High-dose-rate interstitial brachytherapy in combination with androgen deprivation therapy for prostate cancer: are high-risk patients good candidates?

BACKGROUND AND PURPOSE: To evaluate the effectiveness of high-dose-rate interstitial brachytherapy (HDR-ISBT) as the only form of radiotherapy for high-risk prostate cancer patients. PATIENTS AND METHODS: Between July 2003 and June 2008, we retrospectively evaluated the outcomes of 48 high-risk patients who had undergone HDR-ISBT at the National Hospital Organization Osaka National Hospital. Risk group classification was according to the criteria described in the National Comprehensive Cancer Network (NCCN) guidelines. Median follow-up was 73 months (range 12-109 months). Neoadjuvant androgen deprivation therapy (ADT) was administered to all 48 patients; 12 patients also received adjuvant ADT. Maximal androgen blockade was performed in 37 patients. Median total treatment duration was 8 months (range 3-45 months). The planned prescribed dose was 54 Gy in 9 fractions over 5 days for the first 13 patients and 49 Gy in 7 fractions over 4 days for 34 patients. Only one patient who was over 80 years old received 38 Gy in 4 fractions over 3 days. The clinical target volume (CTV) was calculated for the prostate gland and the medial side of the seminal vesicles. A 10-mm cranial margin was added to the CTV to create the planning target volume (PTV). RESULTS: The 5-year overall survival and biochemical control rates were 98 and 87 %, respectively. Grade 3 late genitourinary and gastrointestinal complications occurred in 2 patients (4 %) and 1 patient (2 %), respectively; grade 2 late genitourinary and gastrointestinal complications occurred in 5 patients (10 %) and 1 patient (2 %), respectively. CONCLUSION: Even for high-risk patients, HDR-ISBT as the only form of radiotherapy combined with ADT achieved promising biochemical control results, with acceptable late genitourinary and gastrointestinal complication rates.

Poorly differentiated neuroendocrine carcinoma of the seminal vesicle.

We describe an extremely rare case of poorly differentiated neuroendocrine carcinoma arising from the seminal vesicle. A 67-year-old man presented with a left humeral bone tumor resulting in a pathological fracture. Positron emission tomography scan disclosed a large pelvic tumor mimicking prostatic cancer invading into the seminal vesicle. Laboratory data showed an elevation of neuron-specific enolase, despite the normal prostate-specific antigen. Transrectal needle biopsy showed a poorly differentiated carcinoma of the right seminal vesicle and the metastasis of the pelvic lymph node. Immunohistochemical results were compatible with the features of neuroendocrine carcinoma; synaptophysin, chromogranin A and CD 56 were positive. The previously biopsied bone tumor was finally diagnosed as a metastasis. A systemic chemotherapy using etoposide and cisplatin failed. The patient died of cancer one-and-a-half years later.

[Solitary fibrous tumor of the urinary bladder: a case report].

Solitary fibrous tumor (SFT) is one of the mesenchymal tumor usually occurs in the pleura. Extrapleural occurrence of SFT is uncommon. We herein report an extremely rare case of 72-year old man with SFT originated in the urinary bladder. The tumor was incidentally discovered as a mass of 8.5 mm in diameter by a pelvic MRI. Cystoscopy revealed the protruding submucosal tumor in the center of the trigon. Transurethral resection was carried out. Pathological examination revealed a tumor composed of spindle cells with rich vascularity surrounded by abundant collagen fibers. The immunohistochemical findings showed a strong positivity to CD 34 and relatively weak positivity to Bcl-2. MIB-1 index indicated less than 3%, thus the tumor was diagnosed as a solitary fibrous tumor. The patient has no evidence of disease 16 months after the surgery. The current case was the first report in Japan and the twelfth worldwide.

[Validation of 2009 TNM classification based on a prognostic analysis of 350 patients treated for renal cell carcinoma].

PURPOSE: To validate 2009 TNM classification (7th edition) of renal cell carcinoma (RCC), we reevaluated our RCC database depends on 6th and 7th TNM staging and analyzed a prognostic divergence between subgroups. METHODS: A study population of 350 patients with RCC was retrospectively reviewed based on the TNM classification both 6th and 7th editions. Cause-specific survival (CSS) in each group was estimated using Kaplan-Meier method. RESULTS: Applying the new TNM system, 336 patients were divided into pT1a 131, pT1b 105, pT2a 31, pT2b 13, pT3 a 38, pT3b 3, pT3c 0, pT4 14. Previously pT3b-staged 11 cases with renal vein involvement without vena caval extension were included into pT3a. Due to the positive direct invasion into the adrenal gland, previously pT3-staged six patients were changed to pT4. Kaplan-Meier curves revealed no significant differences in CSS between each a/b subgroups from pT1 to pT3. Particularly, no significant statistical value was recognized between pT2a and pT2b subgroups. Patients with direct adrenal invasion tended to show a less favorable prognosis than those with invasion beyond Gerota. CONCLUSIONS: (1) pT2 subdivision does not affect prognostic value. (2) Population imbalance is enhanced due to the pT 3 reclassification. (3) Direct adrenal invasion is compatible with pT4 category.

Clinical outcome and prognostic factors of sorafenib in Japanese patients with advanced renal cell carcinoma in general clinical practice.

OBJECTIVE: Effects of sorafenib in general clinical practice, especially those with patients of Asian ethnicity, have been rarely investigated. We assessed efficacy, safety and prognostic factors for progression-free survival in Japanese patients receiving sorafenib for advanced renal cell carcinoma. METHODS: We performed a retrospective analysis of 159 Japanese patients with renal cell carcinoma. Progression-free survival was estimated by the Kaplan-Meier method. Objective response (per Response Evaluation Criteria in Solid Tumors) and safety were assessed. Cox proportional hazards model was used to identify independent prognostic factors for progression-free survival. RESULTS: The median progression-free survival was 9.0 months (95% confidence interval, 7.5-10.6 months). In 142 patients with measurable lesions, the objective response rate was 21.8%, and disease control was achieved in 85 (59.9%) patients. Adverse events of any grade occurred in 152 patients (95.6%). Most common adverse events causing discontinuation or interruption of sorafenib were hand-foot skin reaction (22%), rash (10.7%) and liver dysfunction (10.7%). Dose reduction or therapy interruption due to adverse events was required in 128 patients (80.5%). Univariate and multivariate analysis revealed that favorable prognosis according to Memorial Sloan-Kettering Cancer Center prognostic factors and relative dose intensity during the first month of treatment of ≥50% were significant factors for predicting superior progression-free survival with sorafenib treatment. CONCLUSIONS: Sorafenib was effective in Japanese patients with advanced renal cell carcinoma in general clinical practice and was tolerated although most patients required dose reduction or interruption of therapy. Future studies should establish new strategies for treatment without sacrificing both efficacy and patient quality of life.

Expression of Epstein-Barr virus in renal cell carcinoma.

There have been few studies regarding the etiology of renal cell carcinoma. To examine the possible involvement of Epstein-Barr virus (EBV) in this disease, 9 renal cell carcinoma (RCC), 2 nephroblastoma (Wilms' tumor) and 2 RCC cell lines were subjected to mRNA in situ hybridization and indirect immunofluorescence staining. Messenger RNA in situ hybridization using BamHIW, EBNA LP, EBNA 2 and EBER1 probes of EBV revealed signals in all the examined samples, although some samples showed weak signals using the EBNA LP probe. Indirect immunofluorescence staining using anti-EBNA LP, anti-EBNA2, anti-LMP1 and anti-BZLF1 antibodies showed definitive fluorescence. PCR also revealed EBV DNA in all 8 RCC specimens including 7 cases other than hybridization and fluorescence. EBV infected all the RCC and nephroblastoma irrespective of the histological or clinical stage. On the other hand, EBV expression was stronger in papillary and clear cell-type RCC than chromophobe cell-type, as well as being stronger in the higher grades of RCC. These results suggest that the expression of EBV may be involved in the pathogenesis of RCC and nephroblastoma.

New implant technique for separation of the seminal vesicle and rectal mucosa for high-dose-rate prostate brachytherapy.

PURPOSE: For safer treatment of seminal vesicles (SVs), we initiated a new technique using an anchor applicator for high-dose-rate interstitial brachytherapy (HDR-ISBT) of prostate cancer. METHODS AND MATERIALS: Between January 2004 and March 2005, 23 intermediate- to high-risk patients were treated with HDR-ISBT as monotherapy. Transrectal ultrasonography guided implantation of the treatment applicator in and around the prostate gland and proximal SV. We used an "anchor" applicator to prevent posterior displacement of the SV. After insertion of the anchor applicator, the actual treatment applicator was implanted at the best position for optimal SV coverage. SV coverage was analyzed using a dose-volume histogram. RESULTS: Implantation of the applicator on the posterior side of the SV was successful for 43 of 46 SVs (93%). The median percentage of the SVs receiving the prescribed dose was 41% (range 11-86%). Only one case of acute Grade 2 toxicity (3%) was seen. CONCLUSIONS: Our anchor applicator technique for HDR-ISBT can separate the SV from the rectum. This is the first report of dose-volume histogram analysis of the SV for HDR-ISBT.

New ambulatory implant technique of high-dose-rate interstitial brachytherapy for prostate cancer.

PURPOSE: The aim of this study was to improve the performance status of prostate cancer patients during high-dose-rate interstitial brachytherapy (HDR-ISBT). To this end, we have developed a new ambulatory implant technique. MATERIALS AND METHODS: Ten prostate cancer patients were treated with HDR-ISBT as monotherapy from October 2003 until March 2004. We utilized a new removable template, a flexible applicator with a nonmetallic bead and button stopper, and an inner catheter connecting the applicator and the transfer tube of the brachytherapy unit. We shortened the connector end of the flexible applicator to enable the patient to sit down and walk freely during the treatment time. RESULTS: All 10 patients could walk without any support. No problem in the application was observed. CONCLUSION: Our new ambulatory implant technique for HDR-ISBT was able to improve the performance status of prostate cancer patients.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2004). III. Secular changes in susceptibility].

The bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa) isolated from patients diagnosed as urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2004 and July 2005. The susceptibilities of these bacteria to various antimicrobial agents were measured. The bacteria were divided into 2 groups consisting of uncomplicated UTIs and complicated UTIs (with and without indwelling catheter) based on their isolation origins. The results were compared with those obtained between 1995 and 2003. The drug sensitivity of S. aureus in this year was similar to those in up to the previous year and S. aureus showed the best susceptibility to vancomycin (VCM) and arbekacin (ABK). The drug sensitivity of E. faecalis in this year also was similar to those in up to the previous year. The susceptibility of E. coli to cephems in this year was generally good and was similar to those in up to the previous year. MIC90 of cefozopran (CZOP) was the most stable and 0.125 microg/mL or less since 1995. The susceptibility of E. coli to cefpirome (CPR) and cefotiam (CTM) also was good but to cefaclor (CCL), cefixime (CFIX), and cefpodoxime (CPDX) was largely decreased in complicated UTI groups. The sensitivity of E. coli to carbapenems also was good but to carumonam (CRMN) tended to decrease. The susceptibility of E. coli to quinolones, however, has largely changed and has decreased since 2003 in uncomplicated UTIs and 2000 in complicated UTIs. That was suggested the development of the resistance to the drug. The susceptibility of Klebsiella spp. to cefazolin (CEZ), CTM, CCL, CPDX, and cefditoren (CDTR) decreased in the previous year and recovered to the year before the previous year in this year. The susceptibility of Klebsiella spp. to other cephems was stable since 1995, especially against CZOP, the highest sensitivity (MIC90: < or = 0.125 microg/mL) was maintained. The susceptibility of Klebsiella spp. to carbapenems and CRMN also was good. The susceptibility of Klebsiella spp. to aminoglycosides was lower than to CZOP but was stable since 1995. The susceptibility of P. aeruginosa was generally low and has largely changed against the majority of the agents since 1995. The susceptibility of P. aeruginosa isolated from uncomplicated UTIs has largely changed against ceftazidime (CAZ), cefsulodin (CFS), CZOP, imipenem (IPM), meropenem (MEPM), aztreonam (AZT), CRMN, gentamicin (GM), and tobramycin (TOB). The susceptibility of P. aeruginosa isolated from complicated UTIs has largely changed against CSF, CZOP, MEPM, GM, and ciprofloxacin (CPFX). The susceptibility of P. aeruginosa isolated from complicated UTIs has been stable against amikacin (AMK). For annual changes in MIC50, TOB and IPM had a relatively stable and high activity (MIC50: 0.5-2 microg/mL).

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2004). I. Susceptibility distribution].

The bacterial strains isolated from 490 patients diagnosed as having urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2004 and July 2005. The susceptibilities of them to many kinds of antimicrobial agents were measured. Of them, 577 strains were estimated as causative bacteria and used for the measurement. The strains consisted of 156 gram-positive bacterial strains (27.0%) and 421 gram-negative bacterial strains (73.0%). Against Staphylococcus aureus, arbekacin (ABK), vancomycin (VCM) showed the strongest activity and prevented the growth of all strains with 2 microg/mL. Against Enterococcus faecalis, ampicillin (ABPC) and VCM showed a strong antibacterial activity. The antibacterial activity of cephems to Escherichia coli was generally good, and especially cefozopran (CZOP) and cefpirome (CPR) showed the strongest activity (MIC90: < or = 125 microg/mL). Quinolone resistant E. coli [MIC of ciprofloxacin (CPFX): > or = 4 microg/mL] was detected at frequency of 18.8%, which was higher than that in the last year. Against Klebsiella pneumoniae, CZOP, meropenem (MEPM), and carumonam (CRMN) showed the strongest activity and prevented the growth of all strains with 0.125 microg/mL or less. The antibacterial activity of the other cephems was relatively good, and decrease in their activity observed in the last year study was not recognized. Against Serratia marcescens, imipenem (IPM) and gentamicin (GM) had the strongest antibacterial activity. Against Proteus mirabilis, CRMN showed the strongest activity and prevented the growth of all strains with 0.125 microg/mL or less. MEPM prevented the growth of all strains with 0.25 microg/mL. Next, cefmenoxime (CMX), ceftazidime (CAZ), CZOP, cefixime (CFIX), cefpodoxime (CPDX), and cefditoren (CDTR) showed a strong activity. The antibacterial activity of the drugs to Pseudomonas aeruginosa was generally low, and MIC90 of all the drugs was ranged from 32 to > 128 microg/mL except IPM and MEPM having 16 microg/mL. The antibacterial activities of CZOP and CAZ were considered to be relatively good on MIC50 comparison (MIC50: 2 microg/mL).

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2004) II. Background of patients].

Six hundred six bacterial strains isolated from 490 patients diagnosed as having urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2004 and July 2005. The frequency of bacteria isolation stratified with patient clinical background was compared. The clinical background investigated included sex, age, type of infections, timing of antibiotics administration, and presence or absence of surgery affecting a decrease in defense against infection. The bacterial strains were stratified with the age and sex of the patients and the types of infections. In males, the number of patients aged less than 60 years was few and the complicated UTIs without indwelling catheter was observed most frequently. In females, the number of patients aged less than 60 years was comparatively more than in males. In all of ages except 0-19 and > or = 80 years, the ratio of the uncomplicated UTIs was high, accounting for 44.1-90.0% of all types of infections. In the present time, the bacteria most frequently isolated were Escherichia coli. Pseudomonas aeruginosa and Enterococcus faecalis also were relatively frequently isolated. E. coli most frequently isolated with the uncomplicated UTIs and P. aeruginosa and E. faecalis most frequently isolated with the complicated UTIs. With respect to the relation of these results to the age of the patients, in the uncomplicated UTIs, the isolation frequency of E. coli was the highest in all age groups except 0-19 years, accounting for 50% or higher. In the complicated UTIs without indwelling catheter, the isolation frequency of E. coli tended to be high in all age groups. In the complicated UTIs with indwelling catheter, P. aeruginosa were more frequently isolated. In comparison of causative bacteria in UTIs between before and after the administration of antibiotics, P. aeruginosa increased after the administration in any types of UTIs. In comparison of causative bacteria in UTIs with or without surgery, E. coli was more frequently isolated in the patients without surgery, while P. aeruginosa and E. faecalis were more frequently isolated in the patients with surgery in any UTIs.

Elevated expression of valosin-containing protein (p97) is associated with poor prognosis of prostate cancer.

PURPOSE: Valosin-containing protein (VCP) has been shown to be associated with metastasis and prognosis in human cancers. In the present study, the correlation of VCP with recurrence and prognosis in patients with prostate cancer (PCA) receiving conservative therapy was examined. EXPERIMENTAL DESIGN: VCP expression was analyzed immunohistochemically in 136 patients ranging from 46 to 92 years (median, 72 years), who received conservative therapy, including androgen deprivation, radiotherapy, or watchful waiting. Staining intensity of tumor cells was categorized as weaker (level 1) or equal to or stronger (level 2) than that in endothelial cells. The correlation of VCP expression between the mRNA and protein levels was examined in 10 patients. RESULTS: Thirty-two cases (23.5%) showed level 1 and 100 (76.5%) level 2 VCP expression. Quantitative reverse transcription-PCR analysis revealed greater VCPmRNA expression in level 2 (n = 5) than level 1 cases (n = 5; P < 0.05). A significant difference was observed between VCP level 1 and 2 patients in the positive rate for the digital rectal examination (P < 0.01), serum prostate-specific antigen level (P < 0.0001), cancer volume (P < 0.0001), Gleason score (P < 0.0001), stage (P < 0.0001), and progression-free and overall survival (P < 0.0001 for both). Multivariate analysis revealed VCP expression level, serum prostate-specific antigen level, and Gleason score to be independent prognosticators for progression-free and overall survival. Progression of PCA was found in 9.4% of level 1 but in 64% of level 2 patients. CONCLUSIONS: PCA with level 1 VCP expression could be treated conservatively.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2003). I. Susceptibility distribution].

The bacterial strains isolated from 565 patients diagnosed as having urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2003 and July 2004. The susceptibilities of them to many kinds of antimicrobial agents were investigated. Of them, 701 strains were estimated as prophlogistic bacteria and used for the investigation. The strains consisted of 258 Gram-positive bacterial strains (36.8%) and 443 Gram-negative bacterial strains (63.2%). Against Staphylococcus aureus, vancomycin (VCM) showed the strongest activity and prevented the growth of all strains with 2 microg/mL. Against Streptococcus agalactiae, ampicillin (ABPC), cefozopran (CZOP), imipenem (IPM), and clarithromycin (CAM) showed a strong activity and the MIC90 was 0.125 microg/mL or less. Against Enterococcus faecalis, VCM, ABPC, and IPM showed a strong antibacterial activity. The antibacterial activity of cephems to Escherichia coli was generally good, and especially CZOP and cefpirome (CPR) showed the strongest activity (MIC90: < or = 0.125 microg/mL). Quinolone resistant E. coli [MIC of ciprofloxacin (CPFX): > or =4 microg/mL] was detected at frequency of 15.7%, which was higher than that in the last year. Against Klebsiella pneumoniae, meropenem (MEPM) showed the strongest activity and next, the antibacterial activity of CRMN and CZOP was good. The antibacterial activity of the other cephems, however, significantly decreased, compared with that evaluated in last year. Against Serratia marcescens, MEPM had the strongest antibacterial activity. Against Proteus mirabilis, MEPM and CRMN showed the strongest activity and prevented the growth of all strains with 0.125 microg/mL or less. Nest, cefmenoxime (CMX), ceftazidime (CAZ), cefixime (CFIX), cefpodoxime (CPDX), CPR, CZOP, and cefditoren (CDTR) showed a strong activity. The antibacterial activity of the drugs to Pseudomonas aeruginosa was generally low, and MIC90 of all the drugs was ranged from 32 to < or = 256 microg/mL except IPM and amikacin (AMK) having 16 microg/mL. The antibacterial activity of CZOP was relatively good (MIC50: 2 microg/mL).

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2003). II. Background of patients].

Seven hundred and nineteen bacterial strains isolated from 565 patients diagnosed as having urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2002 and July 2003. The frequency of bacteria isolation divided with patient clinical background was compared. The clinical background investigated included sex, age, type of infections, timing of antibiotics administration, and presence or absence of surgery affecting a decrease in defense against infection. The bacterial strains were divided with the age and sex of the patients and the types of infections. In males, the number of patients aged less than 50 years was few and the complicated UTIs without indwelling catheter was observed most frequently. Number of patients aged 20-39 years was greater in female than male. In all of ages except 0-9 and 70-79 years, the ratio of the uncomplicated UTIs was high, accounting for 44.4-91.7% of all types of infections. In the present time, the bacteria most frequently isolated were Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis also were relatively frequently isolated. E. coli was most frequently isolated from the uncomplicated UTIs, and P. aeruginosa and E. faecalis were frequently isolated from the complicated UTIs with indwelling catheter. With respect to the relation of these results to the age of the patients, in the uncomplicated UTIs, the isolation frequency of E. coli was the highest in all age groups, accounting for 40% or higher. In the complicated UTIs without indwelling catheter, the isolation frequency of E. coli decreased with aging of the patients but still was the highest in all age groups. In the complicated UTIs with indwelling catheter, the isolation frequency of E. coli was lower than in the uncomplicated UTIs in all age groups and P. aeruginosa and E. faecalis were more frequently isolated. In comparison of causative bacteria in UTIs between before and after the administration of antibiotics, P. aeruginosa increased after the administration in any types of UTIs. In comparison of causative bacteria in UTIs with or without surgery, E. coli was more frequently isolated in the patients without surgery, while P. aeruginosa and E. faecalis were more frequently isolated in the patients with surgery in any UTIs.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2003). III. Secular changes in susceptibility].

The bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa) isolated from 565 patients diagnosed as urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2003 and July 2004. The susceptibilities of these bacteria to various antimicrobial agents were examined. The bacteria were divided into 2 groups consisting of uncomplicated UTIs and complicated UTIs (with and without indwelling catheter) based on their isolation origins. The results were compared with those obtained between 1994 and 2002. The drug sensitivity of S. aureus in this year was similar to those in up to the previous years and S. aureus showed the best susceptibility to vancomycin. The drug sensitivity of E. faecalis in this year also was similar to those in up to the previous years. The drug sensitivity of E. coli in this year was generally good except penicillins and was similar to those in up to the previous years. Among cephems, cefozopran (CZOP) and cefpirome (CPR) showed the highest potency activity (MIC90: < or = 0.125 microg/mL). An antibacterial activity of cefotiam (CTM) was stable for 10 years and was fine (MIC0: < or = 0.5 microg/mL). The sensitivity of E. coli to carbapenems and carumonam (CRMN) also was good like to CZOP. The sensitivity of the complicated UTIs group to quinolones, however, has decreased after 2000 and it was suggested that the resistance to the drug has developed. Kiebsiella spp. showed a decrease in the susceptibility to some of cephems. The drugs indicating a big decrease in the sensitivity were cefazolin, CTM, cefaclor, and cefpodoxime. Imipenem, carbapenems, also indicated a decrease in the sensitivity. The susceptibility of the strain to the other drugs was similar to that in up to the previous years. Among them, CZOP maintained good susceptibility (MIC90: > or = 0.125 microg/mL against uncomplicated UTIs, 0.25 microg/mL against complicated UTIs) like meropenem. The drug sensitivity of P. aeruginosa was generally low and was not much different from that in up to the previous years.

[Prostate cancer metastasized to thyroid cartilage: a case report].

A 75-year-old male was diagnosed as prostate cancer (serum PSA: 4,772 ng/ml, Gleason score: 4 + 4 = 8) with multiple bone metastases. And he noticed a painless mass of the frontal neck a month before the diagnosis. Computed tomography of the neck showed a tumor in the thyroid cartilage. Biopsy of the neck tumor revealed metastasis of prostate cancer by positive PSA staining. Metastasis of malignant tumor to cartilaginous tissue is extremely rare because there are usually no vessels in it. Only 4 cases of the metastasis of prostate cancer to the thyroid cartilage have been reported. It was thought that tiny bone marrows were formed in the ossified cartilage and it caused hematogenous metastasis.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2002). III. Secular changes in susceptibility].

The bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa) isolated from patients diagnosed as urinary tract infections (UTIs) in 13 institutions in Japan were supplied between August 2002 and July 2003. The susceptibilities of these bacteria to various antimicrobial agents were examined. The bacteria were divided into 2 groups consisting of uncomplicated UTIs and complicated UTIs (with and without indwelling catheter) based on their isolation origins. The results were compared with those obtained between 1993 and 2001. The drug sensitivity of S. aureus in this year was similar to those in up to the previous year and S. aureus showed the best susceptibility to vancomycin. The drug sensitivity of E. faecalis in this year also was similar to those in up to the previous year. The drug sensitivity of E. coli in this year was generally good except penicillins and was similar to those in up to the previous year. Among cephems, cefozopran (CZOP) and cefpirome (CPR) showed the highest potency (MIC90: < or = 0.125 microg/mL). An antibacterial activity of cefotiam (CTM) was similar to it in 10 years ago and was fine (MIC90: < or = 1 microg/mL). The sensitivity of E. coli to carbapenems and carumonam (CRMN) also was good like to CZOP. However, the sensitivity of the complicated UTIs group to quinolones decreased after 2000 and was suggested to develop the resistance to the drug. The drug sensitivity of Klebsiella spp. in this year also was similar to those in up to the previous year. The bacteria showed good susceptibility (MIC: < or = 0.125 microg/mL) to cefmenoxime (CMX), CPR, cefixime (CFIX), flomoxef (FMOX), and CZOP among cephems. The drug sensitivity of P. aeruginosa was generally low. Most of the bacteria were little sensitive to cephems except CZOP and ceftazidime (CAZ). The sensitive bacteria to CZOP and ceftazidime (CAZ) were observed to be 26.8% (15/56 strains) and 39.3% (22/56 strains) in complicated UTIs group, respectively. The sensitivity profile of P. aeruginosa to the other tested drugs was not much different from that in up to the previous year. However, the sensitivity of the bacteria to carbapenems tended to decrease after 2000, and the low sensitive strains (MIC: > or = 256 microg/mL) were detected at 22.2% (2/9 strains) in the uncomplicated UTIs group and 3.6% (2/56 strains) in the complicated UTIs group.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2002). I. Susceptibility distribution].

The bacterial strains isolated from 491 patients diagnosed as having urinary tract infections (UTIs) in 13 institutions in Japan were supplied between August 2002 and July 2003. The susceptibilities of them to many kinds of antimicrobial agents were investigated. Of them, 578 strains were estimated as causative bacteria and used for the investigation. The number of them was 578 strains consisting of 177 gram-positive bacterial strains (30.6%) and 401 gram-negative bacterial strains (69.4%). Against Staphylococcus aureus, vancomycin (VCM) showed a strong activity and prevented the growth of all strains with 1 microg/mL. The susceptibility of Staphylococcus epidermidis to cephems including cefotiam (CTM) was relatively good. Against Enterococcus faecalis, ampicillin (ABPC), imipenem (IPM), and VCM showed the strongest antibacterial activity (MIC90: 2-4 microg/mL). In addition, the low sensitive strains (MIC: > or = 256 microg/mL) to clarithromycin (CAM) were detected at 48.3% but none to cefozopran (CZOP). The antibacterial activity of cephems to Escherichia coli was generally good, and especially CZOP and cefpirome (CPR) showed the highest activity (MIC90: < or = 0.125 microg/mL). Quinolone resistant E. coli was detected at frequency of 13.5%, which was higher than that in the last year. The antibacterial activity of cephems to Citrobacter freundii was generally low but CZOP and CPR had a strong acitivity (MIC90: 0.25 and 0.5 microg/mL, respectively). The antibacterial activity of cephems to Klebsiella pneumoniae was good and especially cefmenoxime (CMX), cefixime (CFIX), flomoxef (FMOX), CPR, and CZOP showed stronger activity (MIC90: < or = 0.125 microg/mL). Against Serratia marcescens, meropenem (MEPM) had the highest antibacterial activity followed by CPR and CZOP. Against Proteus mirabilis, CMX, ceftazidime (CAZ), CPR, MEPM, carumonam (CRMN), and levofloxacin (LVFX) showed the strongest activity (MC90: < or = 0.125 microg/mL). Among other cephems, CZOP and CFIX were also strong (MIC90: 0.25 microg/mL). The antibacterial activity of the drugs to Pseudomonas aeruginosa was generally low, and MIC90 of all the drugs were ranged from 64 to > or = 256 microg/mL except IPM and amikacin (AMK) having 16 microg/mL. The antibacterial activity of CZOP was relatively good (MIC50: 8 microg/mL).

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2002). II. Background of patients].

A total of 615 bacterial strains isolated from 491 patients diagnosed as having urinary tract infections (UTIs) in 13 institutions in Japan were supplied between August 2002 and July 2003. Then, the clinical background of patients were investigated such as sex, age, and type of infections and kind of bacteria, frequency of bacteria isolation by age and infections, bacteria and infections by timing of antibiotics administration, and bacteria and infections by surgical procedures. The bacterial strains were divided by the age and sex of the patients and the types of infections. In males, the number of patients aged less than 50 years was few and the complicated UTIs without indwelling catheter was observed most frequently. In the present time, the bacteria most frequently isolated were Escherichia coli. Pseudomonas aeruginosa and Enterococcus faecalis were also relatively frequently isolated. E. coli decreased and P. aeruginosa increased with the complication of the infections. E. faecalis tended to be isolated more frequently in the complicated UTIs than in the uncomplicated UTIs. With respect to the relation of these results to the age of the patients, in the uncomplicated UTIs, the isolation frequency of E. coli was the highest in all age groups, accounting for 70.8% in 20-49 years old. In the complicated UTIs without indwelling catheter, the isolation frequency of E. coli decreased with aging of the patients and was lower than that of E. faecalis in the patients aged 70 or more (18.3 vs 20.6%). In the complicated UTIs with indwelling catheter, the isolation frequency of E. coli was lower than in the uncomplicated UTIs in all age groups and P. aeruginosa and E. faecalis were more frequently isolated. In comparison of causative bacteria in UTIs between before and after the administration of antibiotics, E. coli decreased and P. aeruginosa increased after the administration in any UTIs. In comparison of causative bacteria in UTIs with or without surgery, E. coli was more frequently isolated in the patients without surgery, while P. aeruginosa was more in the patients with surgery in any UTIs. E. faecalis was more frequently isolated in the patients with surgery in uncomplicated and complicated UTIs without indwelling catheter and in the patients without surgery in complicated UTIs with indwelling catheter.