Early prognoses of 200 renal allografts harvested from non-heart-beating cadavers.

When the concept of brain death is not widely accepted, the viability of renal allografts of non-heart-beating cadaveric donors is one of the serious concerns for transplant surgeons. At our center, 200 kidneys were harvested from cardiac arrest donors using the regional in situ cooling technique, and they were transplanted into recipients treated with cyclosporine (CS). The ages of donors ranged from 7 months to 67 years. At the bedside a specially designed double balloon catheter, 14F, was inserted into the aorta through the femoral artery just before or immediately after the cardiac arrest. A venous drainage tube was also placed in the vena cava. Following the cardiac arrest, both balloons of the aortic catheter were inflated, and regional in situ cooling with cold Lactate Ringer's solution started using the infusion pump at 20 mL/kg/min. In the OR, both kidneys were removed en bloc and preserved in Collins'type solution. They were then transplanted into 200 patients treated with CS and steroid. After the transplant operations, 33 patients (16.5%) had immediate renal function, but 14 grafts (7.0%) were not successful and the patients have never had renal function. When several factors such as donor age, warm ischemic time (WIT; 12.3 ± 14.1 minutes), in situ cooling time (IST; 78.1 ± 18.0 minutes) and total ischemic time (TIT; 619 ± 340 minutes) were associated with the post-transplant renal function, only the donor age had significant correlation both with the posttransplant dialysis period and lowest serum creatine level, as follows: 10.5 days ( ≤ 40 years) vs. 14.6 days ( > 40 years); P < 0.05, and 1.16 mg/dL ( ≤ 30 years) vs. 1.83 mg/dL ( > 50 years) P < 0.001, respectively. Our findings indicate; 1) Due to the in situ cooling technique, the renal grafts of non-heart-beating cadavers can be expected to have relatively good function in the CS-treated recipients; 2) donor age is instrumental in predicting post-transplant renal function as well as the duration of ATN; 3) WIT, 1ST and TIT have no association with the post-transplant renal function if the duration of renal ischemia is within the acceptable range.

[Epidemiological study for comparative biological profiles on MRSA strains isolated in 1992 vs. 1993].

The trend of epidemiological study against MRSA strains which were isolated in 1992 and in 1993 was investigated. Number of stains tested yearly consisted of 30 isolates that were considered to play pathogenic roles for inpatients in clinical departments at our institute. In comparing with biological studies on MRSA strains and the epidemiological surveillance of the background of the isolation, the data summarizes as followings; 1) No. of MRSA strains which were producible for TSST increased from 24/30, 80% up to 30/30, 100%. 2) No. of enterotoxin type harbouring biotype of B/C increased 0/30, 0% up to 12/30, 40%. 3) No. of type of plasmid DNA profile increased in varying from 3 types (A, B, C) to 8 types (A-H). 4) The in vitro activity of antimicrobials, as such MINO, GM, IPM, CMZ was less potent than that of the prior year, and even for VCM, ABK, the activity proved less potent in 1-2 tubes in MIC90. 5) No. significant hospital acquired infection was detected between the inpatients, with MRSA infection and isolates from plasmid DNA profiles. 6) Since the ratio of the coincidence of plasmid DNA profiles of MRSA was only in 4 patients out of 27, 14.9 &, nosocomial infections with MRSA brought to patients have not only been considered by medical, paramedical staff, but that the infection may be caused by broad contamination at the institute.

[Comparative susceptibility of 10 antimicrobials against Pseudomonas aeruginosa isolated from complicated urinary tract infection on 1992 & 1993 vs. 1994 & 1995].

The susceptibility of 10 antimicrobials against P. aeruginosa isolated from complicated UTI during 1992-1995 was determined, and the yearly trend was examined. The drug tested included 3 cephems (ceftazidime [CAZ], cefpirome [CPR], cefclidin [CFCL]), 1 monobactam (aztreonam [AZT]), 2 carbapenem (imipenem/cilastatin [IPM/CS], biapenem [BIPM]), 2 aminoglycosides (netilmicin [NTL], gentamicin [GM]) and 2 new quinolones (ofloxacin [OFLX], ciprofloxacin [CPFX]). A total number of isolates of which MIC were determined was 77 in 1992/1993 and 70 in 1994/1995. MIC50/MIC90(micrograms/ml) on the isolates were as follows (1992/1993 1994/1995); 3.13/ 100 12.5/50 in CAZ, 12.5/100 12.5/100 in CPR, 3.13/25 1.56/25 in CFCL, 6.25/50 12.5/100 in AZT, 6.25/25 3.13/25 in IPM/CS, 1.56/6.25 0.78/50 in BIPM, 12.5/100 6.25/100 in NTL, 6.25/ 50 6.25/100 < in GM, 25.100 < 25/100 < in OFLX, 6.25/100 6.25/100 < in CPFX. When the susceptibility of the yearly trend is compared, no significant changes were detected among the drugs tested expect the decrease of susceptibility on CAZ, AZT and increase of it on IPM/CS. From the data obtained, against complicated UTI infected by P. aerugunosa, CFCL, IPM/CS and BIPM are considered to drugs of first choice in the treatment.

[Clinical study of astromicin administered by intravenous drip infusion against chronic complicated urinary tract infections].

Astromicin (ASTM) was administered by intravenous drip infusion (i.v.d.) to 22 patients with chronic complicated urinary tract infections and the clinical efficacy and safety of this drug were evaluated. The overall clinical efficacy rate obtained was 71.4% (excellent 6; moderate 9) of 21 evaluable cases by the UTI committee's criteria. Concerning the response on clinical isolates, the drug was highly effective especially against strains of Escherichia coli, indole positive Proteus and Serratia marcescens. It was not effective, however, against 2 strains of Pseudomonas aeruginosa. As for adverse reactions, there was one case which complained of headache on the 3rd day after starting treatment. In this case the drug administration was discontinued at the 5th day. The symptom disappeared within 24 hours without any treatment. No any other adverse reactions were noted. With regard to clinical test values for peripheral blood, liver and renal functions, no abnormality was observed in any of the cases treated with the drug. In conclusion, ASTM was found to be a highly effective and safe drug when administered by intravenous drip infusion in the treatment of chronic complicated urinary tract infections.

[Pharmacokinetics of astromicin intravenous drip infusion in patients with renal disorders].

Astromicin (ASTM), a new aminoglycoside antibiotic, was administered to 7 patients with renal disorders. Concentrations of ASTM in blood were determined for pharmacokinetic analysis. ASTM was administered by intravenous drip infusion over 1 hour at a dose of 200 mg to each of 6 patients and at a dose of 100 mg to 1 patient. Renal function was observed by the clearance of intrinsic creatinine (Ccr) as the indicator. Concentrations of ASTM in blood became higher and retention times longer as degrees of the loss of renal function were larger. Although ASTM is proved to be one of drugs with the highest degree of safety compared with other existing aminoglycoside antibiotics, it should be administered with care to patients with renal disorders.

[Clinical studies on long acting amoxicillin in the field of urology].

Long acting amoxicillin (L-AMPC) was studied in the treatment of 40 patients with urinary tract infections. The dosage administered was 1,000 mg/day (b.i.d.) consecutively for 3 days in acute simple UTI and 5 days in chronic complicated UTI. Clinical efficacy was assessed according to the criteria established by the UTI Committee in Japan. Accordingly the response to therapy in 27 patients with acute simple cystitis was excellent in 17, moderate in 8 and poor in 2 cases and for chronic complicated UTI was excellent in 2, moderate in 3 and poor in 6 cases. Thus the overall clinical efficacy ratios for acute simple cystitis and chronic complicated UTI were 93% and 45% respectively. The bacteriological elimination ratios were 25 out of 27 of the causative organisms (93%) for acute simple cystitis and 6 out of 11 for chronic complicated UTI (55%). No side effects of significance were observed. The results obtained demonstrated the usefulness of the b.i.d. administration of L-AMPC and were considered, in the light of previous experience to be similar to those obtained with conventional amoxicillin dosage schedules.

[Clinical evaluation of amoxicillin sustained-release preparation in urinary tract infection].

C-AMOX, a new prolonged acting preparation of amoxicillin was administered to 122 cases by oral administration of daily dosage 500 mg twice. Clinical effectiveness of C-AMOX was evaluated in 115 out of 122 cases (acute simple cystitis 87 cases, acute pyelonephritis 6 cases, complicated urinary tract infection 19 cases and others 3 cases), and the following results were obtained. 1. The clinical effect for 87 cases of acute simple cystitis was excellent in 54 cases (62%), moderate in 24 cases (27.6%) and poor 9 cases (10.3%), overall effective rate being 89.7%. 2. The clinical effect for 19 cases of complicated urinary tract infection was excellent in 6 cases (31.6%), good 8 cases (42.1%) and poor 5 cases (26.3%), overall effective rate being 73.7%. 3. Adverse reaction occurred in 2 patients, one gastric discomfort and the other one slight diarrhoea. No laboratory abnormalities attributable to C-AMOX were observed in the present study.

[Well-controlled comparative study on aztreonam and cefoperazone in the treatment of complicated urinary tract infections].

A well-controlled comparative study was conducted in order to evaluate the efficacy, safety and usefulness of the monobactam antibiotic aztreonam (AZT) in complicated urinary tract infections (UTI) using cefoperazone (CPZ) as the control drug. Patients with complicated UTI due to Gram-negative bacteria were examined. However, in polymicrobial infections, the cases caused by Gram-negative and Gram-positive bacteria were also examined. Both drugs were administered 1 g, twice a day by intravenous drip infusion for 5 days. Overall clinical efficacy was evaluated by the criteria proposed by the UTI committee in Japan. Of the total 394 cases, the clinical efficacy was evaluated for 152 cases in the AZT group and 143 cases in the CPZ group excluding 99 cases of exclusion or dropout. There was no statistically significant difference in the back ground characteristics between the 2 groups. The overall clinical efficacy rate was 55.3% for AZT and 55.2% for CPZ with difference not significant. As for clinical efficacy, in the monomicrobial infection after postprostatectomy (G-2), AZT was superior to CPZ (P less than 0.05), whereas in the polymicrobial infection without indwelling catheter (G-6), CPZ was superior to AZT (P less than 0.1). The overall bacteriological eradication rate was 77.2% for AZT and 74.5% for CPZ. For Gram-negative bacteria only the eradication rate for AZT (83.2%) was superior to that for CPZ (74.6%). This was probably due to the stability of AZT to beta-lactamase. Side effects were observed in 3 cases out of 201 in the AZT group and 5 cases out of 189 in the CPZ group. No severe abnormal laboratory finding was observed in any group; there was no significant difference between the 2 groups. Consequently, AZT was judged to be an antibiotic with clinical usefulness equal to, or even superior to that of CPZ.

[Clinical evaluation of astromicin administered by intravenous drip infusion. Report III. Bacterial infections in the field of urology].

Intravenous drip infusion of a new aminoglycoside agent, astromicin (ASTM), was used for various urological infections, and its clinical efficacy and safety were studied. Each of almost all the patients tested was given 200 mg of ASTM twice a day by intravenous drip infusion. Among 114 cases with complicated urinary tract infections (UTI) evaluated according to the criteria for evaluation of drug efficacy in UTI, clinical response was excellent in 16, moderate in 54 and poor in 44. The efficacy rate was 61.4%. Among 137 cases who were evaluated for side effects, headache was observed in 1 case (0.7%), which recovered spontaneously the day after the withdrawal of the drug. Slight elevation in S-GOT, S-GPT, Al-P and others was observed in 12 cases (8.8%) as abnormal laboratory test values.

[Treatment of advanced renal cell carcinoma with interferon alpha and OK-432 (streptococcal preparation)].

A total of 12 patients with advanced renal cell carcinoma received interferon alpha (3 million units intramuscularly 6 times weekly) and OK-432 (5 KE (Klinische Einheit) intramuscularly twice weekly). Metastatic lesions appeared before operation in six patients and after operation in six patients. Among them 5 patients had received interferon therapy and this combination therapy was started after the judgment of progressive disease for interferon therapy. Eleven pulmonary and 5 bone metastases were evaluable. The median duration of the combination therapy was 89.3 weeks. There were 4 partial responses and no complete responses among the 12 patients, giving a response rate of 33.3%. The median duration of response was 25 months, with a range of 6 to 54 months. Responses were seen predominantly in patients in whom metastases appeared after operation (3 of 4 responders). However, regarding the individual organs, two complete and 2 partial responses were observed among 11 pulmonary metastases and 2 partial responses among 5 bone metastases. The survival period after discovery of the metastasis was 10 to 67 months and the 5-year survival rate was 70.5%. Almost all patients had fever and induration at the injection site. Other side effects included leukopenia, anorexia, and depression. This combination therapy is thought to be effective against bone or other organs metastasis resistant to interferon alone.

[Experience with incontinent urinary diversion--review of 31 ureterocutaneostomies, 101 ileal conduits and 107 colonic conduits].

During the past 20 years, 31 ureterocutaneostomies (UC), 101 ileal conduits (IC) and 107 colonic conduits (CC) were performed. In the UC group, most of the patients were aged or had unresectable invasive pelvic malignancies. The operative mortality was 6.5% and acute pyelonephritis was noted frequently (48.3%). Stomal stenosis also developed significantly (63.5%). The operative mortalities in the IC group and CC group were 6.9% and 9.3%, respectively. Although the incidences of bowel obstruction, bowel fistula and renal calculi were higher in the IC group (18.8% vs 7.5% and 6.9% vs 0%, respectively). The serum creatinine level was lowest in the CC group (0.90 +/- 0.46 mg/dl) and highest in the UC group (1.36 +/- 0.75 mg/dl). Conduit ureteral reflux was frequent in the UC group (66.7%) but rare in the CC group (1.3%). We conclude that UC should be indicated in the selected patients with high risk, and IC and CC are indicated in patients who may have good prognosis but not indicated for continent reservoir or neobladder. We prefer CC in the younger group.

[Treatment of oligospermic patients with varicocele].

The management of oligospermic patients with varicocele was reviewed. Varicocelectomy was performed in 46 oligospermic patients with varicocele (group 1) and kallikrein treatment was followed for those who failed to improve the semen quality after varicocelectomy (group 2). Twenty oligospermic patients with varicocele were given kallikrein for over 6 months as an initial treatment (group 3). A significant increase in total motile sperm count was noted in 34.8% of the patients in group 1, 22.7% in group 2, and 30.0% in group 3 respectively. Conception rate which was calculated after excluding couples, in which the partner received either artificial insemination by husband or any gynecological treatment, was 20.8% in group 1, 15.4% in group 2, 25.0% in group 3 respectively. No significant changes in hormonal data was observed after either treatment, but semen quality was not improved in patients who showed high serum level of luteinizing hormone (LH) or follicle stimulating hormone (FSH). Kallikrein is useful for oligospermic patients with varicocele as an initial treatment and for those in whom semen quality was not improved after varicocelectomy. Varicocelectomy and/or kallikrein treatment can be recommended mainly for those who show normal serum level of LH and FSH.

[Clinical response of chemotherapeutic agents with different activities on chronic complicated pyelonephritis with renal stone. A proposed index of local antimicrobial activity].

In the treatment of one male patient with chronic pyelonephritis, complicated with renal stone, the pathological state of the renal inflammatory lesion was determined. The patient had been persistently infected by the same strain of S. marcescens for more than a year. When he was treated by several antimicrobial agents, the urinary bacteriological response was well correlated to the MICs of each agent. On the basis of the findings obtained, a new index of local antimicrobial activity was proposed. Analysis of such items as strains appearing after treatment, interval of relapse and the identification of the strains relapsed, were suggestive of the renal inflammatory, and pathological conditions. The clinical response also correlated well with the index. The lesion was considered to be mainly localized in the right lower calyx where a tiny stone existed. This disease is considered curable with effective chemotherapy after withdrawal of the stone. This index should be useful for evaluation of the effectiveness of antimicrobial agents.

[Clinical study of cefclidin on bacterial prostatitis].

Cefclidin (CFCL), a new injectable cephem antibiotic, was used in the treatment of bacterial prostatitis. Concentration in prostatic fluid (PF): One hour after the i.v. administration of 1 g of CFCL the concentration of PF was 0.84 +/- 0.72 micrograms/ml (n = 4), the ratio of PF/serum being 2.24%. CFCL was administered at a dose of 1-2 g a day for 6.5 days on average. In acute bacterial prostatitis, the efficacy was evaluated as excellent or moderate in all 7 cases (100%), but in chronic cases, the effectiveness rate was as low as one out of 4 cases (25%). In safety profile, transient skin eruption was seen in one patient, but did not require further treatment. Besides this case, no side reactions or abnormal clinical values were encountered. In conclusion, CFCL was evaluated to be very useful in the treatment of acute bacterial prostatitis, caused by gram negative rods.

[A case of bizarre leiomyoma of the scrotum].

A case report of a bizarre leiomyoma of the scrotum in a 46-year-old male is presented with a review of the literature. The patient was admitted to our hospital with the chief complaint of swelling of the left scrotal content for about 20 years. The tumor was surgically removed easily. Histological findings revealed bizarre leiomyoma. This case is the first report of bizarre leiomyoma of the scrotum in Japan.

[Clinical evaluation of cefmetazole in urological infections].

Clinical efficacy of Cefmetazole was evaluated at four university hospitals and their related hospitals in Nagoya. For the treatment of urinary tract infections with or without complications, 177 patients were administered Cefmetazole. Of these patients, 69 had chronic complicated urinary tract infection defined in the UTI manual and 20 had simple acute pyelonephritis. The other urological infections for which Cefmetazole was administered included prostatitis, epididymitis, urosepsis and wound infections. Fifty four patients were given Cefmetazole intravenously after urological operation to prevent wound and urinary tract infections. The overall clinical efficacy of Cefmetazole for UTI was 76.8%; 84.4% for group 1, 85.7% for group 3, 75% for group 4, 44.4% for group 5 and 66.6% for group 6. In acute pyelonephritis due to E. coli, Klebsiella, Serratia, S. aureus, alpha-Streptococcus and S. epidermidis all patients were cured by Cefmetazole administration. Clinical efficacy of Cefmetazole was assessed to be excellent in 6 cases of prostatitis and 6 cases of acute epididymitis. E. Coli, Serratia and some organisms disappeared from blood after the administration of Cefmetazole but Pseudomonas persisted even after treatment. Postoperative administration of Cefmetazole was effective for eradication of bacteria from the urine in 26 out of 30 patients and in prevention of infection in 24 cases. After the administration of Cefmetazole skin eruption was observed in one patient and nausea in another. Slight elevation of GOT, GPT and total bilirubin was noted in 3 of the 177 patients after medication.

[Clinical and bacteriological study of sparfloxacin on bacterial prostatitis].

Sparfloxacin (SPFX), a new oral quinolone antimicrobial, was studied for the bacterial response, pharmacokinetics and clinical efficacy in the treatment of bacterial prostatitis. The minimum inhibitory concentration (MIC) values for 48 strains isolated from expressed prostatic secretion were measured. The values for 8 out of 12 strains of S. epidermidis were below 0.05 microgram/ml and those for all 6 strains of E. coli were below 0.025 microgram/ml. The SPFX concentrations in prostatic fluid (PF) were 0.33 to 0.49 microgram/ml at 1 to 3 hours after oral administration of 200 mg, the PF/serum ratio being 1.15 to 1.47. SPFX was administered at a dose of 200 to 400 mg daily for an average of 14.1 days to 14 patients with prostatitis (5, acute: 9, chronic). The clinical efficacy judged by physician in charge was effective in 12 cases with an efficacy rate of 85.7%. The bacterial eradication rate was 93.3% (14/15 strains), and eradication was complete in all 7 cases infected with gram-negative rods. SPFX-related abnormal laboratory values were observed in one case with transient increase of glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase and alkaliphosphatase activities, and decrease of platelet. As side effects, one case with gastrointestinal symptoms and the other case with photosensitivity skin rash accompanied by sensory abnormality of palms were observed. The abnormal values or side effects in these patients recovered to normal or disappeared after completion of the treatment without any treatments. In view of the higher concentrations in PF than the MIC values with long remaining in the tissues, SPFX is considered to be effective in the treatment of bacterial prostatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on the virulent factor of Escherichia coli isolated from urogenital infection--pilus type and adherence to human exfoliated uroepithelial cells etc].

One hundred and twenty three strains of Escherichia coli isolated from the urine of patients with urogenital infections and 55 strains isolated from the fecal samples of healthy individuals were assayed for 0 antigen and hemolysin production as virulence factors, and for pilus type and in vitro tests of adhesion to human exfoliated uroepithelial cells as colonization factors. The incidence of MS pili in Escherichia coli isolated from patients with acute uncomplicated cystitis, chronic complicated cystitis, acute uncomplicated pyelonephritis and acute prostatitis was 60.9%, 22.7%, 87.5%, 68.2% and 30.9%, respectively. The incidence of P pili was 69.7%, 51.2%, 62.5%, 54.5% and 25.5%, respectively. The strains showing haemolysin production had MS pili and P pili, which show strong virulence. MS pili strains and P pili strains isolated from the patients with acute uncomplicated cystitis and acute uncomplicated pyelonephritis adhered to human exfoliated uroepithelial cells well. Consequently, the pilus type might be the most significant colonization factor in uncomplicated urogenital infection which is shown by the normal defense mechanism in host side.

[Laboratory and clinical study of ofloxacin in the treatment of bacterial prostatitis].

Ofloxacin (OFLX), a new pyridonecarboxylic acid derivative for oral use, was administered in the treatment of 22 cases of bacterial prostatitis (acute 4, chronic 18). In advance of the clinical trial, the concentration of OFLX in prostatic fluid (PF) was determined following administration of the drug to 3 patients with chronic bacterial prostatitis at a stationary phase. Assays revealed antibiotic concentrations of a mean level of 1.34 micrograms/ml in 3 PF samples. The ratios to the plasma antibiotic level (R value) averaged approximately 1.10. In clinical use, the drug was given at a daily dosage of 300-600 mg for 5-21 days. The bacteriological response of the infections caused by gram negative bacteria, in all eight patients (100%) was complete eradication, whereas that in 14 cases (including 5 mild infections) caused by gram positive cocci, was excellent or moderate in 10 (71%) and poor in 4 cases. Adverse reactions were observed in 2 cases; complaint of diarrhea (drug administration was discontinued in 1 case). No abnormal values such as of kidney or liver functions or of peripheral hematology were encountered. From the data obtained ofloxacin was concluded to be highly effective, safe and useful in treatment of bacterial prostatitis.

[Urinary tract infection associated with benign prostatic hypertrophy and related diseases and transurethral surgery].

Three hundred and fifty five patients were treated with transurethral resection of the prostate for the relief of partial urinary obstruction. Of these, 188 had suffered from bacteriuria before surgery and the remaining 167 had been free of urinary infection before surgery. Urinary infection was caused by urethral instrumentation including indwelling catheter for various periods of time. A significant correlation between volume of residual urine and preoperative infection was demonstrated. No correlation between preoperative infection and postoperative voiding efficiency was however noticed though significant improvement in voiding was demonstrated by postoperative uroflowmetry.