[Percutaneous removal of renal and upper ureteral stones: clinical results and complications of 103 cases]

We report the results and complications of 103 consecutive patients who underwent percutaneous removal of renal and ureteral stones. The overall clinical success rate was 80.6%. For the recent 33 cases in which UL-arm fluoroscopy was used, however, the success rate was as high as 87.9%, which was considered to be due to easier establishment of percutaneous direct access. The most common complications were bleeding (18.5%), extravasation (15.5%) and fever (9.7%). Four cases with significant bleeding required arteriography, but there were no sign of arteriovenous fistula nor pseudoaneurysms in any cases. To study renal parenchymal damage in the percutaneous procedures, plasma renin activities (PRA) were compared in 54 cases after six months. However, significant elevation of PRA did not occur in any case.

[Long-term bioeffects of extracorporeal shock waves on renal tissue and blood pressure in normotensive and spontaneously hypertensive rats]

In order to examine chronic effects of shock waves on renal structure and blood pressure, normotensive Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were uninephrectomized and shock waves were given on the lower half of the residual kidney by Piezolith with the focus pressure of 1020 bar. In the first experiment, 36 WKY were divided into 6 groups; Group 1 served as control, Group 2, 4 and 6 received a single session of 1250, 2500 and 5000 shocks, respectively, whereas the animals in Group 3 and 5 received repeated dose of 1250 or 2500 shocks within 3 days after the first session. All the animals in Group 6 died within 48 hours due to remarkable renal hemorrhage, leaving only 5 Groups for the evaluation of long-term study. The blood pressure, measured by tail-cuff method 60 days after shock wave administration, was not significantly different between the control and shock-waved WKY. Neither was there any remarkable difference between the blood pressures measured prior to and 60 days after the intervention in each Group. At 16th week after the shock wave administration, the animals were sacrificed. There was a slight but statistically significant increase in serum creatinine level in Groups 2, 4 and 5, as compared to the level of control animals in Group 1. On light microscopic sections, there was no remarkable histological change in the kidney of Group 2, however, the renal parenchyma was frequently replaced with interstitial fibrosis in Groups 3, 4 and 5.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic effects of recombinant interferon-gamma in patients with renal cell carcinoma

Immunologic and antitumor effects of human recombinant interferon-gamma were studied in patients with renal cell carcinoma. A daily dose of 6 to 12 x 10(6) units/m2 of interferon-gamma was given by intravenous drip infusion or intramuscular injection to nine patients over a period varying from two to 16 weeks. Antibody-dependent cell-mediated cytotoxicity and OKIa1-positive monocytes count increased significantly after the therapy was started. Interferon-gamma transiently increased OKT3- and OKT4- positive lymphocyte count. Tumor regression was not observed when clinical response was evaluated in seven patients. Two others, who had no measurable metastases, were not evaluated, because interferon-gamma were given to them as post-operative adjuvant therapy. Our results indicate that interferon-gamma stimulated monocytes and enhanced cell-mediated cytotoxicity; they also suggest the necessity of combining monoclonal antibodies and other biological response modifiers that effect tumor-associated antigens.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1987). III. Secular changes in susceptibility]

Sensitivity spectra of major species of bacteria (namely Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Serratia marcescens and Pseudomonas aeruginosa) which were among the clinical isolates mentioned in the first and second reports to various antibacterial and antibiotic agents and time courses of the spectra are reported below. 1. E. coli was sensitive to cefmenoxime (CMX), latamoxef (LMOX), ceftazidime (CAZ), cefzonam (CZON) and flomoxef (FMOX) which are third generation cephems, carumonam (CRMN) which is a monobactam, imipenem (IPM) which is a carbapenem, ofloxacin (OFLX) and ciprofloxacin (CPFX) which are new quinolones. Compared to the preceding 5-year period, sensitivities to most drugs have increased. 2. Klebsiella spp. were sensitive to CMX, CZON and FMOX which are third generation cephem antibiotics, CRMN which is a monobactam and gentamicin (GM) and arbekacin (HBK) which are aminoglycosides. Compared to the preceding 5-year period, the sensitivity on the whole has increased slightly. 3. Proteus spp. were sensitive to CMX, LMOX, CAZ and CZON which are third generation cephems, CRMN, a monobactam and OFLX and CPFX which are new quinolones. Compared to the preceding 5-year period, increased sensitivities, particularly to parenteral cephems, were found. 4. Citrobacter spp. were sensitive to CPFX which is a new quinolone antibiotic and CRMN, a monobactam. Compared to the preceding 5-year period, the sensitivity as a whole increased but there were still strains against which cefotiam, cefmetazole and, cefoperazone (CPZ) showed high MIC values. 5. Enterobacter spp. were sensitive to OFLX and CPFX, which are new quinolones, IPM, a carbapenem, and GM and HBK which are aminoglycosides. Compared to other bacteria, bacteria of this group were less sensitive to CPZ, CAZ, CZON, and FMOX which are third generation cephems. Compared to the preceding 5-year period, slight increases in sensitivity were found in cases of simple urinary tract infections. 6. S. marcescens as a whole was not very sensitive to antibiotics tested. Compared to the preceding 5-year period, sensitivities to CRMN and minocycline improved slightly. 7. P. aeruginosa was not very sensitive to any drug, as other bacteria were. Compared to the preceding 5-year period, sensitivities to new quinolones OFLX and CPFX and carbapenem IPM decreased slightly.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1987). II. Background of patients]

In the retrospective survey of the sensitivity of clinical isolates reported in this journal, patients' backgrounds were also investigated. Some findings are summarized below. 1. Age distribution by sex: Patients with ages 50 years and older accounted for a majority, irrespective of their sexes amounting 67.6% for both sexes combined. 2. Annual distribution of sexes by age group: Females accounted for a majority in younger age brackets, but the proportion of males increased with age, accounting for a majority in patients 70 years or older. This pattern has been repeated practically every year. 3. Distribution of infection types by sex: Complicated urinary tract infections were predominant in males, while simple urinary tract infections were more frequent in females. 4. Annual distribution of sexes by type of infection: Complicated and simple urinary tract infections combined accounted for approximately 70% in both males and females. This pattern has been repeated practically every year. 5. Distribution of infection types by age: Patients of advanced ages were predominant as a whole but this trend was particularly pronounced in complicated urinary tract infection cases. 6. Annual distribution of infection types by age: The frequency of simple urinary tract infections among patients older than 20 years of age declined with age and this pattern has been repeated practically every year. Among patients older than 20 years of age, annual frequencies of complicated urinary tract infections have been on the decrease. 7. Distribution of isolated bacteria by sex: Escherichia coli was more frequent in females, while Enterococcus faecalis and Pseudomonas aeruginosa were more frequent in males. Compared with the previous year, the frequencies of coagulase-negative staphylococci, Enterococcus spp., and E. coli increased, while that of P. aeruginosa decreased. 8. Distribution of isolated bacteria by age: E. coli was most frequent on the whole, followed by E. faecalis, P. aeruginosa, Klebsiella spp., and coagulase-negative staphylococci, in that order. By age group, E. coli was frequent in younger patients and the frequencies of E. faecalis and P. aeruginosa increased with age. 9. Annual distribution of isolated bacteria by infection type: Coagulase-negative staphylococci increased as a whole and P. aeruginosa and Serratia marcescens decreased compared to 1986, but E. coli continued to be the most frequent. E. coli was isolated from a majority of simple urinary tract infection cases. The frequencies of E. faecalis and P. aeruginosa were high in cases of complicated urinary tract infections.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1987). I. Susceptibility distribution]

Since 1979, Ikemoto et al. have been retrospectively surveying the sensitivity of major species of bacteria isolated from patients with urinary tract infections to various antibacterial agents and antibiotics. Their findings for the past year are reported below. A total of 825 clinical strains of bacteria was investigated. Of this total, Gram-positive bacteria accounted for 28.0% (231 strains) and Gram-negative bacteria for 72.0% (594 strains). Taxonomically, Escherichia coli accounted for 34.7% (286 strains), Enterococcus faecalis for 14.3% (118), Pseudomonas aeruginosa for 11.0% (91), Klebsiella pneumoniae for 7.8% (64), and coagulase-negative staphylococci for 7.3% (60). Sensitivity spectra of these major bacteria to various drugs were as follows. 1. E. faecalis was sensitive to parenteral imipenem (IPM) and ampicillin and oral vancomycin. It was also sensitive to ofloxacin (OFLX) and ciprofloxacin (CPFX), which are new quinolones. Some strains were only slightly sensitive to second and third generation cephems cefmenoxime (CMX) and cefuzonam (CZON) aminoglycosides amikacin (AMK) and arbekacin (HBK), and erythromycin which is a macrolide. 2. Staphylococcus aureus was sensitive to dicloxacillin (MDIPC) which is a penicillin drug, cefotiam (CTM) which is a cephem, IPM, minocycline (MINO), and HBK. A fairly large number of strains were only slightly sensitive to cefazolin (CEZ), OFLX and CPFX. 3. Coagulase-negative staphylococci were sensitive to MDIPC which is a penicillin derivative, cephems CTM and CZON, IPM, HBK, clindamycin (CLDM) and MINO. Some strains, however, were only slightly sensitive to a majority of these drugs. 4. E. coli was sensitive to CTM, CMX, latamoxef (LMOX), ceftazidime (CAZ), CZON, and flomoxef (FMOX), all of which are second or third generation cephems. It was also sensitive to IPM, a carbapenem, carumonam (CRMN), a monobactam, and new quinolones, OFLX and CPFX. 5. K. pneumoniae was sensitive to cephems, viz. CTM, CAZ, CZON, FMOX and cefixime, CRMN which is a monobactam, IPM, a carbapenem and new quinolones, OFLX and CPFX. Some strains were only slightly sensitive to CTM, cefmetazole cefoperazone (CPZ), and FMOX. 6. Citrobacter freundii was sensitive to CRMN which is a monobactam, and new quinolones, OFLX and CPFX. Many strains were only slightly sensitive to cephems, viz. CEZ, CTM, CPZ and CAZ. 7. Enterobacter cloacae was sensitive to gentamicin and AMK which are aminoglycosides, but showed a bimodal pattern of sensitivity to CPZ, CAZ and CZON, all of which are cephems, and to quinolones, OFLX and CPFX.(ABSTRACT TRUNCATED AT 400 WORDS)

Primary adrenocortical micronodular dysplasia: enzyme histochemical and ultrastructural studies of two cases with a review of the literature

The adrenal glands from two patients with primary adrenocortical micronodular dysplasia (PAMD) were studied (no. 1, a 23-year-old man with cardiac myxomas and sarcoidosis; no. 2, a 16-year-old girl). The PAMD cells showed intense activity of 3 beta-hydroxysteroid dehydrogenase (3 beta DH), succinate DH, glucose-6-phosphate DH, alkaline phosphatase (AlPase), and other DHs and lysosomal hydrolases, giving a characteristic staining pattern. The staining patterns correlated well with ultrastructural findings. The larger adrenals (no. 1: 16.6 g) were associated with larger black nodules and internodular cortex (INC) with fairly well-retained enzyme activities, and contained cell clusters and single cells with intense AlPase activity with the appearance of PAMD nodules in the buds. The smaller adrenals (no. 2: 5.4 g) were associated with smaller black/yellow nodules, and had INC with weaker enzyme activity. Analysis of descriptions of INC in 25 previously reported cases revealed that the larger adrenals (more than 10 g) had less atrophic INC than the smaller ones. The characteristic enzyme pattern in PAMD cells explains the paradox that PAMD adrenals smaller than normal can cause Cushing's syndrome, and may be useful for investigating neoplastic and non-neoplastic counterparts in other adrenal lesions. The relationship between PAMD cells and INC is not simply one of autonomy versus atrophy, and both cell types may be stimulated by a certain common trophic factor. Thus, PAMD belongs to the category of hyperplasia.

[Analysis of histopathological prognostic factors in patients who underwent radical cystectomy in cancer of the bladder]

The relationship between histopathological characteristics and their long-term prognosis was studied on a total of 110 patients with bladder cancer who underwent total cystectomy from 1978 to 1985 at Keio University Hospital in the period after computer tomography (CT) was initiated for the evaluation of tumor stagings. The actuarial five-year survival rate in the 110 patients estimated by Kaplan-Meier method was 54.3%. Disclosed as histological poor prognostic factors (p less than 0.05) were the presence of non-transitional cell elements (actuarial five-year survival rate: 26.3%), IFN gamma for growth patterns (26.3%), grade-3 for histological grades (39.1%), lymph-duct involvement ly(+) (28.2%), venous involvement v(+) (25.2%), muscle-invaded tumor and extravesical lymphnode involvement. As for the comparative relation among these histological factors, grade-3 tumors tended to have a high incidence of lymph-duct involvement (73.2%), venous involvement (26.8%) and positive lymph-nodes (35.7%) when compared to grade-2 tumors. The analysis of the degree of influence of those histological prognostic factors using the non-proportional hazard model revealed that the major priorities were positive lymphnodes (p = 0.0006), histological types (p = 0.0036) and lymph-duct involvement (p = 0.0839). These results suggest that intensive adjuvant treatment should be indicated for improving the prognosis of patients with bladder cancer who have undergone total cystectomy when non-transitional cell elements and/or vascular involvement are evidenced.

[Experimental study on usefulness of fine-needle aspiration cytology as a diagnostic tool of acute rejection]

The value of fine-needle aspiration cytology (FNAC) for the diagnosis of acute rejection in canine allotransplantation was determined. To reduce the surgical stress associated with repeated anesthesia and operations, the contra-lateral kidney was left intact. FANC, open biopsy and peripheral blood sampling were performed on day 0, 3, 5, postoperatively. Cytocentrifuged cell smear was prepared from each FNAC specimen, and stained with Giemsa. Specimen on day 3 had an increased number of mono-nuclear cells mainly composed of monocytes, and plasmacytes appeared, but they were not clearly identified. To exclude the contamination of peripheral blood from the specimen, we established an index, increased infiltrate score, to evaluate the percentage gap between the transplanted kidney and the normal own kidney. This score revealed that some kind of mono-nuclear cells increased on day 3, prior to the appearance of plasmacytes which were usually seen on day 5. On the other hand the specimen from the open renal biopsy on day 3 showed little change. We concluded that the FNAC is valuable in the early diagnosis of acute rejection of canine renal allotransplantation.

[Clinical evaluation on differential quantitation of human chorionic gonadotropin in testicular cancer]

In 113 patients with testicular germ cell tumor, the authors determined human chorionic gonadotropin (hCG) and the free beta subunit levels in sera by differential quantitation using homologous hCG-beta radioimmunoassay (RIA) and hCG enzyme immunoassay (EIA), respectively. In 59 patients with seminoma, intact hCG was positive in 6 patients (10.1%), whereas free hCG-beta was positive in 23 patients (39.0%). Syncytiotrophoblastic giant cells were detected in 4 cases out of 6 patients with positive intact hCG seminoma. Seventeen cases (28.8%) revealed positive free hCG-beta only without elevation of intact hCG. In 54 patients with nonseminoma, both intact hCG and free hCG-beta were positive in 36 cases (66%). In some cases, hCG-beta/hCG ratio increased up to 275% when recurrence of tumor developed. Molecular heterogeneity of hCG is closely related to proliferation and differentiation of hCG producing cells. The differential quantitation of intact hCG and hCG-beta using these two assays is valuable for clinical detection of molecular heterogeneity of hCG in testicular tumor.

[Retrograde prostatic urethroplasty with balloon catheter]

Retrograde prostatic urethroplasty with balloon catheter was first described by Castaneda et al. in 1987. This procedure is performed using local anesthesia with modified angioplasty balloon catheter. We applied this technique in 5 cases, including benign prostatic hypertrophy in 4 and prostatic cancer with urethral stricture in 1. Improvement in clinical symptoms was seen in 4 patients. Uroflowmetry was performed in 3 patients and flow was improved. Urinary retention recurred a few days after the procedure in one other patient. This was though to be related to the predominant hypertrophy of the middle prostatic lobe. A strong urge to void is commonly present at the time of balloon dilatation. Transient hematuria is seen after the procedure. To prevent the risk of postprocedural incontinence, it is very important to avoid dilating the external sphincter. Further investigation is necessary for the evaluation of long-term results, but this procedure can be performed in poor risk patients since it is less invasive. Hence, retrograde prostatic urethroplasty with balloon catheter is thought to be useful treatment for urethral stricture in poor risk patients.

[Present status and background of occupational uroepithelial tumors]

The incidence of urothelial cancers in a group of 231 dyestuff plant workers who had been exposed to benzidine (BZ) or to beta-naphthylamine (BNA) was surveyed from 1962 to 1988. Fifteen out of 231 patients (6.5%) were found to have bladder cancer with the mean age at onset of 57.1 +/- 8.7 years. The estimated average period of engaging in this dyestuff exposure for these 15 patients was 92.4 +/- 47.3 months. The mean latent periods from the initial and last exposure until tumor development were 28.8 +/- 5.7 years and 16.6 +/- 7.0 years, respectively. Good negative correlation was observed between exposure periods and latent periods from the last exposure to onset (R = -0.06814). All 15 patients demonstrated tumors in the bladder, and one patient had a metachronous upper urinary tract cancer after treatment for bladder cancer. All tumors were histologically transitional cell carcinomas except for one adenocarcinoma. For initial treatment, five underwent total cystectomy, eight had transurethral resection (TUR) of the tumor, and one had partial cystectomy. Five out of 8 patients who had TUR have developed recurrent bladder tumors, and two of those patients underwent total cystectomy for second treatments. The mean follow-up period was 8.6 +/- 5.2 years, with two dying of cancer. For detection and monitoring, flow cytometric (FCM) analyses were available in five cases with bladder tumor and in two follow-up cases after bladder preserving treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term results of M-VAC for the treatment of advanced urothelial cancer]

Total of 37 patients with measurable lesions originating in advanced urothelial cancers received M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) combination chemotherapy and have been followed for a minimum of 12 months. The study included initial diagnoses of 24 bladder cancers and 13 upper urinary tract cancers in patients whose mean age was 62 years. The patients received a mean of three cycles of M-VAC. Clinical complete remission was observed in five of the 37 patients (13.5%) and partial remission was achieved in 10 patients (27.0%) after mean treatment of 2.4 and 2.1 cycles, respectively, for an over-all objective response rate of 40.5%. The mean duration of response was 11.6 +/- 7.1 months and 4.4 +/- 3.5 months for complete and partial remissions, respectively. A mean of 5.2 +/- 1.7 cycles of M-VAC was given for complete remissions and 3.5 +/- 1.4 cycles in partial remissions. An over-all survival rates after one and two years were 28.125% and 5.859%, respectively. Two of the five patients who had once marked complete remissions died after a mean survival time of 14.5 +/- 4.5 months and three survived with a mean duration of 20.3 +/- 5.4 months. Meanwhile, all of the patients who had achieved partial remissions died after a mean survival of 9.1 +/- 5.4 months except for one patient who survived more than 12 months. These results indicate that M-VAC combination chemotherapy for advanced urothelial cancer is extremely efficacious in initial responses.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1986). I. Susceptibility distribution]

Susceptibilities to various antibacterial and antibiotic agents of bacterial strains isolated from urinary tract infections at 8 hospitals in Japan from July to October in 1986 are summarized as follows. 1. Enterococcus faecalis was susceptible to sulfamethoxazole/trimethoprim (ST) and imipenem (IPM) with MIC90s of 0.78 and 1.56 microgram/ml. Minocycline had the strongest activity against Staphylococcus aureus; the MICs for all strains tested were lower than 0.39 microgram/ml. The MIC80s of dicloxacillin, and arbekacin (HBK) were 0.20 and 0.78 microgram/ml, respectively. Among the cephems, the MIC80 of flomoxef was 25 micrograms/ml, whereas those of cefmenoxime (CMX) and cefotiam (CTM) were 50 micrograms/ml. 2. Escherichia coli was most susceptible to ofloxacin (OFLX) among the oral antibacterial and antibiotic agents tested. OFLX showed the minimum inhibitory concentration against 90% (MIC90) of the 274 strains of E. coli tested to be lower than 0.10 microgram/ml. The antibacterial activities of the third generation cephems such as CMX and latamoxef (LMOX) were the strongest among the injectable antibiotics tested. The MIC90s of CMX and LMOX were lower than 0.10 and 0.20 microgram/ml, respectively. CTM and cefmetazole, the second generation cephems, were also highly active against E. coli with MIC90s of 0.39 and 1.56 micrograms/ml, respectively. 3. Among the oral antibacterial and antibiotic agents tested, OFLX was the most active against Klebsiella pneumoniae. Its MIC90 was 0.78 microgram/ml. Among the injectable antibiotics tested, CMX was the strongest with an MIC90 of 0.20 microgram/ml; MIC90 of CTM and LMOX were 0.39 microgram/ml. 4. The tested antibacterial and antibiotic agents were generally less active against Citrobacter freundii than against other bacteria. The MIC80 of OFLX was 0.39 microgram/ml. Gentamicin (GM) and ST were slightly active against C. freundii. Among the cephems, CMX had the MIC80 of 25 micrograms/ml. 5. Enterobacter cloacae was less susceptible to the cephems tested. OFLX, GM, and mecillinam were active against this bacteria with MIC80s of 0.78, 0.78 and 1.56 micrograms/ml, respectively. 6. Among the oral antibacterial and antibiotic agents and penicillins examined, piperacillin (PIPC) was the most active against Proteus mirabilis. Its MIC90 was 0.39 microgram/ml. Those of sulbenicillin, cefaclor, ampicillin, OFLX, and ST were 0.78, 0.78, 1.56, 3.13 and 3.13 micrograms/ml, respectively. CMX was highly active against P. mirabilis with an MIC90 of less than or equal to 0.10 microgram/ml; LMOX followed with an MIC90 of 0.20 microgram/ml among the injectable antibiotics tested. CTM was also active against this bacterium; the MIC90 was 0.39 microgram/ml. 7. The antibacterial and antibiotic agents were generally only slightly active against Proteus vulgaris.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1986). II. Background of patients]

From July to October in 1986, hospital data on 717 isolates of causative microorganism from patients with urinary tract infections and background information on 562 patients were collected. The urinary tract infections were divided into 3 groups; simple infections and complicated infections with or without the use of indwelling catheter. We investigated such factors as the patients' sex, age, and drug treatments, and the isolates obtained from the infections. From 1981 to 1986, about 25% of the patients with simple infections were males and about 60 to 70% among those with complicated infections were males each year. During these 6 years, no noticeable changes occurred in sex and age distributions of patients with any type of the infections, but the species of isolates changed remarkably. In 1982 and 1983, the isolation rates of Enterococcus faecalis (Streptococcus spp. or Streptococcus faecalis) obtained from the patients were about 8% in both of male and female patients. In 1984, the rate in females increased to 17.9%. In 1985, the rates in males and females were 14.9% and 7.6%, respectively. Similar rates were also observed in 1986: 16.1 and 7.4%. The isolation rate of Staphylococcus aureus in 1982 was 0.7%, as was in 1983. In however, increased to 1.7% in 1984 and to 3.2% in 1985. It was 2.5% in 1986. The isolation rate of Gram-positive bacteria was 11.1% in 1982; it increased to 18.9% in 1983 and to over 20% between 1984 to 1986. Among Gram-negative bacteria, the isolation rate of Pseudomonas aeruginosa form patients with complicated urinary tract infections with a catheter was high and over 20% in both 1985 and 1986. When antibacterial agents were administrated for 3 days, changes in number of species of isolates tended to be more pronounced in complicated infections with or without the use of catheter than in simple infections. According to date obtained in 1986, when antibiotic agents were administered for 8 or more days, the changes were definitely more drastic in complicated infections than in simple ones. An upmost care in the selection of antibiotic drugs according to their antibacterial spectra and activities, therefore, appears necessary, and an attention should be paid on future changes in species of bacteria isolated from infections.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1986). III. Secular changes in susceptibility]

Changes in the susceptibility of various infectious microorganisms to antimicrobial agents from 1982 to 1986 were evaluated. The microorganisms investigated were Escherichia coli, Klebsiella spp., Citrobacter spp., Enterobacter spp., Proteus spp., Serratia marcescens and Pseudomonas aeruginosa isolated from patients with urinary tract infections. We compared susceptibilities of microorganisms obtained from simple urinary tract infections with those from complicated infections with or without indwelling catheter. Among penicillins, mecillinam (MPC) showed the strongest activity against E. coli obtained from the patients: 3.13 to 6.25 micrograms/ml of MPC inhibited the growth of over 90% of the isolates. Among the second and the third generation cephalosporins, cefotiam and cefmenoxime (CMX) showed the strongest activity and the growth of isolates was inhibited at concentrations of 0.39 to 0.78 microgram/ml and below 0.10 to 0.20 microgram/ml, respectively. The activities of penicillins against Klebsiella spp. were weak. CMX showed strong activity against Klebsiella spp; 91.7% of the isolates from patients with simple infections were inhibited at 0.39 microgram/ml of the agent; 90.7% and 91.6% of isolates from patients with complicated infections with or without indwelling catheter were inhibited at 0.78 microgram/ml and 1.56 microgram/ml of the agent, respectively. Gentamicin (GM) also showed strong activity against isolates from patients with simple infections and weaker activity against isolates from patients with complicated infections with the catheter; 0.78 microgram/ml of ofloxacin (OFLX) inhibited the growths of 90% of the isolates from these patients. Penicillins showed weak activity against Citrobacter spp. obtained from the patients. Among the second and the third generation cephalosporins, CMX and latamoxef (LMOX) showed strong activities against the Citrobacter isolates; about 50% of the isolates were inhibited at 0.20 microgram/ml of either agent. 1.56 microgram/ml of minocycline inhibited the growth of 75 to 90% of the isolates and 1.56 microgram/ml of OFLX inhibited the growth of 93 to 100% of the isolates. Against isolates of Proteus spp. penicillins also showed weak activities. Among them, however, piperacillin (PIPC) inhibited the growth of over 90% of the isolates at concentrations ranging from 0.78 to 1.56 micrograms/ml. Among the second and third generation cephalosporins, CMX and LMOX showed strong activities; 0.20 microgram/ml of CMX inhibited the growth of 94.4%, 90.4%, and 83.1% of isolates from the 3 types of the patients, respectively. 0.20 microgram/ml of LMOX inhibited the growth of 94.4%, 91.8%, and 88.3% of the isolates, respectively. Enterobacter spp. showed resistance to the beta-lactam antibiotics.(ABSTRACT TRUNCATED AT 400 WORDS)

[Priapism with malignant lymphoma: a case report]

A case with priapism in a 66-year-old male due to malignant lymphoma is reported. Physical examination revealed an erected penis and enlarged lymph nodes in left neck and bilateral inguinal areas. Rectal digital examination of prostate revealed an irregular surface and swollen hard left lobe. Open biopsy of the bladder and vesicostomy were carried out. Several nodular lesions in the trigone and in the left wall were excised. Pathologically the diagnosis was malignant lymphoma, diffuse, large cell type and clinical stage was stage IV. CHOP therapy with bleomycin and methotrexate was performed. Priapism disappeared 7 days after the initiation of the chemotherapy, but impotence has been noticed after the chemotherapy for more than one year. This will be the first case with priapism due to malignant lymphoma reported in Japan so far.

[Studies on biological characteristics of transitional cell carcinoma of the bladder in patients under 30 years of age]

The incidence of transitional cell carcinoma (TCC) of the bladder has been increasing in men with a peak incidence occurring in the sixth decade. However, development of tumors under the age of 30 is relatively rare. In this regard, it has been reported that vesical tumors in the young group is less malignant and rare to recur when compared with those in the elderly group. Recently, flow cytometric DNA histograms (FCM) provides quantitative and objective informations for detection and evaluation of malignant potential of bladder neoplasms. Here we report patients with tumor of the bladder under 30 years old and assess the clinical properties and biological characteristics of their tumors based on FCM. A total of 11 patients from 1975 through 1988 were reviewed. Their mean age at the diagnosis was 22.6 years old (range from 22 to 29 years old). Male/female ratio was 2.7:1. The mean follow-up period was 4 years and 7 months (range from 8 months to over 13 years). An asymptomatic gross hematuria was found in all of the patients, which is the most common sign. Filling defects of the bladder on excretory urograms were observed in six out of the 11 patients (54.5%). Cystoscopically, the size of tumors was less than 2 cm in diameter. Ten patients had a single tumor and one patient had multiple tumors at the time of the initial diagnosis. Endoscopically tumors were papillary in all but one patient, who had a non-papillary tumor. Their urine cytology showed class I in one, class II in eight, class III in one, class IV in one and class V in none.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical experience with Ureteromat in transurethral ureterorenoscopy]

By September 1988, we performed 58 ureterorenoscopies (52 for primary ureteral calculi, 3 for ureteral biopsy, 2 for ureteral stricture and 1 for ureteral foreign body) using a Ureteromat (Uromat Storz, West Germany). Continuous saline irrigation with the Ureteromat has obviated mechanical dilation of the ureteral orifice in 93.1% of the cases, which made this endoscopy as easy as the conventional cystourethroscopy. In 4 cases (6.9%), however, balloon dilation of the ureteral orifice was necessary for the passage of a rigid ureterorenoscope. Of 52 ureteral calculi, 37 were assigned for transurethral ureterolithotripsy (TUL), whereas transurethral ureterorenoscopy (TUURS) was indicated to flush the remaining 15 calculi up into renal pelvis for later extracorporeal shock wave lithotripsy. TUL was successful in 81.1% (30/37). The causes of failure were stone migration in 6 cases and ureteral avulsion by electrohydraulic lithotripsy necessitating open surgery in 1 case. The irrigation with the Ureteromat facilitated the manipulation of intraluminal ureteral lesions always under clear vision; by-passing the impacted stone with a guide wire and flushing-up of the calculi were successfully performed in 100%, in spite of the co-existing edematous and inflammatory mucosal changes. In 7 cases where ureteroscope could not be advanced well up to the lesion because of spasm in the iliac ureter, the irrigation pressure was transiently increased up to 200 mmHg to allow safe and easy dislodgement of impacted calculi under fluoroscopic guidance. This procedure was also effective to introduced a ureteral stent over a guide wire in 2 cases of ureteral stricture, which could not be achieved by conventional cystoscopic procedure. Immediate postoperative complications were fever in 8.6% and gross hematuria lasting for more than 4 days in 8.6%.(ABSTRACT TRUNCATED AT 250 WORDS)

[A comparative study of the sensitivity of bladder washing flow cytometry, voided urine cytology and bladder washing cytology in the detection of bladder carcinoma]

In order to evaluate flow cytometric deoxyribonucleic acid measurement (FCM) of bladder washing in the diagnosis of bladder carcinoma, the sensitivity of voided urine cytology, bladder washing cytology and bladder washing FCM was tested in 76 samples from 56 patients with histologically proven bladder carcinomas. The positive rates were 43.2% and 75.7% in bladder washing cytology and bladder washing FCM, respectively. On the other hand, 36.5% and 57.1% positive rates for once- and three-times-voided urine cytology, respectively, were obtained. Bladder washing cytology and bladder washing FCM were positive in 20% and 70% patients with a histological diagnosis of atypia or dysplasia, respectively. The sensitivity of bladder washing FCM according to the tumor grade was 33.3%, 81.9% and 88.9% for grade-1 (G-1), G-2 and G-3 tumors, respectively. The sensitivity of bladder washing cytology according to the tumor grade was 0, 40.9% and 77.8% for G-1, G-2 and G-3 tumors, respectively. The sensitivity of three-times-voided urine cytology was 25.0%, 55.6% and 83.3% for G-1, G-2 and G-3 bladder tumors, respectively, and it was superior to that of single bladder washing cytology. These results indicate that FCM is more sensitive than voided urine cytology and/or bladder washing cytology in patients with bladder carcinoma. FCM may indicate urothelial neoplasia before it is apparent on urine cytology, especially against a background of inflammation. Therefore, FCM is valuable for case finding in suspect populations or for follow-up cases with diagnosed bladder cancer.

Vaginal metastasis from transitional cell carcinoma of renal pelvis in horseshoe kidney

We describe a case of transitional cell carcinoma of the renal pelvis in a horseshoe kidney with vaginal tumor as the first manifestation of remote metastasis. While the occurrence of adenocarcinoma in a horseshoe kidney appears to be no higher than in nonfused kidneys, the incidence of transitional cell carcinoma among neoplasms in horseshoe kidneys is higher. Vaginal metastasis from transitional cell carcinoma of the renal pelvis is considered extremely rare. To our knowledge, this is the first case reported of transitional cell carcinoma of the renal pelvis in a horseshoe kidney with metastasis to the vagina. The patient was successfully treated with surgery, irradiation, and chemotherapy.

[Therapeutic guide for renovascular hypertension with reevaluation of surgical treatment]

Therapeutic guide for renovascular hypertension has been greatly changed by a development of beta-blockers and captopril, and an introduction of percutaneous transluminal angioplasty (PTA) The accepted opinion was that surgical therapy was superior to drug therapy since Hunt & Strong reported the follow-up results in 1973. However, efficacy of drug therapy was reevaluated by an appearance of beta-blockers and captopril and the number of patients applied to operation was decreased. Further, since PTA was widely used in clinical practice from the end of 1970s, surgical therapy for renovascular hypertension was hardly or never considered. Has the necessity of surgical therapy really ceased to exist? Recently, we encountered 2 cases of bilateral renovascular hypertension and reevaluated the necessity of surgical therapy during the course of treatment. The first case was in a 43-year-old male, for whose bilateral renovascular stenosis a bilateral PTA was applied. One year later a complete occlusion of the right renal artery and re-stenosis of the left renal artery developed. Thus, removal of the right kidney and the auto-transplantation of the left kidney were conducted. The second case was in a 17-year-old female with bilateral renovascular stenosis complicated by moya-moya disease. PTA was conducted for the left kidney with shorter range of stenosis and auto-transplantation was conducted for the right kidney with longer range of stenosis. The prognosis was favorable in both cases and hypertension was cured or improved. We recognized and re-evaluated the necessity of surgical therapy for patients who were unsuccessful to PTA or patients with bilateral renovascular hypertension from our experience and literatures.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study on nephrotoxicity in rats receiving cis-diammine-1,1-cyclobutane dicarboxylate platinum II--special reference to morphological changes]

Nephrotoxic effects of cis-Diammine-1,1-cyclobutane dicarboxylate platinum II (CBDCA) were investigated in male 6 weeks old Wistar rats. The animals were divided into 4 groups: Group I (each received a single intraperitoneal injection of CBDCA 80, 120 mg/kg); Group II (a single intraperitoneal injection of CBDCA 80, 120 mg/kg after withdrawal of food and water for 2 days); Group III (intravenous administration of CBDCA 15, 30 mg/kg for 7 consecutive days after withdrawal of food and water for 2 days); Group IV (controls). Rats from each group were sacrificed at 3, 7, 10 and 14 days following the start of the experiment. Serum levels of BUN and creatinine were then measured and renal histopathological examination was conducted by light and electron microscopy. In addition, the total platinum concentration in the serum was measured in Group I, and X-ray microanalysis was performed after intraperitoneal administration of CBDCA (100 mg/kg) and cis-Diamminedichloroplatinum (II) (CDDP) (6 mg/kg) for 2 consecutive days (Group V). The results showed increased levels of BUN in each group due to catabolism. No significant increase in serum creatinine was observed and there appeared to be no evidence of renal dysfunction. For all groups, localized vacuolar degeneration in the epithelial cells of the tubules was predominantly apparent. Electron microscopy revealed only degeneration of the epithelium mainly in the proximal tubules and also showed reabsorption of platinum from the lumen of the tubules.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural killer cell activity and recycling capacity of natural killer cells in patients with carcinoma of the prostate

Natural killer (NK) cell activity and recycling capacity of NK cells in patients with carcinoma of the prostate (CaP) was determined by combining the 51Cr-release cytotoxicity assay and single cell cytotoxicity assay in agarose. The NK cell activity in patients with advanced CaP (stage D) was significantly lower than the NK cell activity of normal controls and that of patients with localized CaP (stage B and C). The number of active NK cells in the peripheral blood lymphocytes was similar in all groups tested including normal controls, patients with localized CaP, and patients with advanced CaP. Maximal killing potential (Vmax) and maximal recycling capacity (MRC) were significantly reduced in patients with advanced CaP as compared to patients with localized CaP or normal controls. Obtained results indicated that the depressed NK cell activity in advanced CaP was not due to a reduced number of active NK cells but due to the decreased recycling capacity of the individual NK cells.

Phase II trial of carboplatin in patients with advanced germ-cell testicular tumors and transitional cell carcinomas of the urinary tract

Carboplatin, an analog of cisplatin, was evaluated in a phase II study involving 25 patients with advanced testicular tumor and 45 with transitional cell carcinoma (TCC) of the urinary tract; 21 and 38 cases, respectively, were evaluable for response. Prior treatment with cisplatin-based chemotherapy had occurred in 7 of the testicular cancer patients and in 11 with TCC. The response rate (complete + partial response) in testicular tumors was 47.6%. The best response rate was observed in seminomas (70.0%), whereas the response rate in nonseminomas was 27.3%. The seminoma patients had mainly stage IIIA or less than IIIA disease, with metastatic lesions restricted to the lymph nodes. Three responses were seen in patients previously treated with cisplatin. In TCC, the response rate was 18.4%. Good-risk patients were treated with a dose of 400 mg/m2 every 4 weeks, whereas poor-risk patients received a lower dose of 300 mg/m2. The response rates for good-risk patients were 50.0% in testicular lesions and 26.1% in TCC. For poor-risk patients, the response rates were 40.0% and 6.7%, respectively. Carboplatin was well tolerated, with no significant renal impairment or ototoxicity detected. Nausea and vomiting were experienced by 51.7% of patients, but the severity was low; half of these patients demonstrated WHO grade I toxicity. However, myelosuppression was severe. In conclusion, carboplatin demonstrated activity in both testicular tumors and TCC and is worthy of further study, especially in combination with other active drugs.