[Clinical evaluation of the combination of carumonam and fosfomycin in the treatment of complicated urinary tract infection]

Carumonam (CRMN), the first monobactam antibiotic in Japan, has excellent activity against gram-negative bacteria and is useful in the treatment of urinary tract infections. However, it may be insufficient in the treatment of complicated urinary tract infections because of the increase in isolation of gram-positive bacteria, and it may be necessary to co-administer antibiotics active against gram-positive organisms to achieve a broader spectrum of coverage in connection with severe infections. The combination of CRMN and fosfomycin (FOM) was evaluated for its effectiveness and safety at the Department of Urology, Yamagata University Hospital and 7 affiliated hospitals. Clinical efficacy was assessed on 64 patients with complicated urinary tract infection according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd. ed.) recommended by the Japan UTI Committee. Clinical efficacy was evaluated as excellent in 16, moderate in 32, poor in 16, with an overall clinical effectiveness rate of 75.0%, which is superior compared with CRMN alone. Of the total of 92 bacterial strains isolated, 66 (71.7%) were eradicated. Subjective adverse reaction was seen in 1 patient (1.4%), as nausea and anorexia. Slight increases in serum GOT and GPT ware recorded in 5 patients (7.1%). These findings disappeared after the termination of administration without treatment. The combination of CRMN and FOM might therefore be useful in the treatment of complicated urinary tract infections.

[Adrenal hemangioma: a case report]

We report a rare case of adrenal hemangioma incidentally discovered by computed tomography (CT) in a 75-year-old female, the hormonal examination showed within the normal range, and ultrasound-sonography, CT scan and angiography disclosed the mass to be a non-functioning adrenal tumor. The tumor was removed operatively and the pathological finding was adrenal hemangioma. Twenty reported cases found in the Japanese literature are reviewed.

Ultrasonically guided biopsy of nonpalpable lesions of the breast by the spot method

A new biopsy method by injecting dye under ultrasonic guidance is most efficient and accurate for nonpalpable lesions revealed by ultrasonography. It can also minimize the amount of tissue that is resected. The conventional method by needle-wire localization has to be used in instances of calcification which cannot be defined by ultrasonography.

Kinetic approach with ab initio MO method on ionic selectivity and size in sodium channel

Three kinds of models for ionic selectivity and size of the filter in sodium channel have been treated by using ab initio molecular orbital (MO) calculations with MINI-3 and MIDI-3* basis sets. A three-components system, HCO2M-H2O (M = Li+, Na+ or K+), is acceptable for describing experimental facts well. Thermochemical parameters obtained from harmonic vibrational analysis with MINI-3 basis sets, for the translocation of the permeant metal cations in the HCO2M-H2O system, are that the activation enthalpies for Li+, Na+ and K+ are 7.0, 6.4 and 23.4 kJ/mol, and also the free energies of activation are 10.6, 1.5 and 19.0 kJ/mol, respectively. These results are qualitatively in good correspondence with experimental facts of the ion selectivity of the channel. One of water molecule was found to have a key role in the translocation of the permeant cations.

[Undescended testis cancer: report of two cases--review of the literature of 179 cases in Japan]

Recently, we experienced two cases of testicular tumor in patients with cryptorchidism. Case 1: A 35-year-old man was admitted because of right inguinal mass. He had a tumor of right undescended testis and underwent right orchiectomy. Case 2: A 45-year-old man, who was pointed out to have bilateral cryptorchidism was admitted because of right groin mass. He underwent right orchiectomy and left orchiopexy. Histological examination of two cases were seminoma. Testicular tumor in undescended testis was made with 179 reported cases from the Japanese literature.

[A case of urachal cyst prolapsed from external orifice. Review of the literature of 172 cases in Japan]

A case of urachal cyst prolapsed from external orifice in a 15-year-old female is reported. She was admitted to the hospital with complaints of macrohematuria and palpation of a thumb's head size tumor prolapsed from external urethral orifice. An urachal cyst was suspected from the cystogram, CT and the cystoscopy. We extirpated the tumor with the bladder wall. Pathological examination demonstrated a urachal cyst.

A case of metastasis from gastric cancer to the thyroid gland

Metastatic tumors in the thyroid gland are rarely seen in clinical practice. This report describes a case of metastasis from gastric cancer to the thyroid, found five years after removal of the primary gastric lesion. The patient had a large thyroid mass extending to the mediastinum, but there were no obvious metastatic lesions anywhere except in the thyroid. Subtotal thyroidectomy was performed and histological examination revealed the same findings a those of the original gastric cancer. Of additional interest are the findings that led us to believe this metastatic tumor produced alpha-fetoprotein. Seven months following the operation, the patient dies suddenly and, although it is difficult to say whether the patient's survival was prolonged, we believe that the thyroid surgery gene him considerable palliation.

Whether Zn2+ for the polymerase system was selected inevitably or by historical accident

Zinc ion was found in various kinds of polymerases and involved in the activation of the 3'-hydroxyl group of primer chain's growing end. In order to investigate whether zinc ion was selected for nucleotide synthesizing system inevitably or by historical accident, ab initio molecular orbital calculations were carried out and the results suggest that zinc ion may have been selected inevitably.

Induction of cytochrome P-450, cytochrome b-5, NADPH-cytochrome c reductase and change of cytochrome P-450 isozymes with long-term trichloroethylene treatment

Several reports have described the effects of trichloroethylene (TCE) on the microsomal mixed function oxidase system (MFOS). These studies suggest that repeated TCE administration induces MFOS, especially cytochrome P-450 and NADPH-cytochrome c reductase. However, it is uncertain what isozymes are induced by TCE treatment, and it is not clear how microsomal enzymes or cytochrome P-450 isozymes are altered when TCE is administered for a duration longer than 28 days. We investigated the changes of MFOS by long-term TCE treatment. Male Wistar rats were injected with TCE, 1.0 g/kg body weight once a day for 5 continuous days or 2.0 g/kg body weight twice a week for 15 days. The mean body weight of the rats treated with TCE for 15 weeks was slightly, but not significantly, less than that of the control rats. Relative liver weights (liver wt/body wt) of the TCE-treated group were however significantly larger (21%) than those of the control group. The weights of the other organs were not changed by long-term TCE treatment. Trichloroethylene treatments for 5 days and 15 weeks caused significant increases in microsomal protein, cytochrome P-450, cytochrome b-5 and NADPH-cytochrome c reductase. TCE treatments produced an increase in a polypeptide band at 52,000 molecular weight range observed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). This increase in similar to, but less pronounced than that induced by phenobarbital (PB) treatment. There were no remarkable changes at 56,000 molecular weight range where a band appeared after the treatment with 3-methylcholanthrene (MC). It is likely that the induction of cytochrome P-450 by TCE is relatively similar to that by PB.

Molecular orbital study on the metabolic pathway through the diol epoxide form of carcinogenic benzene in comparison with benzo[a]pyrene

The stabilization energy for the hydronium-ion-catalyzed hydrolysis of benzene diol epoxide (BDE) in the configuration of anti- or syn-form has been estimated by using the semi-empirical molecular orbital calculations with the CNDO/2 method. The values for the formation of carbonium ion from BDE are compared with those from benzo[a]pyrene, and it is suggested that the anti-form BDE belongs to a relatively strong reactive group with benzo[a]pyrene and benz[a]anthracene. The reactivity of BDE to the cation is completely different from that of polycyclic aromatic hydrocarbon diol epoxides (PAHDEs) from the viewpoint of the electronic structure; the cation from the anti-form BDE has a three center-four electron bond, whereas cations from PAHDEs do not have such a bond and the aromaticity still remains.

Renovascular hypertension: a case of intimal fibroplasia with congenital anomaly of the renal artery

We report a case of renovascular hypertension caused by fibromuscular dysplasia (intimal fibroplasia) with congenital anomaly of the renal artery. Arteriography revealed complete occlusion from the root to the middle of the right renal artery and a collateral artery from the right lumbar artery. Histological examination showed intimal fibroplasia and three arterioles in the intima of the renal artery.

Metabolism of chloral hydrate in the anoxic perfused liver

The metabolism of chloral hydrate (CH) under anoxic conditions was investigated in the non-recirculating, hemoglobin-free liver perfusion system. CH uptake in the anoxic liver decreased to about 80% of that in the oxygen-supplied liver. The reduction of CH to trichloroethanol (TCE) increased and the oxidation of CH to trichloroacetic acid (TCA) decreased. The TCE/TCA ratio increased; however, the total trichloro compounds, that is TCE and TCA, were not significantly altered by anoxia. Though approximate 14% of the CH infused into the oxygen-supplied liver was changed to substances other than TCE or TCA, the unknown part was a very small portion in the anoxic liver. The decrease in CH uptake, by the anoxic liver, is thought to be equivalent to the decrease of the unknown metabolites. The TCE/TCA ratio under anoxia was also altered by pyruvate or lactate infusion.

Role of Mg2+ in the ribozyme system

Recently, several kinds of catalytic activities have been identified from L-19 IVS RNA or 'ribozyme'. In the catalytic process of ribozyme, Mg2+ is required. We investigated the role of Mg2+ by molecular orbital calculation. Based on the results of the calculation, a model for the self-splicing reaction was constructed.

The metabolism of trichloroethylene and its metabolites in the perfused liver

The metabolism of trichloroethylene (TRI) and its metabolites, chloral hydrate (CH), trichloroethanol (free-TCE) and trichloroacetic acid (TCA), were examined in the isolated perfused rat liver, to clarify the role of the liver in the metabolism of TRI. TRI was rapidly converted to TCE and TCA by the perfused liver. TCA was produced from TRI about 2.5 times greater than was total-TCE. CH was metabolized to TCE and TCA immediately. TCA was also a dominant metabolite of CH over total-TCE. TCE(free type) was speedily conjugated by the liver. A portion of TCE was converted to TCA. Less than 10% of these metabolites produced by the liver were excreted into the bile. Most of them appeared in the perfusate.

[Bacterial and clinical studies on imipenem/cilastatin sodium in urological infection]

Antibacterial activities of imipenem (MK-0787), cefazolin (CEZ), cefmenoxime (CMX) and cefoperazone (CPZ) were measured by using an agar dilution method against 243 strains of bacteria isolated from the patients with urinary tract infections. The MIC80 of MK-0787 against S. epidermidis, E. faecalis, E. coli, K. pneumoniae, E. cloacae, S. marcescens, P. mirabilis, P. vulgaris and P. aeruginosa was less than or equal to 0.10, 3.13, less than or equal to 0.10, 0.20, 0.78, 1.56, 3.13, 3.13 and 6.25 micrograms/ml, respectively. MK-0787 was more active than CEZ, CMX and CPZ against all bacterial species except Proteus spp. Imipenem/cilastatin sodium (MK-0787/MK-0791) 500 mg/500 mg two times a day for 5 days was given to 31 cases of chronic complicated urinary tract infections and a case of acute prostatitis. Overall clinical effectiveness rate judged by the criteria proposed by the Japanese UTI committee in 22 cases of chronic complicated urinary tract infection treated with MK-0787/MK-0791 was evaluated to be 86% including excellent in 6 cases, moderate in 13 cases and poor in 3 cases. As side effects, 2 cases encountered eruption or anorexia. Abnormal laboratory findings were observed in 6 cases.

The relation between Ames test data and electronic structure for a series of benzidine derivatives investigated by using cluster analysis

The dose-response curves of benzidine derivatives calculated from Ames test data were analyzed by combining the least-squares method with cluster analysis. The calculations of the electronic structures of various benzidine derivatives have at the same time been performed by using the CNDO/2 method. The cluster analysis was carried out on various parameters concerning the electronic structure, such as total electron density, frontier electron density, the energy level of HOMO (highest occupied molecular orbital), and so on. It was found that the total electron density on the nitrogen atom gives a similar pattern of classification to that for mutagenic compounds in cluster analysis. In other words, it may be inferred that the nitrogen atoms of the benzidine derivatives play an important role in the metabolic activation of the compounds. Consequently, cluster analysis with a parameter of electronic structure should be a useful initial screening procedure for various analogous mutagenic compounds as well as carcinogenic compounds.

Functional recovery of the bladder in patients with spinal cord injury--prognosticating programs of an aseptic intermittent catheterization

Ninety patients with spinal cord injury were managed by aseptic intermittent catheterization program I (preventing the over-distension of the bladder) and program II (allowing overdistension) in which recovery of bladder function and the clinical effects were comparatively investigated. Using program I, cases with positive BCR restored the automaticity of the bladder on average 8 weeks after injury. When urinary incontinence first occurs during aseptic intermittent catheterization, urinary training may be commenced since the bladder has then recovered from spinal shock. Cases with no BCR do not restore automatic bladder contraction. Program II delayed or weakened the recovery of bladder function considerably. Patients with incomplete lesions and sacral sparing, particularly those with urinary sensation, should be managed by program I which does not impair recovery of the bladder. It is possible to prevent urinary incontinence and infection, if paraplegics with complete lesions are managed by program II. The percentage of urinary infection was 22.6 +/- 16.0% (N = 90) during aseptic intermittent catheterization (non-touch technic) among whom no statistically significant difference between those with trigger voiding (22.2 +/- 17.2%, N = 57) and those with self-catheterization (23.2 +/- 14.0%, N = 33) was found.

Over-distension therapy of the bladder in paraplegic patients using self-catheterisation: a preliminary study

Over-distension therapy was performed in 60 patients during the period of spinal shock after complete spinal cord injury. Forty-five developed upper motor neurone (UMN) hypo-active decompensated bladder function and 39 achieved satisfactory social activity without urinary incontinence using self-catheterisation. Self catheterisation appeared a safer and more comfortable means of urinary management than trigger voiding in paraplegics with complete spinal cord injury. This is a preliminary communication as it is hoped that a comparative study will follow in due course.