Granulocytopenia and thrombocytopenia associated with combination therapy of amphotericin B and low-dose flucytosine in a patient with cryptococcal meningitis

A patient was admitted complaining of fever and headache. He was suspected of meningitis due to nuchal rigidity, and a lumbar puncture was performed. The patient was diagnosed as having cryptococcal meningitis, as Cryptococcus neoformans was found in an India ink preparation of the cerebrospinal fluid. Both amphotericin B and low-dose flucytosine (50 mg/kg/d) were concomitantly administered to the patient and his clinical symptoms improved. However, the combination therapy induced granulocytopenia and thrombocytopenia, which resolved after discontinuance of the drugs. Amphotericin B alone failed to cause granulocytopenia or thrombocytopenia. These results suggest that the mechanisms of granulocytopenia and thrombocytopenia may be toxic reactions to flucytosine in the azotemic state caused by amphotericin B. Our report emphasizes the need for clinicians to monitor for granulocytopenia and thrombocytopenia in patients receiving treatment with both amphotericin B and flucytosine, even when flucytosine is administered in a low dose.

[Study of long-survival cases with liver metastasis of colorectal cancer by hepatic arterial infusion chemotherapy]

We performed arterial infusion chemotherapy through hepatic artery in 33 patients with liver metastasis of colorectal cancer. Regarding the survival rate, the 1-year survival rate was 55.6% and the 5-year rate was 27.8% in cases of H2, and 1-year as 28.9% in H3. According to criteria of Saito-Koyama, the response rate was 24.2%, including 2 CR and 6 PR cases. There were more patients with H2 factor and without peritoneal dissemination who survived for one year and more. The dose of 5-FU was 9.6 +/- 3.6 g in case of longer survivals and 5.1 +/- 3.0 g in non-responders. There were significant differences between them. The pretreatment value of CEA was lower than 100 ng/ml in 8 of 11 longer survivals, and the CEA values were decreased after this treatment in 9 of 11 responders. On the other hand, it was noted that the non-responders had a higher level of CEA such as more than 100 ng/ml, and in these cases CEA was not decreased after treatment. There are two favourable responders who are still living 9 and 5 years after successful treatment. Their pretreatment value of CEA was lower at 13.6 and 23.8 ng/ml, respectively, and these levels were decreased to 1.0 ng/ml with administration of 5-FU with ADM and 5-FU with MMC. It was concluded that arterial infusion chemotherapy was good for treatment of metastatic liver tumors from colorectal cancers.

Factors affecting postoperative ventilatory support in patients with cardiac cachexia

Factors affecting early v late weaning from ventilatory support after cardiac surgery were retrospectively compared in 15 patients with cardiac cachexia. These patients were divided into two groups based on the duration of postoperative ventilatory support, group I (n = 7) less than two days (22 +/- 8 hours) and group II (n = 8) over three days (140 +/- 125 hours). Findings in 14 randomly selected patients without cardiac cachexia who underwent cardiac valve replacement were also examined. Comparisons were made between the groups in regards to the following parameters: (1) preoperatively: anthropometric, biochemical, and immunologic parameters of nutritional status, hepatic function, cardiothoracic ratio (CTR) on chest x-ray, and data from cardiac catheterization; (2) intraoperatively and postoperatively: anesthetic drugs, duration of surgery, cardiopulmonary bypass (CPB), aortic cross-clamp, and postoperative use of inotropes. The anthropometric measurements, cell-mediated immunity, and hepatic function were significantly decreased in all patients with cachexia, but with no significant differences between the groups. Serum transferrin levels, which increased in patients with cachexia, showed no significant difference between the groups. The levels of serum albumin were significantly lower in cachectic patients than in patients without cachexia; they were significantly higher in group II than in group I. The durations of surgery and CPB were significantly longer in group II, but there was no significant difference in the duration of aortic clamping between the groups. The postoperative use of inotropes was higher in group II. These results indicate that group II patients were nutritionally as well sustained as group I. However, they had less satisfactory cardiac function, and therefore required a longer duration of postoperative ventilatory support.

[Sleep apnea in well-controlled myasthenia gravis]

Polygraphic monitoring of the respiratory status during sleep provides a definitive test for the presence of the sleep apnea syndrome. This syndrome has been recognized in various kinds of neurological disorders. However, as far as we know, there have been no reports of describing the sleep apnea syndrome in myasthenia gravis (MG). We conducted overnight polygraphic sleep studies of 10 patients of clinically well-controlled MG.

PATIENTS

We examined 10 patients of MG (4 men and 6 women). The subtypes of MG were IIA(1), IIB(8) and V(1) according to Osserman's criteria.

RESULTS

Six patients, with an average age of 47.8 and the average duration of 6.2 years, had polysomnographically obstructive and central types of sleep apnea, appearing longer than 10 seconds and more than 30 times in one night. Their mean Apnea Index (AI) was 14.6. The duration of mean apnea was 23.4 seconds and 99.0 times the average frequency. On the other hand, in four patients of MG, averaged age at 30.8 and for a 0.9-year duration, the sleep apnea syndrome was never seen. Therefore, the longest duration of MG tended to have the sleep apnea syndrome.

DISCUSSION

Six out of the 10 patients of MG had obstructive and central types of the sleep apnea syndrome. Since their respiratory functions examined in a daytime were normal and the physical findings concerned with MG were well controlled by medications, our findings of nocturnal sleep apnea might be indicative of a central cholinergic system disturbance in MG during sleep.

[Clinical evaluation of second-look operations in colorectal cancer]

The second look operation (SLO) for early detection of recurrent tumor is indicated rarely because of the advance in diagnostic techniques such as imaging radiology, tumor marker serology and colonofiberscopy. The SLO was performed in 21 out of 362 curative cases of colorectal cancer resected in our department; 13 for re-elevation of plasma CEA level (Group 1), 6 for unclear symptoms or signs (Group 2) and 2 for postchemotherapy or postirradiation (Group 3). Liver metastases were found in four cases in group 1 and two in group 2. Nothing was found in three cases in group 1 and two in group 2. In group 3 the radical operation was carried out in all cases following SLO with good survival results. In group 1 and 2 the excisional rate of liver metastases in 57%, its salvage rate 75%, and the excisional rate of the lymph nodes is 50%, with a salvage rate of 100%. The SLO today is indicated for cases of asymptomatic re-elevation of CEA titer, for cases of undeterminable signs or for cases of postchemotherapeutic or postirradiation improvement.

The deconjugation ability of bacteria isolated from the jejunal fluids in the blind loop syndrome with high 14CO2 excretion--using the breath analysis technique and thin-layer chromatography

Five patients with blind loop syndrome (Billroth II) were examined by measuring 14CO2 specific activity of expired breath samples taken at intervals after a meal containing glycine-1-14C cholate. The 5 patients tested showed a marked increase of 14CO2 specific activity. Furthermore, the ability of deconjugation of bacteria isolated from the jejunal fluids in the efferent loop of these patients was tested by thin layer chromatography. The bacterial species identified from the samples were as follows: enterococcus, Lactobacillus (L) buchneri, L. bifidus, L. brevis, Eubacterium (E) lentum, Bacteroides (B) vulgaricus, B. filamentosum, Corynebacterium (C) granulosum, Escherichia (E) coli, Staphylococcus (S) epidermidis, and Aerobacter (A) aerogenes. These species of bacteria, except E. coli and A. aerogenes, showed the deconjugation ability by which conjugated bile acids in ox gall was hydrolyzed. Administration of chloramphenicol (1g per day for 14 days orally divided doses) to the 5 patients reduced 14CO2 specific activity significantly. On the other hand, 9 healthy men (control subjects) who were tested showed a flat curve, and 8 of the 9 had no growth of bacteria isolated from the jejunal fluids. The remaining healthy man showed an overgrowth of E. coli and Pseudomonas (P) aeruginosa, but the species did not have the ability of deconjugation. Thus, we concluded that the patients with blind loop syndrome(Billroth II) had the bacterial overgrowth in the efferent loop that contained species with deconjugation ability, and, as a result the bacterial overgrowth contributed to causing abnormalities (increased deconjugation) in the metabolism of bile acids in the small intestine. When the concentration of conjugated bile acids in the small intestine was reduced to levels below the critical micellar concentration by several factors, fat malabsorption and subsequent steatorrhea were induced (1,-4). Furthermore, H. Fromm and A. F. Hofmann presented in vivo that the patients with blind loop syndrome had fat malabsorption and the patients who had a high 14CO2 output after oral administration of glycine-1-14C cholate showed a low 14CO2 output after oral administration of antibiotic drug (5,6). However, there has been no report on the deconjugation ability of bile acids of bacteria isolated from the jejunal fluids in the efferent loop of patients with Billroth II who had positive breath tests.(ABSTRACT TRUNCATED AT 400 WORDS)

A case of spontaneous rupture of ureter due to ureteral stone in G syndrome

A case of spontaneous rupture of ureter with formation of urinoma due to ureteral stone, which was noticed in an infant with G syndrome, is described. Investigation revealed that the patient had bilateral vesicoureteric reflux. The urinary tract anomalies in G syndrome are discussed.

BCG induced killer cell activity

To investigate the mechanism of Bacillus de Calmette Guérin (BCG) bladder instillation therapy, the killer cell activity induced in peripheral blood mononuclear cells (PBMNCs) after BCG instillation was examined. Significant cytotoxic activity against natural killer (NK) cell resistant target tumor cells was detected after 3 days of instillation. To characterize this BCG induced cytotoxic activity further, human PBMNCs were cultured with BCG in vitro. From 24 h maximum cytotoxicity was obtained and continued for 3 days, then decreased slightly. Neither a DNA synthesis inhibitor Cytosine-arabinoside (Ara-C) nor a cytotoxic T cell (CTL) generation inhibitor Cyclosporine A inhibited this killer cell activation. Monoclonal antibody treatment revealed that both precursor and effector cells are Leu1-, 3a-, 7+, 11b+. The recognition specificity from cold target competition experiments was selective. Taken together NK type precursor was activated with BCG into NK type effector which has wider spectrum of target cells than usual NK cell.

[Rectal cancer therapy compatible with preservation of function]

Rectal cancer surgery causes often postoperative morbidities such as defecation disturbance, dysuria and male sexual impotence. Compatibility of cancer eradication and function preservation are the problem should be resolved in the rectal cancer surgery. Defecation function were preserved in the patients with middle and upper rectal cancer by anterior resection transsacral resection, invagination or pull-through operation. Since 1984, usage of suture instruments made it practicable to increase sphincter preserving operation up to more than 65% of rectal cancer. Postoperative 5-years survivals were 81% of anterior resection, 71% of invagination operation and 57% of pull-through. Autonomic nerves preserving operation (ANP), aimed to prevent the urinary and sexual disfunction were studied both sides of the cancer spreads and extend of nerve plexuses. And ANP were adopted to the 185 cancers, limited to the submucosa or the proper muscle coat, by Study Group of Welfare Ministry. Their postoperative disfunction decreased to 15% of urination and 21% of male potency, while 33% and 81% respectively following conventional operation. Local excision for early cancer, which are defined as mucosal or submucosal cancer are discussed.

[A clinico-statistical study of testicular tumors--a reevaluation of 90 cases at the Nagasaki University Hospital and affiliated hospitals]

We have treated 90 cases of testicular tumors at our institutes from April, 1962 to March, 1986. Of 75 which were germ cell type tumors, 35 were a seminoma, for which the 5-year survival rate was 100% for patients in stage I, and 50% for those in stage III, respectively. Forty cases were non-seminomas, and all cases determined as being in stage I survived for 5 years, whereas 47.6% cases of those in stage III survived for 4.5 years. Thirty-six percent of those with a stage I germ cell tumor were treated with a orchiectomy alone, while other cases also combined radiotherapy and/or chemotherapy. Almost all cases of an advanced tumor received combined retroperitoneal lymph node resection, radiotherapy and/or chemotherapy. Patients with an advanced nonseminomatous tumor showed better a survival rate if they were given CDDP chemotherapy.

[A long-term therapeutic experience with Cernilton in chronic prostatitis]

Thirty-two patients with chronic prostatitis were given 6 tables of Cernilton daily for 12.6 weeks on the average. Improvement of subjective symptoms and objective findings was noted in 74.2% and 65.6% of the cases, respectively. The effective rate was 75.0%. No subjective symptoms or abnormal changes in laboratory data were observed in any case after Cernilton medication.

[Historical course of surgery in rectal cancer in Japan]

Rectal cancer surgery in Japan started to first step of Lisfranc type resection by T. Sato in 1887. Since H. Ito (1902) published in success of three cases of abdominosacral excision (ASE), ASE occupied the main position of rectal cancer surgery in Japan. In 1944, however, M. Kuru reported the superiority of abdominoperineal resection (APR), an orient of surgery had changed to APR from ASE with time. His operative mortality was 2.0% or less, and 5-year survival rate was more than 50%. D. Jinnai (1961) introduced endorectal pull-through operation, and in 1972 he exhibited an excellent survival and satisfying function following sphincter preserving operation, such as anterior resection and pull-through, for mid and upper rectal cancer. T. Kajitani (1975) and Y. Koyama (1977) improved the survivals through an extended pelvic nodes dissection. Today, the principle of rectal cancer surgery in Japan is a limited resection for early cancer, sphincter preserving operations for upper and mid-rectal cancer and extended pelvic nodes dissection for advanced lower rectal cancer.

[Clinico-pathological study on prostatic cancer, stage A using step section technic]

Of 52 male bladder cancer cases treated with radical cystectomy, 12 cases (23.9%) were incidentally diagnosed as stage A prostatic cancer. Histological analysis was done according to the "general rules for clinical and pathological studies on prostatic cancer." The average age of the prostatic cancer cases was 62.0 years with a range of 50 to 78 years. Three cases were of well differentiated adenocarcinoma, and 9 cases were of moderately differentiated adenocarcinoma. Six cases were at pT1, 3 at pT2, and 3 at pT3. One case was stage A1, and 11 were stage A2 cases. Perineural and capsular invasions were found in 3 cases each. Neither lymphatic nor vascular invasion was found in any case, and no evidence of seminal vesicular, urethral, bladder and rectal invasion was found in any case. Lymph node metastasis was not found in any of the 3 pelvic lymph node dissected cases.

[Pharmacokinetic and clinical studies on latamoxef in the field of obstetrics and gynecology]

Latamoxef (LMOX) 1 g was administered twice daily for 5 days to patients undergoing operation for myoma uteri and the time course of tissue concentrations of the drug and the prophylactic effect of the treatment on postoperative infection were studied. 1. Area under concentration-time curve (AUC) of LMOX was the highest in the perimetrium (45.3%), followed by the cervix uteri (39.2%), endometrium (35.9%), oviduct (35.1%), myometrium (29.5%), and ovary (24.4%). 2. Cmax was the highest in oviduct (46.9 micrograms/g), followed by Cmax's in perimetrium (44.2 micrograms/g), cervix uteri (35.8 micrograms/g), myometrium (26.9 micrograms/g), endometrium (25.6 micrograms/g), and ovary (24.3 micrograms/g). 3. Serum half-lives were T1/2(alpha) = 0.27 hour and T1/2(beta) = 1.81 hours. 4. Prophylactic efficacy against postoperative infections was 94.3%, and febrile morbidity was 5.7%. The preoperative and postoperative laboratory tests did not show appreciable changes, no adverse reaction was observed. In the present study, LMOX showed good transfer into gynecological tissues, suggesting its very high usefulness in the treatment of infection and in the postoperative management.

[Intraperitoneal versus intravenous infusion of cis-platinum in advanced ovarian cancer--examination of pharmacokinetics]

The pharmacokinetics of i.p.- and i.v.-infused cis-platinum (55 mg/m2) was studied in five patients with advanced ovarian cancer. The area under the concentration time (AUC) of non-protein-binding platinum in ascites had on anti-tumor activity 44 times larger with i.p. infusion than that with i.v. infusion. Comparing with the concentration curve of non-protein-binding platinum in plasma, there was little difference between i.p. and i.v. infusion, and the AUC of non-protein-binding platinum was almost equal between i.p. and i.v. infusion. In cases of low renal function, cisplatin was infused at 70 mg/m2 with sodium thiosulfate (STS). The AUC of ultrafiltrable platinum in plasma was 3 times larger in STS combination therapy. Therefore, STS was confirmed to be a powerful antidote against cis-platinum in plasma. Amounts of total platinum in 24-h urinary secretion were slightly less for i.p. than for i.v. infusion. Consequently, i.p. infusion of cis-platinum was shown to be highly effective on the local site and as effective as i.v. infusion on the whole body. Moreover, this route is effective for reducing ascites production and is expected to be effective against metastatic sites other than the abdominal cavity.

[Pharmacokinetic studies on cefmenoxime. Distribution into the uterus and intrapelvic genital organs]

Concentrations of cefmenoxime (CMX) in peripheral venous serum, uterus and intrapelvic genital organs were determined by bioassay. The obtained results are summarized below. When 1 g of CMX was administered by an intravenous injection, peak concentrations in various tissues of female genital organs were as follow: 17.4 and 46.8 micrograms/g in ovary and oviduct, respectively, and from 28.2 to 43.8 micrograms/g in other genital organs. These concentrations of CMX were maintained at higher level than minimal inhibitory concentrations against E. coli, Bacteroides and other organisms. In these studies, CMX showed a satisfactory clinical efficacy and a potent antibacteriological effect in the treatment of infections in the field of obstetrics and gynecology.

Acute hemorrhagic cystitis caused by adenovirus type 11 after renal transplantation

A case of acute hemorrhagic cystitis caused by adenovirus type 11, which occurred in an allograft recipient 6 months after a living-related renal transplantation, is described. The patient lacked a neutralizing antibody to adenovirus type 11 before transplantation. Adenovirus type 11 was isolated from his urine and he developed a neutralizing and complement-fixing antibody to this virus. Although adenovirus type 11 isolates had been obtained from 2 of 18 renal allograft recipients, only 1 patient suffered acute hemorrhagic cystitis. Adenovirus type 11 may play a role in acute hemorrhagic cystitis in renal allograft recipients during immunosuppressive therapy.

Reversed-phase liquid chromatographic investigation of nucleosides and bases in mucosa and modified nucleosides in urines from patients with gastrointestinal cancer

Reversed-phase high-performance liquid chromatography (HPLC) has been used to determine the level of nucleic acid metabolites in perchloric acid extracts of gastrointestinal mucosa. By comparing the levels of these compounds in the normal portion with the levels in the neoplastic portion of mucosa resected from patients with malignant cancer, it was found that uracil was significantly elevated in the neoplastic colorectal mucosa (adenocarcinoma) of eight patients with colorectal cancer (P less than 0.01, statistically significant with the paired t test). The mean level of uracil in neoplastic colorectal mucosa was 2.7-fold higher than that in normal mucosa. However, in neoplastic gastric mucosa, only one out of four patients with gastric cancer showed elevated uracil. In neoplastic mucosa, the levels of hypoxanthine and uridine for colorectal cancer, and inosine for gastric cancer, were also significantly higher than those in normal mucosa (P less than 0.05, with the paired t test). The urinary modified nucleosides were prefractionated with a boronate affinity gel column, and their levels determined by the same HPLC method. No significant differences in the concentrations of pseudouridine, 1-methylguanosine, N2-methylguanosine or N2,N2-dimethylguanosine were observed in pre- and post-operative urines from patients with colorectal cancer and normal urines.

Reversed-phase high-performance liquid chromatographic investigation of mucosal nucleosides and bases and urinary modified nucleosides of gastrointestinal cancer patients

Reversed-phase high-performance liquid chromatography (HPLC) was used to determine the levels of nucleosides, bases and their metabolites in perchloric acid extracts of gastrointestinal mucosa. By comparing the levels of these compounds in the normal portion with the neoplastic portion of mucosa resected from malignant cancer patients, it was found that there was significant elevation of the uracil level in the neoplastic mucosa of all eight patients with colorectal cancer (2.7-fold in normal mucosa), but only in the neoplastic mucosa of one out of four patients with gastric cancer. The levels of hypoxanthine and uridine in the colorectal cancer mucosa samples and the inosine in gastric cancer samples were also significantly higher than those in normal mucosa. The urinary modified nucleosides were prefractionated with a boronate affinity gel column, and their levels were determined by the same HPLC method. There was no significant difference in the concentrations of pseudouridine, 1-methylguanosine N2-methylguanosine and N2,N2-dimethylguanosine between urine samples taken before and after surgery from eight patients with malignant colorectal cancer. Contrary to other reports, no significant differences in modified nucleoside levels were observed between urine samples from patients with colorectal cancer and those from normal subjects.

Captopril-associated granulocytopenia in hypertension after renal transplantation

A living related kidney transplant recipient with normal renal functioning and hypertension secondary to renal artery stenosis was treated with captopril and developed reversible granulocytopenia. Complications caused by captopril, an angiotensin converting enzyme inhibitor, have been reported previously in hypertensive patients with systemic lupus erythematosus or with renal artery stenosis after renal transplantation. It is recommended that this drug be used with caution in this setting.

[Carcinoma of the urachus--report of 4 cases]

Four cases of urachal carcinoma are presented. The first case was a 36-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiation therapy were performed. Histological findings showed a well differentiated adenocarcinoma. He has been well for twelve years postoperatively. The second case was a 52-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiochemotherapy were performed. Histological findings showed a moderately differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The third case was 70-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed multiple tumors at the dome of the bladder, internal urethral orifice and right lateral wall. Total cystectomy, ureterocutaneostomy and postoperative chemotherapy were performed. Histological findings showed a poorly differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The fourth case was a 68-year-old woman who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. CT scan demonstrated a mass with calcification extending from the bladder dome superiorly. Partial cystectomy and postoperative chemotherapy were performed. Histological findings showed a well differentiated adenocarcinoma. She has been well for three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

[The indication and effect of radiation therapy in rectal carcinoma]

A total of sixty one patients with carcinoma of the rectum accepted radiotherapy of 40 Gy/4W to whole pelvis including the perineum. Randomized study of preoperative radiation to the pelvis showed that patients with advanced carcinoma of the lower rectum and the anus benefited in the prevention of the local recurrence and in the curability of unresectable tumor. Postoperative radiation therapy was indicated in the case of the residual tumor, metastatic lymphnodes, distinct lymphatic permeation and insufficient excision of the rectum. For the pelvic recurrence irradiation of doses more than 36 Gy was effective in the case of slow growing tumor. A radical treatment is expected for patients with inoperable tumor or for patients without indication of major surgery because of age or medical problems by the whole pelvic irradiation plus interstitial irradiation.

[The Cohen cross-trigonal technic for vesicoureteral reflux with contracted bladder in children]

A 8-year-old girl was referred with both vesicoureteral reflux and repeated urinary infection since she was 30 months old. At 5 years old, she had had cystoscopy. Her excretory urogram (IVP) was almost normal; her voiding cystogram showed both vesicoureteral reflux of grade III and a maximum bladder capacity of 75 ml. At cystoscopy the ureteral orifices were in normal position of the trigone and the orifices were dilated like a golf-hole. Both ureters were reimplanted without ureter stents by the Cohen cross-trigonal advancement technique. Her IVP and a renograms postoperatively have shown normal kidney function and no urinary retention in either kidney. Her voiding cystograms have shown no vesicoureteral reflux. For 15 months after operation she has had no urinary infection. The Cohen cross-trigonal technique is a simple, safe and more applicable method than other anti-vesicoureteral reflux operations in cases of vesicoureteral reflux with contracted bladder.

[Studies on prophylaxis and therapy of pivmecillinam against post-prostatectomy urinary tract infection]

Patients received pivmecillinam (PMPC) after prophylactic use of various antimicrobial chemotherapeutic agents following prostatectomy, and their clinical responses were assessed for effectiveness in the treatment and prevention of postoperative infection. The data were also analyzed to explore the relationship between bacterial isolates obtained during the postoperative course and the antimicrobial agents administered prophylactically against postoperative infection. Therapeutic effect of PMPC: Treatment of postoperative infections with PMPC was effective in 36 (53.7%) out of 67 patients who had undergone prostatectomy. Prophylactic effect of PMPC: The use of PMPC provided effective prevention of infection in 22 (64.7%) out of 34 patients from whom no bacterial pathogen had been isolated before postoperative antimicrobial chemotherapy. Therapeutic responses to PMPC, compared between different types of operative procedure: There was little or no difference in therapeutic effectiveness of PMPC against postoperative infection when compared between two types of operative procedure, transurethral prostatectomy and subcapsular removal of the prostate. Incidence and types of bacterial isolates following prophylactic chemotherapy with various agents after prostatectomy: Possibly because cephapirin (CEPR) and ticarcillin (TIPC) were mainly administered, alone or in combination, for prophylaxis against postoperative infection, Serratia and Pseudomonas were most frequently isolated. The findings offer suggestions as to the appropriate combination of antimicrobial agents to be used for prophylactic purposes. Effectiveness of PMPC in the presence or absence of a preoperative indwelling urethral catheter: The use of PMPC was more effective both in the treatment and prevention of postoperative infection in cases without preoperative indwelling urethral catheterization than in those with it.

Carcinosarcoma of the bladder

We report a case of carcinosarcoma of the bladder. Total cystectomy with ileal loop urinary diversion was performed. Histologically, the bulk of the tumor tissue was rhabdomyosarcoma and adenocarcinoma. At distant areas from the bulk tumor transitional cell carcinoma was noted. The literature is reviewed and the clinicopathologic condition of carcinosarcoma of the bladder is discussed.

[Histopathological study on hepatic metastases and blood CEA levels in patients with intestinal carcinoma]

In 37% of 177 cases with colo-rectal cancer, our original staining method succeeded in the detection of cancer cells invaded in the small vein vessels in the primary lesion, 35.4% of which metastasized to the liver. Cancer cells were found histologically in the portal vein in these cases. Serum CEA levels were abnormally high in the cases of vein invasion in 57%. Hematogenic metastases occurred in 90% in the cases of vein invasion with abnormal CEA level. Serum CEA level decreased after the resection of the involved intestine, but increased sharply when hematogenic metastases occurred, while the CEA level increased gradually and slowly in cases of local recurrences or peritoneal disseminations .

Measurement of the area of the anterior horn of the right lateral ventricle for the diagnosis of brain atrophy by CT. Correlation with several ventricular indices

The area of the anterior horn of the right lateral ventricle and five ventricular indices: (1) maximum width of the anterior horns, (2) minimum width of the anterior horns, (3) sum of these maximum and minimum widths, (4) ventricular index, and (5) cella media index were measured from the CT scans of 198 cases considered to be "normal". The area of the right anterior horn and indices 1-4 were measured on the slice which most clearly showed Monro's foramina and index 5 was measured on the slice 2 cm above. The size of the ventricular system increased steadily with age. The sum of the maximum and minimum widths of the anterior horns was most highly correlated with the area of the right anterior horn. Using this ventricular index, we graded brain "atrophy" in each age group.

[Clinical studies of cefoxitin in the field of internal medicine]

Ten patients with sepsis and pneumonia complicated by leukemia or lung cancer were treated with cefoxitin (CFX) at daily dose of 6 g. The following results were obtained. 1. Clinical effects of CFX were good in 5 patients, fair in 2 and poor in 3 with effective rate of 50%. 2. Out of 8 patients with sepsis, 5 showed good response to CFX and effective rate was 62.5%. 3. Bacteriological outcomes were eradicated in 1, unchanged in 1, replaced in 2 and unknown in 6 cases. 4. Diarrhea was observed in 1 patient but this was not considered related to CFX therapy. 5. No abnormal laboratory finding due to CFX was observed. 6. It should be considered that 6 g or more of CFX is given in case of severe infections, such as sepsis or pneumonia complicated by serious underlying diseases.

Effects of chronic renal failure on wound healing in rats. I. Biomechanical study

Chronic renal failure was induced in rats by a five-sixths nephrectomy, after which incisional wounds were made in the abdominal skin, aponeurosis of linea alba, stomach and colon. Bursting strength of the colon and tensile strength of the skin, aponeurosis and stomach were usually lower in the uremics than in the controls, but there was no statistical significance except for colonic wounds on the 7th and 10th postoperative days. Before these results can be extrapolated to clinical cases, pre- and post-surgical treatment must be considered, because immunosuppressants, anticoagulants, and other compounds may influence the retardation of wound healing.

Effects of chronic renal failure on wound healing in rats. II. Microscopic study and hydroxyproline assay

Incisional wounds of the abdominal skin, aponeurosis, stomach and colon were investigated microscopically for a comparison of the findings between uremic and normal rats. The grade of edema and number of inflammatory cells were increased in the rats with uremia and the granulation zone was also larger in the uremics. Hydroxyproline was assayed in the wound tissues by a modification of the technique of Stegemann and Stalder. The hydroxyproline level was lower in the uremics (p less than 0.05) only in the aponeurosis of the 5th postoperative day and in the colon of the 3.5th to 7th day. The correlation coefficient calculated for the blood urea level, biomechanical strength and hydroxyproline level was nil. If these results can validly be extrapolated to patients with chronic renal failure, careful management and avoidance of possible wound infections is of the greatest importance for surgical patients.

Epidermoid carcinoma compared with adenocarcinoma of the anal canal

Sixty-five cases of anal carcinoma have been treated in the past 20 years - 44 adenocarcinomas, 15 epidermoid carcinomas and 6 others. The sex ratio of male to female was 2:13 among those with epidermoid carcinoma and 27:17 in the adenocarcinoma group. There was no significant difference between the five-year survival associated with both kinds of carcinoma, though adenocarcinomas invaded more deeply and were larger. Lymph node metastases were found in 60% of cases in each group, but inguinal metastases were found in 47% of epidermoid carcinomas and 32% of adenocarcinomas; lung and liver metastases were seen in 13% of the former and 18% of the latter (there was no statistical significance). A new staging is proposed, supported by the five-year survival rate (in parentheses), as follows: stage 1-T1, T2, NO, MO (100%); Stage II - T3, T4, NO, Mo (66.7%) Stage III - any T, N1, MO (31.6%); Stage IV - any T, any N, M1 (0%).