ABSTRACT
INTRODUCTION: Calcineurin inhibitor (CNI)-induced nephrotoxicity (CNI-T) is a post-transplantation complication that leads to graft dysfunction. Older-donor kidney grafts may be susceptible to chronic CNI exposure because of long-term arteriolar damage. The primary aim of this study was to examine the CNI-T incidence and time-course changes in the graft function according to donor age. METHODS: We included 334 kidney transplant recipients. CNI-T was defined by Banff arteriolar hyaline thickening scores of ≥2 based on allograft protocol biopsy. Depending on donor age, participants were divided into the D > 70 (≥70 years), D60 (60-69 years), D50 (50-59 years), and D < 49: (≤49 years) groups. We investigated the extent to which CNI-T affected the transplanted kidney function. Patients who did not develop CNI-T during the study period were included in the non-CNI-T group; the remaining were grouped into the CNI-T group. RESULTS: The CNI-T incidence was higher in donors aged >50 years. Compared to D < 49, the CNI-T risk was 1.86 times higher in D50 and 2.9 times higher in D > 70. Furthermore, the CNI-T group exhibited a significantly lower graft function 10 years after transplantation. CONCLUSION: CNI-T incidence increases in donors aged ≥50 years and affects renal function after 10 years.
Subject(s)
Kidney Diseases , Kidney Transplantation , Humans , Aged , Immunosuppressive Agents/adverse effects , Calcineurin Inhibitors/adverse effects , Kidney Transplantation/adverse effects , Kidney , Risk Factors , Graft Rejection/etiology , Graft SurvivalABSTRACT
Neisseria gonorrhoeae is one of the important pathogens of sexually transmitted infections. N. gonorrhoeae is rapidly becoming antimicrobial resistant, and there are few drugs that are effective in the initial treatment of gonorrhea. To understand the trends of antimicrobial susceptibility of N. gonorrhoeae, the Surveillance Committee of the Japanese Society of Infectious Diseases, the Japanese Society for Chemotherapy, and the Japanese Society of Clinical Microbiology conducted the third nationwide antimicrobial susceptibility surveillance of N. gonorrhoeae isolated from male urethritis. The specimens were collected from male patients with urethritis at 30 facilities from May 2016 to July 2017. From the 159 specimens collected, 87 N. gonorrhoeae strains were isolated, and 85 were tested for susceptibility to 21 antimicrobial agents. All strains were non-susceptible to penicillin G. Seven strains (8.2%) were ß-lactamase-producing strains. The rates of susceptibility to cefixime and cefpodoxime were 96.5% and 52.9%, respectively. Three strains were non-susceptible with a minimum inhibitory concentration (MIC) of 0.5 mg/L for cefixime. None of the strains were resistant to ceftriaxone or spectinomycin. The susceptibility rate for ciprofloxacin was 23.5% (20 strains), and no strains showed intermediate susceptibility. The susceptibility rate against azithromycin was 81.2%, with one strain isolated with a MIC of 8 mg/L against azithromycin. The results of this surveillance indicate that ceftriaxone and spectinomycin, which are currently recommended for gonococcal infections in Japan, appear to be effective. It will be necessary to further expand the scale of the next surveillance to understand the current status of drug-resistant N. gonorrhoeae in Japan.
Subject(s)
Anti-Infective Agents , Gonorrhea , Urethritis , Humans , Male , Neisseria gonorrhoeae , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Cefixime/pharmacology , Cefixime/therapeutic use , Ceftriaxone/therapeutic use , Azithromycin/therapeutic use , Spectinomycin/pharmacology , Spectinomycin/therapeutic use , Urethritis/drug therapy , Urethritis/epidemiology , Urethritis/microbiology , Japan/epidemiology , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Anti-Infective Agents/therapeutic use , Microbial Sensitivity TestsABSTRACT
The Urogenital Sub-committee and the Surveillance Committee of the Japanese Society of Chemotherapy, The Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology conducted the second nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis. In this second surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 26 hospitals and clinics from May 2016 to July 2017. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 41 isolates; the MICs (MIC90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, azithromycin and solithromycin were 2 µg/ml (2 µg/ml), 1 µg/ml (0.5 µg/ml), 0.25 µg/ml (0.25 µg/ml), 0.125 µg/ml (0.063 µg/ml), 0.125 µg/ml (0.125 µg/ml), 0.25 µg/ml (0.25 µg/ml), 0.031 µg/ml (0.031 µg/ml), 0.25 µg/ml (0.125 µg/ml), and 0.016 µg/ml (0.008 µg/ml), respectively. In summary, this surveillance project did not identify any strains resistant to fluoroquinolone, tetracycline, or macrolide agents in Japan. In addition, the MIC of solithromycin was favorable and lower than that of other antimicrobial agents. However, the MIC of azithromycin had a slightly higher value than that reported in the first surveillance report, though this might be within the acceptable margin of error. Therefore, the susceptibility of azithromycin, especially, should be monitored henceforth.
Subject(s)
Chlamydia trachomatis , Urethritis , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Azithromycin/pharmacology , Drug Resistance, Bacterial , Humans , Japan/epidemiology , Male , Microbial Sensitivity Tests , Urethritis/drug therapy , Urethritis/epidemiologyABSTRACT
An investigation of alternatives to immune checkpoint inhibitors for advanced urothelial cancer (aUC), with biologic information, is urgently needed. Clinical data for 53 patients who received gemcitabine-paclitaxel therapy (GP) as 2nd-line chemotherapy for aUC refractory to platinum-based chemotherapy were retrospectively reviewed. The efficacy and tolerability of GP were evaluated, and the predictive value of phosphoglycerate kinase 1 (PGK1) immunostained in surgical specimens was investigated for treatment outcomes in 1st- and 2nd-line chemotherapy. GP was associated with an objective response rate of 35.8% and a median overall survival duration of 12.3 months. Multivariate analysis showed that PS2 and 1st- and 2nd-line non-response are independent predictors of worse progression-free survival and that PS2 and 1st-line non-response are independent predictors of worse overall survival. Adverse events were manageable, and no therapy-related deaths occurred. Non-response rates to 1st-line chemotherapy were significantly higher in patients with a high expression of PGK1 in the nucleus than in those with low expression (p = 0.006). Our study demonstrates the efficacy and tolerability of 2nd-line GP for patients with aUC who are refractory to platinum-based chemotherapy. Moreover, PGK1 in the nucleus was predictive values for resistance to platinum-based chemotherapy in aUC.
Subject(s)
Biological Products , Carcinoma, Transitional Cell , Humans , Cisplatin/therapeutic use , Retrospective Studies , Immune Checkpoint Inhibitors , Phosphoglycerate Kinase/genetics , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Paclitaxel , Carcinoma, Transitional Cell/drug therapy , Platinum/therapeutic use , Biological Products/therapeutic use , GemcitabineABSTRACT
Sitafloxacin (STFX) is an alternative treatment against azithromycin-resistant Mycoplasma genitalium (MG), whereas STFX-resistant MG have appeared recently. Therefore, another antimicrobial regimen for non-chlamydial non-gonococcal urethritis (NGU) is required. Garenoxacin (GRNX) is a fluoroquinolone against respiratory infections, not against urethritis in Japan, but its in-vitro antimicrobial activity against MG is known as similar to or higher than that of moxifloxacin. To clarify the efficiency of GRNX against MG, we examined the clinical efficacy of GRNX for NGU. Seventy-nine male patients with NGU were enrolled and treated with GRNX once daily for 7 days. For assessing microbiological and clinical efficacies, the bacteria including Chlamydia trachomatis (CT), MG, Mycoplasma hominis (MH), Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) were detected by means of nucleic acid amplification tests before- and after-treatment. After excluded 3 patients, seventy-six patients were evaluated: the median age; 31 (20-61) years, vaginal infection (66%); the most common infectious route and commercial sex worker (43%); the most common source. There were 50 bacteria-positive NGU cases, including 10 multiple bacterial infections. Clinical cure rate was 85.7% (36/42). Detection frequency of each bacterium was similar to the previous reported. The eradication rates of CT, MG, MH, UU and UP were 96.1%, 71.4%, 100%, 85.7% and 100%, respectively. These results indicate that GRNX has the excellent efficacies for NGU except those of MG. Further study of drug-resistant MG urethritis; for instance, studies on the clinical effectiveness of long-term such as 2-week medication of GRNX or the efficacy of alternative treatment regimens are necessary.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Fluoroquinolones/therapeutic use , Urethritis/drug therapy , Adult , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/drug effects , Fluoroquinolones/pharmacology , Humans , Male , Middle Aged , Mycoplasma genitalium/drug effects , Prospective Studies , Urethritis/microbiology , Young AdultABSTRACT
OBJECTIVES: To investigate the presence of microorganisms related to urethritis in the oral cavity of male patients with urethritis and the efficacies of antimicrobials for urethritis on microorganisms in the oral cavity. METHODS: Ninety-two male patients with urethritis and 17 male controls participated to this study at 12 urology clinics in Japan between March 2014 and March 2015. The first voided urine (FVU) and oral wash fluid (OWF) specimens were collected from the participants. The microorganisms in both FVU and OWF specimens were detected by nucleic acid amplification tests at the first and follow-up visit. The efficacies of antimicrobials were evaluated after 1-4 weeks treatment completion. RESULTS: In a total of 92 male patients with urethritis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Trichomonas vaginalis and Gardnerella vaginalis were detected from OWF specimens of 12%, 3%, 9%, 0%, 12%, 3%, 3% and 15% patients, respectively. From control males, no microorganism was detected from OWF specimens. Among 46 patients who could be evaluated for antimicrobial efficacies at the follow-up visit, 5 in FVU specimens failed by azithromycin (AZM), and 10 failed in OWF specimens (7 by AZM, 2 by tetracycline, 1 by spectinomycin; p = 0.002). Especially, a high prevalence of G. vaginalis remained positive after treatment for urethritis in the oral cavity. CONCLUSION: Microorganisms related to urethritis were detected in the oral cavity of male patients with urethritis. Antimicrobials that focused on urethritis, especially AZM regimen seem to be less effective for microorganisms in the oral cavity.
Subject(s)
Bacteria/isolation & purification , Mouth/microbiology , Urethritis/microbiology , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Bacteria/drug effects , Humans , Japan , Male , Middle Aged , Mouthwashes , Urethritis/drug therapy , Urine/microbiology , Young AdultABSTRACT
BACKGROUND: Tacrolimus (TAC) is a narrow therapeutic range drug that requires therapeutic drug monitoring. TAC concentration is measured using whole blood owing to its high red blood cell (RBC) transfer rate of 95%. The distribution and whole-blood TAC concentration may be affected by the transfusion of red cell concentrates (RCCs); however, this has not been studied in kidney transplant recipients (KTR). Therefore, we investigated the relationship between changes in whole-blood TAC concentration and RBC parameters before and after RCC transfusion in KTR. METHODS: Fifteen KTR who received TAC and RCC transfusions were enrolled. The change rates of RBC parameters (RBC count, hemoglobin [Hgb], hematocrit [Hct]), and TAC concentration/dose before and after transfusion were calculated. The correlation between each RBC parameter and the TAC rate was evaluated. RESULTS: The TAC concentration and rate increased after RCC transfusion. Moreover, the TAC rate showed a significant and strong correlation with RBC count, Hgb, and Hct, with RBC count showing the highest correlation coefficient (r = 0.811, 0.766, and 0.764, respectively; p < .01). Serum creatinine and potassium levels remained stable, suggesting the absence of typical adverse effects associated with TAC, such as acute kidney injury or hyperkalemia. CONCLUSION: Changes in whole-blood TAC concentration and RBC parameters were correlated, and whole-blood TAC concentration increased after RCC transfusion. Therefore, the TAC dose should be adjusted accordingly.
Subject(s)
Erythrocyte Transfusion , Immunosuppressive Agents , Kidney Transplantation , Tacrolimus , Humans , Tacrolimus/blood , Immunosuppressive Agents/blood , Female , Middle Aged , Male , Adult , Hematocrit , Erythrocytes , Hemoglobins/analysis , Erythrocyte CountABSTRACT
Tumor markers that can be detected at an early stage are needed. Here, we evaluated the epiplakin expression levels in sera from patients with bladder cancer (BC). Using a micro-dot blot array, we evaluated epiplakin expression levels in 60 patients with BC, 20 patients with stone disease, and 28 healthy volunteers. The area under the curve (AUC) and best cut-off point were calculated using receiver-operating characteristic (ROC) analysis. Serum epiplakin levels were significantly higher in patients with BC than in those with stone disease (p = 0.0013) and in healthy volunteers (p < 0.0001). The AUC-ROC level for BC was 0.78 (95% confidence interval (CI) = 0.69-0.87). Using a cut-off point of 873, epiplakin expression levels exhibited 68.3% sensitivity and 79.2% specificity for BC. However, the serum epiplakin levels did not significantly differ by sex, age, pathological stage and grade, or urine cytology. We performed immunohistochemical staining using the same antibody on another cohort of 127 patients who underwent radical cystectomy. Univariate and multivariate analysis results showed no significant differences between epiplakin expression, clinicopathological findings, and patient prognoses. Our results showed that serum epiplakin might be a potential serodiagnostic biomarker in patients with BC.
ABSTRACT
A 38 year-old man was referred to our hospital for high fever and lower abdominal pain. The laboratory data showed his inflammatory state with a few puss cells in the urine analysis. Computed tomography (CT) scan and magnetic resonance imaging (MRI) scan demonstrated perivesical abscess and the cystoscopy on the day just before the operation revealed no abnormal findings in the bladder mucosa. In the operation, under the preoperative diagnosis of pyourachus, the appendix with the tip open was found inside the abscess cavity. Therefore, appendectomy and partial cystecomy were carried out. On the grounds of the pathological findings ; remarkable inflammatory change in the perivesical fatty tissue and slight inflammatory lesions in the subserous layer of the appendix, in addition to the clinical course and the retrospective findings of the preoperative MRI scan : existence of a tubular structure connecting with the abscess cavity, the final diagnosis was made as perivesical abscess secondary to ruptured appendicitis. This case is reported with a brief discussion as to the diagnosis and treatment.
Subject(s)
Abscess/etiology , Appendicitis/complications , Urinary Bladder , Adult , Appendectomy , Appendicitis/surgery , Humans , MaleABSTRACT
We report a case of papillary adenocarcinoma inside a seminal vesicle cyst associated with contralateral renal agenesis in a 30-year-old man. Coexistence of a seminal vesicle cyst and tumors is rare. Surgical excision was performed but he died due to liver metastases one year later.
Subject(s)
Adenocarcinoma, Papillary/diagnosis , Cysts/diagnosis , Genital Neoplasms, Male/diagnosis , Kidney/abnormalities , Seminal Vesicles , Adenocarcinoma, Papillary/complications , Adenocarcinoma, Papillary/pathology , Adenocarcinoma, Papillary/surgery , Adult , Cysts/complications , Cysts/surgery , Genital Neoplasms, Male/complications , Genital Neoplasms, Male/surgery , Humans , Magnetic Resonance Imaging , Male , Seminal Vesicles/surgery , Tomography, X-Ray ComputedABSTRACT
A 37-year old man underwent extracorporeal shock wave lithotripsy for left renal stones after placing a ureteral stent (6 Fr multilength stent). Three months later the stent could not be extracted because of knot formation at the upper end. We performed ureterotomy and removed the stent.
Subject(s)
Lithotripsy/adverse effects , Stents/adverse effects , Ureter , Adult , Humans , Lithotripsy/instrumentation , Male , Radiography , Ureteral Calculi/diagnostic imaging , Ureteral Calculi/therapyABSTRACT
A 62-year-old woman, who had undergone left nephrectomy for renal cell carcinoma and had received interferon-alpha for metastasis to the lung, was hospitalized because of cough, dyspnea and anorexia 16 months after nephrectomy. Chest radiography showed collapse of the right lung. We performed bronchoscopy and found a red polypoid tumor completely obstructing the right bronchus. Biopsy specimens showed clear cell carcinoma, similar to previous specimens of renal cell carcinoma. We removed the endobronchial tumor with laser and electrosurgical snaring, after which the right lung reinflated.
Subject(s)
Bronchial Neoplasms/secondary , Bronchial Neoplasms/surgery , Carcinoma, Renal Cell/secondary , Carcinoma, Renal Cell/surgery , Electrosurgery , Kidney Neoplasms/pathology , Laser Therapy , Pulmonary Atelectasis/etiology , Pulmonary Atelectasis/surgery , Bronchial Neoplasms/complications , Bronchoscopy , Carcinoma, Renal Cell/complications , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
We report here the 21st case of polyorchidism in Japan. A 3-year-old boy with left undiscending testis was referred to our hospital for orchiopexy. At surgery, the undiscending testis was identified as two testes. We performed left orchiopexy, because these tests had no malignancy.
Subject(s)
Cryptorchidism/surgery , Testis/abnormalities , Child, Preschool , Cryptorchidism/pathology , Humans , Male , Testis/pathology , Testis/surgeryABSTRACT
PURPOSE: This study was undertaken to clarify the usefulness and problems involved in the clinical path of transurethral prostatectomy (TUR-P) in hospital. PATIENTS AND METHODS: The subjects consisted of 50 patients, for whom the Department of Urology, Jikei Medical University Hospital introduced its own clinical path and performed TUR-P during a period of 9 months from July 1999 to March 2000. The mean length of hospital stay, rate of postoperative complications, and the medical insurance claims made by these patients were clarified and compared with those of 73 patients before introduction of the clinical path. RESULTS: With the introduction of the clinical path, the length of hospital stay decreased by an average of 3.4 days and the total medical insurance claims decreased by an average of 18.5%. The rate of postoperative complications before and after introduction was almost equal. CONCLUSION: Our clinical path for TUR-P was well accepted by both patients and comedicals. However, the present medical treatment system in Japan is not as yet prepared to promote the introduction of this clinical path, and it will take some time before this clinical path is introduced on a full scale.