Increased adrenomedullin immunoreactivity and mRNA expression in coronary plaques obtained from patients with unstable angina

OBJECTIVE

To examine the expression and localisation of adrenomedullin in human coronary atherosclerotic lesions from patients with unstable angina (UAP) and stable angina (SAP), and to study the relation between adrenomedullin expression and plaque instability.

DESIGN

A retrospective observational study.

PATIENTS

Directional coronary atherectomy samples were obtained from 15 patients with UAP and 12 with SAP.

METHODS

The localisation of adrenomedullin was examined by immunohistochemistry, and adreno-medullin mRNA expression was measured by quantitative polymerase chain reaction.

RESULTS

Adrenomedullin immunoreactivity was preferentially localised in macrophages, intimal smooth muscle cells, and proliferated microvessels. The mean number of adrenomedullin positive cells in five high power fields (x 400) per specimen was higher in patients with UAP than in those with SAP (mean (SEM), 110 (13) v 76 (7); p < 0.05); and the ratio of adrenomedullin positive to total cells was higher in patients with UAP (43.0 (2.2)% v 34.2 (2.0)%; p < 0.01). More adrenomedullin mRNA was expressed in the plaque of patients with UAP than in those with SAP (60.4 (16.9)% v 9.7 (3.3)%; p < 0.01).

CONCLUSIONS

The findings suggest that adrenomedullin is involved in the development of atherosclerosis and plaque instability in human coronary arteries, in an autocrine or paracrine manner.

LIGHT, a member of the TNF superfamily, induces morphological changes and delays proliferation in the human rhabdomyosarcoma cell line RD

LIGHT is a member of the tumor necrosis factor (TNF) superfamily, which binds two known receptors, lymphotoxin-beta receptor (LTbetaR) and the herpesvirus entry mediator (HVEM)/TR2. We investigated the effects of LIGHT on the human rhabdmyosarcoma cell line RD. LIGHT delayed cell proliferation and induced morphological changes of the cells. These effects were not shown by other TNF family ligands such as TNFalpha and LTalpha, which induced the transcriptional activity of nuclear factor-kappaB (NF-kappaB) and NF-kappaB-responsible chemokine productions in the same manner as did LIGHT. LTalpha1beta2, another TNF family ligand for LTbetaR, was shown to have similar activities in RD cells as LIGHT. Both LIGHT and LTalpha1beta2 induced the expression of muscle-specific genes such as smooth muscle (SM) alpha-actin, while TNFalpha and LTalpha did not. These findings indicate that LIGHT may be a novel inducer of RD cell differentiation associated with SM alpha-actin expression through the LTbetaR.

[Diagnostic accuracy of carotid ultrasonography in screening for coronary artery disease]

OBJECTIVES

This study investigated the diagnostic accuracy of carotid ultrasonography in screening for significant coronary artery disease (% diameter stenosis > or = 75%).

METHODS

Five hundred sixty patients (342 males, 218 females, mean age 66.4 years) underwent both coronary angiography and carotid ultrasonography. Gensini's coronary score was calculated as a quantitative parameter of coronary atherosclerosis. The most hypertrophic intimal-medial complex thickness (IMT) of the bilateral common carotid arteries (distal and proximal to the echo probe in each artery) was measured within 2 or 3 cm from the carotid bifurcation. The mean IMT (mean of these 4 sites), the maximum IMT (maximum of these 4 sites), and number of plaques (localized hypertrophy of IMT > or = 1.1 mm) were calculated as a quantitative parameter of carotid atherosclerosis.

RESULTS

The screening parameters were determined as 0.85 mm mean IMT, 1.1 mm maximum IMT, and at least 2 sites of plaque. The sensitivity, specificity and accuracy rate for the detection of coronary artery disease were 57.3%, 61.6% and 59.6% for mean IMT, 43.5%, 71.1% and 58.6% for maximum IMT, and 60.8%, 70.5% and 66.1% for number of plaques. Furthermore, the overall results (except maximum IMT) were 73.3%, 49.2% and 60.2%.

CONCLUSIONS

These results suggest that carotid ultrasonography is useful as a non-invasive and easy screening method for coronary artery disease. Furthermore, carotid ultrasonography will allow routine observations to follow the progression of coronary atherosclerosis.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1995). III. Differences in susceptibilities from previous years]

Susceptibilities to various antimicrobial agents were examined for Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa that were isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June, 1995 through May, 1996, and the results were compared with those obtained during the same period in earlier years. 1. Macrolide resistant E. faecalis isolated from uncomplicated UTIs during the latest study period appeared to have increased compared to those in previous study periods. More than 50% of the isolated E. faecalis during the latest study period were resistant to macrolide antibiotics, for the first time in our history. 2. No obvious changes were observed through the years for susceptibilities of S. aureus to various antimicrobial agents. Vancomycin (VCM) showed the highest activity against S. aureus, with MICs below 2 micrograms/ml or below. 3. Among E. coli strains, those with low susceptibilities to quinolones appeared to have increased over the years with MIC90 changed from between 0.125 microgram/ml or below and 0.5 microgram/ml in the 1989-1990 period to between 8 micrograms/ml and 128 micrograms/ml in the latest study period. 4. Klebsiella spp. showed higher resistance to most antimicrobial agents during periods of 1993-1994 and 1994-1995, but somewhat lower resistance during period of 1995-1996. No resistant Klebsiella spp. were detected from uncomplicated UTIs during the latest study period. 5. Among P. aeruginosa isolates from complicated UTIs, resistance isolates to gentamicin appeared to be increasing over the years. Resistant strains to quinolones were isolated at lower frequencies during periods of 1991-1994, but higher frequency was observed in the latest period, and MIC50s were between 0.5 and 4 micrograms/ml during 1991-1994, but were 16-32 micrograms/ml during 1995-1996. These susceptibility changes should be utilized in determining clinical treatments.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1995). II. Background of patients]

Clinical background was investigated on patients with urinary tract infections (UTIs) from whom 785 bacterial strains were isolated in 11 hospitals during the period from June, 1995 through May, 1996. 1. Distributions of age and sex of patients and type of infections. Among the patients examined, those with ages 50 years or older were the most frequent (males: 80.5%, females: 69.7%), and, among females, those with ages in the 20's were 12.6%. With regard to types of infections, more than a half of infections among males were of complicated types, but most of infections among females were of uncomplicated types, especially among females of ages less than 60 years. 2. Ages of patients and types of pathogens. The higher the ages of patients, the lesser became the isolation frequencies of Proteus spp. and Serratia spp., but the higher were those of Klebsiella spp. and Pseudomonas spp. 3. Effect of antibiotic use on isolation frequencies of pathogens. Use of antibiotics decreased pathogens isolated from patients with uncomplicated UTIs drastically (237 isolates before antibiotics compared to 33 after). Even isolated pathogens from patients with complicated UTIs decreased drastically with the use of antibiotics when indwelling catheters were not in use (200 isolates before antibiotics compared to 83 after), but when indwelling catheters were in use, antibiotics apparently failed to decrease the isolation frequency. 4. Surgical procedures and types of causative organisms for UTIs. Escherichia coli was the most frequently isolated organism from uncomplicated cases of UTIs. From cases of complicated UTIs without indwelling catheters, Enterococcus faecalis was the most frequently isolated, followed by E. coli, P. aeruginosa and Klebsiella spp. When a surgical procedures were not done, E. coli was isolated most frequently. From cases of complicated UTIs with indwelling catheters, P. aeruginosa, E. faecalis and S. aureus were the organisms that were mainly isolated, with isolation frequencies of 23.9%, 17.3% and 12.7%, respectively. When no surgical procedures were used, isolation frequencies of P. aeruginosa, Klebsiella spp. and E. faecalis were 25.7%, 14.3% and 14.3%, respectively.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1995). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 704 bacterial strains isolated from patients with urinary tract infections (UTIs) in 11 hospitals during the period of June 1995 to May 1996. Of the above bacterial isolates, Gram-positive bacteria accounted for 29.8% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 70.2% and most of them were Escherichia coli. Susceptibilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) and imipenem (IPM) showed the highest activities against E. faecalis isolated from patients with UTIs. The MIC90S of them were 1 microgram/ml. Vancomycin (VCM) and piperacillin (PIPC) were also active with the MIC90S of 2 micrograms/ml and 4 micrograms/ml, respectively. The others had low activities with the MIC90S of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA VCM showed the highest activities against S. aureus isolated from patients with UTIs. Its MIC90 was 1 microgram/ml against both S. aureus and MRSA. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The other except minocycline (MINO) had very low activities with the MIC90S of 64 micrograms/ml or above. 3. Staphylococcus epidermidis ABK and MINO showed the strongest activities against S. epidermidis isolated from patients with UTIs. The MIC90S of them were 0.25 microgram/ml. VCM was also active with the MIC90 of 1 microgram/ml. The MIC90S of cephems ranged from 2 micrograms/ml to 16 micrograms/ml in 1994, but they ranged from 8 micrograms/ml to 128 micrograms/ml in 1995. These results indicated that some resistances existed among S. epidermidis to cephems. 4. Streptococcus agalactiae All drugs except gentamicin (GM) were active against S. agalactiae. ABPC, cefmenoxime (CMX), IPM, erythromycin (EM), clindamycin (CLDM) and clarithromycin (CAM) showed the highest activities. The MICs for all strains were lower than 0.125 microgram/ml. The MIC90S of the others were 2 micrograms/ml or below. 5. Citrobacter freundii IPM showed the highest activity against C. freundii isolated from patients UTIs. Its MIC90 was 1 microgram/ml. GM was also active with the MIC90 of 2 micrograms/ml. Cefpirome (CPR), cefozopran (CZOP) and amikacin (AMK) were also active with the MIC90S of 4 micrograms/ml. Penicillins and cephems except CMX, CPR and CZOP showed low activities with MIC90S of 256 micrograms/ml or above. 6. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 1 microgram/ml. MINO and tosufloxacin (TFLX) were also active with the MIC90S of 8 micrograms/ml. Penicillins and cephems except CPR and CZOP showed lower activities with the MIC90S of 256 micrograms/ml or above. 7. Escherichia coli. Most of the antimicrobial agents were active against E. coli. Particularly CPR, CZOP and IPM showed the highest activities against E. coli. The MICs for all strains were equal to or lower than 0.5 microgram/ml. CMX and TFLX were also active with the MIC90S of 0.125 microgram/ml or below. Penicillins were slightly active with MIC90S of 128 micrograms/ml or above. 8. Klebsiella pneumoniae K. pneumoniae was susceptible to all drugs except penicillins, with MIC90S of 2 micrograms/ml or below. Carumonam (CRMN) had the strongest activity against K. pneumoniae, the MICs for all strains were equal to or lower than 0.125 microgram/ml. Comparing with the result of 1994, the sensitivities of K. pneumoniae against all drugs had obviously changed into a better state. For example, the MIC90S of cephems ranged from 0.25 microgram/ml to 16 micrograms/ml in 1994, but they were all lower than 2 micrograms/ml in 1995. 9. Proteus mirabilis P. mirabilis was susceptible to a majority of drugs. CMX, ceftazidime (CAZ), cefixime (CFIX), and CRMN showed the highest activities against P. mirabilis isolated from patients with UTIs. MICs of CRMN for all

[Genetic diagnosis of pelvic lymph node metastasis using fine needle aspiration samples in prostate cancer]

We have developed a highly sensitive method to detect pelvic lymph node metastasis using the reverse transcriptase-polymerase chain reaction (RT-PCR) with primers specific for prostate-specific antigen (PSA) gene. Fine needle aspiration biopsy (FNAB) of pelvic lymph nodes was performed in 24 patients with prostate cancer. Each aspirated sample (0.05-0.1 ml) was divided into 2 parts; one for RNA extraction and RT-PCR to detect the fragment of PSA mRNA, and the other to smear on a slide glass for conventional cytology. The PSA gene was detected by RT-PCR in 11 FNAB samples which included not only all 6 cytologically positive and 2 cytologically class III cases but also 3 of 16 cytologically negative cases. The PSA gene was not detected by RT-PCR of FNAB samples in any of the 20 cases of bladder cancer. Thus RT-PCR for detection of the PSA gene in FNAB samples may be useful as a new diagnostic technique for detection of early lymph node metastasis in prostate cancer and an additional tool for cytological diagnosis of prostate cancer.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). III. Secular changes in susceptibility]

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1994 to May 1995 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. No remarkable changes were found in susceptibilities of Citrobacter spp., Enterobacter spp. and Serratia spp. The susceptibilities of E. faecalis to amikacin and quinolones were better than those in 1993. As for S. aureus, susceptible strains to all drugs increased in uncomplicated UTIs. Against E. coli in 1993, the antimicrobial activities of piperacillin, cefotiam and aminoglycosides have decreased, however, in 1994, these activities have turned to the better state. As for Klebsiella spp. susceptible strains to ABPC decreased. The susceptibilities of P. mirabilis to all drugs except minocycline were good. Against P. aeruginosa in 1993, the activities of aminoglycosides have decreased, but, in 1994, these activities have turned to the better state. These data should be considered in clinical treatment of various urinary tract infections.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). II. Background of patients]

Clinical background was investigated on 628 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during period from June, 1994 to May, 1995. 1. Distributions of sex, age and urinary tract infections Among over sixties males, the majority was taken by complicated urinary tract infections. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age. As for over 40 females, the increase of complicated UTI was admitted. 2. Distribution of sex, age and pathogens isolated from UTIs In uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age, and next Enterococcus faecalis and CNS. In complicated UTIs without indwelling catheter, E. coli, Pseudomonas aeruginosa and E. faecalis were isolated the most frequent. In complicated UTIs with indwelling catheter, P. aeruginosa was most frequently isolated, and next E. faecalis and Staphylococcus aureus. 3. Administration of antimicrobial agents and pathogens isolated from UTIs In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 216 to 32 isolates. And also, pathogens of complicated UTIs without indwelling catheter, have decreased from 127 to 50 isolates. However, in complicated UTIs with indwelling catheter, pathogens after or before administration of antibiotics, were not revealed an obvious change. 4. Pathogens and UTIs with or without factor and operation In uncomplicated UTIs with or without factor and operation, E. coli was mainly detected. In complicated UTIs without indwelling catheter and with factor and operation E. faecalis was mainly detected, and next E. coli, S. aureus and P. aeruginosa. Without factor and operation, E. coli was mainly detected. In complicated UTIs with indwelling catheter and with factor and operation, P. aeruginosa, E. faecalis and S. aureus were mainly detected at 23.5%, 15.0%, 15.0%, respectively. Without factor and operation, Proteus spp. 22%, and next E. faecalis and P. aeruginosa 10% and 12%, were detected, respectively. The distribution of pathogens, in the case of Proteus spp. and P. aeruginosa has been obviously varied by the influence of factor and operation.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 567 bacterial strains isolated from patients with urinary tract infections in 10 hospitals during the period of June 1994 to May 1995. Of the above total bacterial isolates, Gram-positive bacteria accounted for 26.8% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 73.2% and most of them were Escherichia coli. 1. Enterococcus faecalis. Ampicillin (ABPC) and imipenem (IPM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC90s of them were 1 microgram/ml. Vancomycin (VCM) was also active with the MIC90 of 2 micrograms/ml. Piperacillin (PIPC) and biapenem (BIPM) were also active with the MIC90s of 4 micrograms/ml and 8 micrograms/ml, respectively. The others were not so active with the MIC90s of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA. VCM showed the highest activities against S. aureus isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml against both S. aureus and MRSA. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The others except minocycline (MINO) were not so active with the MIC90s of 64 micrograms/ml or above. 3. Staphylococcus epidermidis. MINO showed the strongest activity against S. epidermidis isolated from patients with urinary tract infections. Its MIC90 was 0.25 microgram/ml. ABK was also active with the MIC90 of 1 microgram/ml. Cephems were active with the MIC90s of 2 approximately 16 micrograms/ml, but penicillins and quinolones were not so active with the MIC90s and 64 approximately 128 micrograms/ml. 4. Citrobacter freundii. Gentamicin (GM) showed the highest activities against C. freundii isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml. IPM was also active with the MIC90 of 2 micrograms/ml. Cefpirome (CPR) and cefozopran (CZOP) were also active with the MIC90s of 4 micrograms/ml and 8 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 5. Enterobacter cloacae. IPM showed the highest activities against E. cloacae. Its MIC90 was 0.5 microgram/ml. GM and amikacin (AMK), ciprofloxacin (CPFX) and tosulfloxacin (TFLX) were also active with the MIC90s of 4 micrograms/ml. Penicillins and cephems except latamoxef (LMOX), cefmenoxime (CMX), CPR and CZOP showed lower activities with the MIC90s of 256 micrograms/ml or above. 6. Escherichia coli. Most of antimicrobial agents were active against E. coli. CPR, CZOP, IPM, carumonam (CRMN), CPFX and TFLX showed the highest activities against E. coli. The MIC90s of them were 0.125 microgram/ml or below. Cefotiam (CTM), flomoxef (FMOX) CMX, ceftazidime (CAZ), and LMOX were also active with the MIC90s of 0.25 microgram/ml. Penicillins were not so active with the MIC90s of 128 micrograms/ml or above. 7. Klebsiella pneumoniae. CRMN showed the highest activities against K. pneumoniae. Its MIC90 was < or = 0.125 microgram/ml. CZOP was also active with the MIC90 of 0.25 microgram/ml. Penicillins were not so active with the MIC90s of 128 micrograms/ml or above. 8. Proteus mirabilis. P. mirabilis was susceptible to a majority of drugs. CMX, CAZ, LMOX, CRP, cefpodoxime (CPDX), CRMN, CPFX and TFLX showed the highest activities against P. mirabilis isolated from patients with urinary tract infections. The MIC90s of them were 0.125 microgram/ml or below. MINO was not so active with the MIC90 of 128 micrograms/ml. 9. Pseudomonas aeruginosa. Most of the agents were not so active against P. aeruginosa. IPM showed MIC90 of 8 micrograms/ml. The others were not so active with the MIC90s of 16 micrograms/ml or above. CPFX showed MIC50 of 0.5 microgram/ml.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1993). III. Secular changes in susceptibility]

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1993 to May 1994 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis to chloramphenicol decreased. As for S. aureus, susceptible strains to minocycline (MINO) decreased in complicated UTIs. As for Citrobacter spp., and Enterobacter spp., their susceptibilities were not observed an obvious change. Against E. coli, the activities of cefotiam decreased in complicated UTIs, and aminoglycosides decreased. As for Klebsiella spp., susceptible strains to aminoglycosides decreased. The susceptibilities of P. mirabilis to all drugs except aminoglycosides and MINO were good. The susceptibilities of P. aeruginosa to quinolones isolated from complicated UTIs with indwelling catheter increased, but susceptible strains to aminoglycosides decreased. The susceptibilities of Serratia spp. to MINO has decreased. These data should be considered in clinical treatment of various urinary tract infections.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1992). III. Secular changes in susceptibility]

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June 1992 to May 1993 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis isolated from uncomplicated UTIs to quinolones has decreased. As for S. aureus, Citrobacter spp., Enterobacter spp., P. mirabilis and Serratia spp., which were detected very few in 1989, 1990, 1991 and 1992, their susceptibilities were not observed an obvious change. E. coli, all strains were highly susceptibilities to latamoxef and cefozopran. And the susceptibilities of E. coli isolated from uncomplicated UTIs and complicated UTIs without indwelling catheter to minocycline has decreased in 1991, but they has been indicated a trend of recovery in 1992. The difference in according UTI's classification of the susceptibilities of Klebsiella spp. to minocycline in 1991 has not recognized in 1992. And the susceptibilities of Klebsiella spp. isolated from complicated UTIs without indwelling catheter to quinolones has decreased. The susceptibilities of P. aeruginosa isolated from complicated UTIs to quinolones has been indicated a trend of recovery. These data should be considered in clinical treatment of various urinary tract infections.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1993). II. Background of patients]

Clinical background was investigated on 734 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period from June, 1993 to May, 1994. 1. Distribution of sex, age and infections Among over fifties males, the majority was taken by complicated urinary tract infections. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age. 2. Distribution of sex, age and pathogens isolated from UTIs In uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age, and next Klebsiella spp. and CNS. In complicated UTIs without indwelling catheter, E. coli and Enterococcus faecalis were the most frequent. In complicated UTIs with indwelling catheter, Pseudomonas aeruginosa were most frequently isolated, and next E. faecalis. 3. The frequency of complexed infections in UTIs The frequency of complexed infections has increased from in uncomplicated UTIs to complicated UTIs. 4. Administration of antibiotics and pathogens isolated from UTIs In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 222 to 33 isolates. And also, pathogens of complicated UTIs without indwelling catheter, have decreased from 205 to 50 isolates. However, in complicated UTIs with indwelling catheter, pathogens after or before administration of antibiotics, were not revealed an obvious change. 5. Pathogens and UTIs with or without factor and operation In uncomplicated UTIs with or without factor and operation, E. coli was mainly detected. In complicated UTIs without indwelling catheter and with or without factor and operation, E. coli and E. faecalis were mainly detected. In complicated UTIs with indwelling catheter and with factor and operation, P. aeruginosa and E. faecalis were mainly detected, 22.0% and 14.1%, respectively. Without factor and operation, was detected, E. faecalis 21.1%, and next Proteus spp. 15.8%. The distribution of pathogens, in the case of Serratia spp., has been obviously varied by the influence of factor and operation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Differentiation of brown adipose cells in three-dimensional collagen gel culture

Brown adipose cells are heat-producing cells through non-shivering thermogenesis by intramitochondrial "thermogenin". This specific protein is a marker for their cellular differentiation. It has long been known that cultured brown adipose cells in monolayer rapidly lose the thermogenin bioactivity. In this study, we cultured brown adipose cells in three-dimensional type I collagen gel matrix. Under this culture condition, they were able to survive, and differentiated morphologically and functionally for a long period of time, especially exhibited the characteristic immunohistochemical activity of thermogenin. These findings suggest that brown adipose cells differentiate in type I collagen gel. In this condition, cholera toxin or BRL 37344, one of beta 3-adrenoceptor agonists, specifically stimulated the brown adipose cells.

A unique case of extramammary Paget's disease. Derivation from eccrine porocarcinoma?

A unique case of extramammary Paget's disease is reported that may have derived from eccrine porocarcinoma. A palm-sized erythematous plaque on the patient's pubis spread to the lower abdominal wall. The center of the lesion contained a reddish tumor. Histologic findings of the erythematous plaque showed features of extra-mammary Paget's disease. Those of the reddish tumor, however, corresponded most closely to eccrine porocarcinoma, though we could not entirely rule out that the changes corresponded to larger nests of less differentiated Paget cells. The two distinct neoplastic areas showed continuity both clinically and histologically; our case differed from epidermotropic eccrine porocarcinoma in several clinicopathologic respects. Our case suggests the possibility that extramammary Paget's disease could arise from preexisting porocarcinoma.

Differentiation of human thyroid follicle cells from normal subjects and Basedow's disease in three-dimensional collagen gel culture

Thyroid follicles, an essential functional unit of the thyroid, exist in the extracellular matrix of the tissue in vivo. Therefore, in any monolayer culture system, the follicles cannot be reconstructed. Our previous study adopting three-dimensional collagen gel culture showed that isolated porcine follicle cells reconstructed thyroid follicles specific for the thyroid gland in vivo. To elucidate whether this culture system is also applicable to human follicle cells, and furthermore to provide a culture system for investigations of the pathogenesis of human thyroid diseases, we tried to culture isolated human follicle cells of normal thyroid tissue and of Basedow's disease in three-dimensional collagen gel. In this culture system, they apparently reconstructed thyroid follicles. The component cells of the reconstructed follicles exhibited structural polarity specific for human thyroid follicle cells and produced thyroid hormones. In addition, the cells responded to a TSH-stimulation in terms of morphological and functional differentiation, and they presented HLA-DR antigen with an interferon-gamma-stimulation. This report is a first instance of reconstruction of human thyroid follicles and HLA-DR antigen induction in three-dimensional follicle structures in vitro. This culture system provides a more physiological environment in vitro for biological and pathogenetic investigations of human thyroid follicle cells than the monolayer culture system. Further experiments using this method will probably provide new clues to the pathogenetic mechanisms of human thyroid diseases.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1988). III. Secular changes in susceptibility]

Sensitivities to various antibacterial and antibiotic agents of strains of Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Serratia marcescens and Pseudomonas aeruginosa isolated from patients with urinary tract infections (UTIs) in 9 hospitals during June to November 1988 were compared with those in the same period of previous year according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. No remarkable changes were found in sensitivities of E. coli, Proteus spp., Citrobacter spp. and S. marcescens. The sensitivity of Klebsiella spp. to cephems decreased in complicated UTI without indwelling catheter and increased in complicated UTI with indwelling catheter. The sensitivity of Enterobacter spp. to third generation cephems decreased in complicated UTI with indwelling catheter. Sensitivities of P. aeruginosa to aspoxicillin and cefsulodin increased. The number of resistant strains to new quinolones increased slightly.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1988). II. Background of patients]

Clinical background was investigated on 916 bacterial strains isolated from patients with urinary tract infections (UTIs) in 9 hospitals during the period from June to November, 1988. 1. Distribution of sexes, ages and infections: Among males, fifties and older were most frequent and most of them had complicated UTIs. Among females, most cases among twenties or thirties were uncomplicated UTIs. Forties and older cases were most frequent and complicated UTIs were more frequent among them than among patients in twenties and thirties. 2. Distribution of sexes, ages and pathogens isolated from UTIs: In males, Pseudomonas spp. and Enterococcus spp. were frequently isolated. In contrast, in females, Escherichia coli was the most frequent. In thirties, E. coli was not the most frequently isolated bacterium. Frequency of Pseudomonas spp., other non-fermented Gram-negative rods and Enterococcus spp. were greater among patients with higher ages. 3. Administration of antibiotics and pathogens isolated from UTIs: (1) Before administration: In uncomplicated UTIs, E. coli accounted for the majority of causative organisms. In complicated UTIs, particularly in those cases with indwelling catheter, Enterococcus spp. and Pseudomonas spp. were rather frequently isolated. (2) After administration: In complicated UTIs, higher number of pathogens were isolated. Pseudomonas spp. and Enterococcus spp. were the most frequent. Distribution of pathogens isolated from complicated UTIs without indwelling catheter was similar to that before antibiotic administration.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1988). I. Susceptibility distribution]

Isolation frequencies and sensitivities to antibacterial and antibiotic agents were investigated on 801 bacterial strains isolated from patients with urinary tract infections in 9 hospitals during the period of June to November 1988. Of the above total bacterial population, Gram-positive bacteria accounted for 29.3% and a majority of them were Enterococcus spp. Gram-negative bacteria accounted for 70.7% and most of them were Escherichia coli. 1. Enterococcus faecalis: Vancomycin was most active with its MIC90 < or = 0.78 microgram/ml. Ampicillin, piperacillin, ofloxacin (OFLX), ciprofloxacin (CPFX) and imipenem (IPM) were also active. 2. Staphylococcus aureus: Arbekacin and minocycline were most active with their MIC90s 0.39 microgram/ml and 1.56 micrograms/ml, respectively. Among penicillins, dicloxacillin was the most active. Activities of cephems were considerably lower. 3. E. coli: Most of the agents were tested active. Particularly the second and third generation cephems were active in a range of < or = 0.10-0.20 microgram/ml. Carumonam (CRMN), IPM, OFLX and CPFX were also active with MIC90s < or = 0.10 microgram/ml. 4. Klebsiella pneumoniae CRMN and IPM were highly active. Penicillins generally showed lower activities. Cephems and new quinolones had high activities with their MIC90s in a range of 0.39-0.78 microgram/ml. 5. Proteus mirabilis: The third generation cephems were active with their MIC90s in a range of < or = 0.10-0.20 microgram/ml. CRMN, OFLX and CPFX were also active with their MIC90s < or = 0.10 microgram/ml, 0.39 microgram/ml and 0.20 microgram/ml, respectively. 6. Pseudomonas aeruginosa: IPM and tobramycin were active with their MIC90s 1.56 micrograms/ml and 3.13 micrograms/ml, respectively. CRMN and new quinolones showed MIC80s of 25-100 micrograms/ml. Most of penicillins and cephems were not active. 7. Other Gram-negative rods: Against Citrobacter freundii, Enterobacter cloacae and Serratia marcescens, IPM, CPFX and OFLX were active. Penicillins and cephems were not so active. CRMN was active against S. marcescens with its MIC80 at 6.25 micrograms/ml.

[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)

A simple culture method of fat cells from mature fat tissue fragments

To obtain immature fat cells in vitro, we used a primary culture of undigested mature fat tissue fragments. The immature fat cells, i.e., fibroblast-like fat cells, proliferated extensively from the fat tissue and differentiated after reaching confluence. The process of differentiation was assumed by the development of intracytoplasmic lipid droplets and by the triglyceride content in the cells. Cellular differentiation was induced in high percentages (over 70-80%) of the cells in the medium containing high glucose concentrations (200 mg/dl) supplemented with 10-20% newborn calf serum. The intracellular accumulation of triglyceride was also enhanced by insulin administration. In these cells, a reciprocal relationship was observed between proliferation and differentiation. Fibroblast-like fat cells derived from mature fat tissue in this simple culture system are suitable for the study of the proliferation and differentiation of immature fat cells.

[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)

[Synchronously occurring transitional cell carcinoma of the ureter with adrenocortical carcinoma]

A sixty eight-year-old man was admitted to our hospital complaining of macroscopic hematuria. Ultrasonography, X-ray and laboratory examination revealed a right ureter tumor and left non-functioning adrenal tumor. Pathological diagnosis was transitional cell carcinoma of the ureter and left adrenocortical carcinoma. A review of persistent Japanese literature revealed this case to be the 97th case of non-functioning adrenocortical carcinoma and the first case synchronously occurring with transitional cell carcinoma of the ureter. Forty eight cases of synchronously occurring transitional cell carcinoma of the ureter with cancers in other organs, especially renal cell carcinoma and gastric cancer, have been reported. Recently, an increasing number of cases of non-functioning adrenal carcinoma are detected by CT scan, ultrasonography, adrenal radioisotopic scintigraphy and urinary 17-OHCS, 17-KS.

[Cryoprostatectomy of prostatic tumors]

Since 1968, we have carried out cryoprostatectomy on prostatic hypertrophy and prostatic cancer patients. As for the method of monitoring during cryoprostatectomy, digital examination only was carried out at the beginning in order to confirm the range of freezing and to determine the freezing time. In 1972, we developed a cryoprostatectomy method under direct intravesicular observation using the Trocar Cystoscope and furthermore in 1980, we developed echoguided cryoprostatectomy using the transrectal linear electronic scanner. These new developments ensure the safety of cryoprostatectomy and furthermore, cryoprostatectomy can now be easily carried out. The above-mentioned procedures are described.

[Pheochromocytoma in an elderly patient: report of a case]

This is a case report of a pheochromocytoma which developed in a 67-year-old man. The patient presented himself with a productive cough and orthopnea, both of which were subsequently proved to be due to hypertensive heart failure. The diagnosis of a pheochromocytoma originating from the left adrenal gland was established endocrinologically and roentgenologically. Transperitoneal adrenalectomy was undertaken, and a tumor weighing 300 g was obtained. Histopathologically, the tumor was composed of two elements: cells with profuse cytoplasma having chromaffin-positive granules, and other cells consisting of spindle cells with mitosis. Surgical exploration could not identify another tumor or metastasis, and his blood pressure returned to normal, with normal catecholamine levels, after surgery. This is the first reported case of an elderly person with a pheochromocytoma complicated by congestive heart failure and renal insufficiency preoperatively; however, it was controlled well, and he underwent surgery successfully. This case constitutes the 64th report on a pheochromocytoma in persons over 60 years of age in the Japanese literature.

[Adrenal cyst: report of a case]

This is a case report of an adrenal cyst which developed in a 36-year-old man. The patient experienced sudden abdominal pain, accompanied by sweating. The diagnosis was established by ultrasound-sonography and CT-scan. The adrenal cyst was removed surgically; it measured 20 X 10 X 10 cm and contained 1,900 ml of a white, cloudy fluid. Histological examination showed that the cyst wall was lined with mesothelial cells and was of congenital origin. The cyst was endocrinologically non-functioning, for all the endocrinological data were within normal limits. After surgery, however, hypertension has persisted and has been diagnosed as being essential in origin. This is the 63rd case reported in the Japanese literature.