of G-CSF (5560 pg/ml). Significant G-CSF mRNA expression and G-CSF receptor mRNA expression in the cultured cells were demonstrated by the reverse transcription-PCR method. In addition, binding studies with the use of radiolabeled recombinant G-CSF demonstrated the presence of high-affinity G-CSF binding receptors on the cultured cancer cells. Finally, the proliferation of the cultured cancer cells was stimulated by exogenous G-CSF administration, and this stimulation was inhibited by adding anti-G-CSF antibody, as demonstrated by both the flow cytometric bromodeoxyuridine incorporation technique and the [3H]thymidine incorporation assay. These results strongly suggest that G-CSF production by the bladder cancer cells studied augments autocrine growth. Therefore, we recommend exercising caution in the clinical use of G-CSF for bladder cancer patients.

Intrarenal satellites of renal cell carcinoma: histopathologic manifestation and clinical implication

OBJECTIVES

This study was designed to gain more insight into the incidence of satellites of renal cell carcinoma related to the pathologic stage and grade of the primary tumor.

METHODS

One hundred eight nephrectomized kidneys with renal cell carcinoma were sectioned at 3-mm intervals and inspected microscopically for satellite carcinomas. The number, site, size, and distance of satellite carcinomas found were recorded in relation to the primary carcinoma.

RESULTS

The overall incidence of satellite carcinoma was 6.5% (7 of 108). The incidence of satellite carcinoma in relation to the pathologic staging of the primary tumor was 7.1% (1 of 14) in pT1, 3.0% (2 of 66) in pT2, and 14.3% (4 of 28) in pT3. The incidence was higher in patients with N1 disease (25%) than in those with NO (5.0%), and higher in M1 disease (25%) than in those in MO (5.77%). There was no relationship between the grade and multicentricity.

CONCLUSIONS

The incidence of satellite carcinoma was higher in cases with high-stage primary carcinoma. However, even in localized diseases (PT1, pT2), satellite carcinomas were found at at 3.75% incidence. When nephron-sparing surgery is indicated in low-stage cases, precise clinical staging using a combination of various imaging modalities is mandatory, with intraoperative ultrasonography being one possible modality for detecting a concomitant satellite carcinoma.

Laparoscopic adrenalectomy: clinical results in 25 patients

Adrenal tumors would be eminently suitable for laparoscopic surgery because of their size and location. We have performed 25 cases of laparoscopic adrenalectomy, and the purpose of this study was to evaluate the clinical results. Since November 1992, 12 men and 13 women with a mean age of 47.3 (range 29-71) years underwent laparoscopic adrenalectomy. Fifteen lesions were on the left side, and ten lesions were on the right side. The clinical diagnosis was primary aldosteronism in eight patients, Cushing's syndrome in seven, and a nonfunctioning adrenal tumor in ten. The mean operating time was 254 +/- 72 minutes (range 155-412 minutes), but the time on the last 10 cases was 216 +/- 40 minutes, which was equal to the mean operating time of the 15 open adrenalectomy cases (190 +/- 66 minutes). There was no difference in the operating time by clinical diagnosis. The time to first oral intake after the operation was shorter in the laparoscopic group, the need for analgesics was less, and the hospital stay and the time until return to preoperative activity were shorter than after open surgery. The laparoscopic cases had no significant complications, and every operation was performed completely. Although there was the learning curve for the performance of laparoscopic adrenalectomy, its operating time was equal to that of open surgery, and the postoperative recovery was significantly faster. Therefore, laparoscopic adrenalectomy would be useful compared with open surgery on the basis of invasiveness and cost.

p53 gene mutation in recurrent superficial bladder cancer

Surgical specimens from 30 patients with transitional cell carcinoma of the bladder were examined for the presence of mutation of the p53 tumor suppressor gene using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. All of the specimens were superficial, low grade cancer, and 10 patients had recurrences during an observation period of 24 months following the initial surgical treatment. Among the 30 patients with superficial bladder cancer, 4 were found to have the mutated p53 gene and 3 of them had recurrences, which involved either invasive or high grade tumors. Two of these recurrent tumors with the p53 gene mutation showed identical mutations with those primary tumors, whereas the other one did not have the same mutation. The data suggest that bladder cancers with a mutation of the p53 gene have a greater probability of poor prognosis than those which do not, even if the primary lesion was a superficial, low grade tumor. Therefore, the presence of the p53 gene mutation may provide important clues to the factors involved in bladder cancer.

[Clinical efficacy of methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy following radical surgery for locally invasive urothelial cancers: long-term results]

Determined were long-term results of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) adjuvant chemotherapy following radical surgery for locally invasive urothelial cancers. All cases at least histologically exhibited one of the following findings, a stage beyond pT3b (bladder cancer) or pT3 (upper tract urothelial cancer), lymph duct tumor involvement (ly +), venous involvement (V +), and/or regional lymph node involvement (N1) without any evidence of distant metastasis and/or residual tumors. Two cycles of M-VAC chemotherapy were given after radical surgery for each case. A total of 33 cases comprising 21 bladder cancers and 12 upper tract urothelial cancers following cystectomy and/or nephroureterectomy with partial cystectomy who had a mean follow-up period of 56.7 +/- 9.2 months could be analyzed. Overall actuarial survival rates of three- and five-years estimated by Kaplan-Meier method were respectively 41.9% and 31.6%. These results indicate that the postoperative outcome was extremely poor in patients with locally advanced urothelial cancer even after extensive adjuvant chemotherapy. Therefore, more effective modalities including optimal dose and scheduling of chemotherapy are needed to assure therapeutic improvement of locally invasive urothelial cancers.

MRI evaluation of cavitation induced by laser prostatectomy

Magnetic resonance images obtained by endorectal surface coils have shown histopathological changes in the prostate. In patients who underwent laser prostatectomy, MR imaging demonstrated how deeply the laser energy penetrated and how different changes were induced by the coagulation and vaporization techniques. Cavitation effects were quantitatively analyzed, and the processes of reepithelization after sloughing of necrotic tissues were observed in gadolinium-enhanced T1-weighted images.

Effects of 5 alpha-dihydrotestosterone (DHT) on the transcription of nm23 and c-myc genes in human prostatic LNCaP cells

Proliferation of the androgen-dependent human prostate LNCaP cells was increased by the androgen DHT. Changes in the steady state level of the nm23 and c-myc mRNA in LNCaP cells, with or without 10 nM DHT, showed the nm23 mRNA to change rapidly, beginning to rise after 2 h and reaching its peak by 4 h of DHT treatment. In contrast, increases in the c-myc gene only became apparent after 4 h of treatment. Maximal increase of nm23 mRNA was observed at 10(-9) M DHT. The basal expression of c-myc and nm23 mRNAs was between 30-70% lower in the LNCaP cells, as compared with the androgen-independent PC-3 and JCA-1 human prostatic human carcinoma cells. Thus nm23 may be classified as a member of the early androgen-responsive genes.

Magnetic resonance imaging following microwave thermotherapy, laser ablation and transurethral resection in patients with BPH

Morphologic changes in hyperplastic prostate tissue following three different treatments were analysed by MRI using an endorectal surface coil. In cases treated by TUMT, the MRI findings of the prostate showed hemorrhagic necrosis, which was absorbed in 12 weeks, and a widened prostatic urethra. In cases treated by laser ablation, the thermal effect went deep, causing necrotic changes, and it took more than 8 weeks for the tissue to be shed and re-epithelization completed. In TURP, degenerative changes were seen only near the surface following mass reduction of the hyperplastic tissue, and the capsule shrinkage resulted in normalization of the prostatic urethra. It is suggested that improvement of the other parameters, such as IPSS and peak flow, in patients with obstructive BPH basically depends on these morphologic changes shown by MRI.

Flow cytometric measurements of deoxyribonucleic acid ploidy and proliferative activity for evaluating malignant potential of human bladder cancers

Flow cytometric bromodeoxyuridine/deoxyribonucleic acid (DNA) bivariate analysis for transitional cell carcinoma of the human bladder tumor was performed to evaluate whether or not this technique can determine the malignant potential of these tumors. In vitro bromodeoxyuridine incorporation into the tumor cells, which were obtained from biopsy or cystectomy, was carried out by 1-h bromodeoxyuridine incubation under hyperbaric oxygen. Flow cytometric DNA aneuploidy was designated when distinctly different cell peaks were presented on the basis of DNA histograms. Bromodeoxyuridine-labeled cells were determined as the percentage in the entire cell population (Labeling index: LI). Of the total of 100 tumors, 45 tumors demonstrated DNA diploidy with a mean bromodeoxyuridine LI of 4.9 +/- 3.0%. On the other hand, the remaining 55 DNA aneuploid tumors featured a mean bromodeoxyuridine LI of 13.5 +/- 8.6%. Respectively observed in grades 1, 2, and 3, tumors were 26.7% aneuploidy (4 of 15) with a mean bromodeoxyuridine LI of 4.8 +/- 3.0%, 45.9% aneuploidy (28 of 61) with a mean bromodeoxyuridine LI of 8.5 +/- 7.0%, and 95.8% aneuploidy (23 of 24) with a mean bromodeoxyuridine LI of 15.7 +/- 8.9%. When the tumors were classified as superficial tumor and muscle-invaded tumor, all muscle-invaded tumors exhibited DNA aneuploidy with a mean bromodeoxyuridine LI of 17.2 +/- 8.5%, which was statistically significantly higher than those of superficial DNA aneuploid tumors having a 9.4 +/- 6.7% bromodeoxyuridine LI. Moreover, 66 patients with low LI tumors had a 3-year survival rate of 96.1% compared with 38.1% for 34 patients with high bromodeoxyuridine-LI tumors, which was statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Retroperitoneal Ewing's sarcoma

We report a case of extraskeletal Ewing's sarcoma arising in the retroperitoneal cavity. The tumor was excised en bloc with the left kidney and infiltrated portion of the left ureter. Histological diagnosis was confirmed by both electron micrography and immunohistochemical staining using a newly developed mouse monoclonal antibody 5C11, which specifically reacts with Ewing's sarcoma. An adjuvant chemotherapy T-11 regimen has been successfully preventing the recurrence.