[Clinical evaluation of flucytosine in patients with urinary fungal infections].

The clinical effectiveness of flucytosine (5-FC) was evaluated in 52 patients with urinary fungal infections which were diagnosed because of the presence of both funguria (greater than or equal to 10(4) cfu/ml) and pyuria (greater than or equal to 5 WBC/hpf). The patients received oral daily doses of 5-FC ranging 20 to 150 mg/kg, with a mean treatment duration of 11 days. The 57 fungus strains isolated from urine specimens consisted of 51 Candida spp. including 28 Candida albicans, 10 Candida glabrata, 4 Candida tropicalis and 6 Trichosporon beigelii. Forty-seven (92.2%) and 4 (66.7%) of the 51 Candida spp. and 6 T. beigelii strains isolated were eradicated by the treatment, respectively, giving an overall eradication rate of 89.5%. Clinical responses in 32 patients, from whom only fungi were submitted, were excellent in 5, moderate in 22, and poor in 5, thus the overall efficacy rate was 84.4%, based on the criteria of Japanese UTI Committee. Of the 18 strains of Candida spp. tested, 5-FC showed 0.20 micrograms/ml or less of the minimum inhibitory concentrations (MICs) against 16 strains and higher than 100 micrograms/ml against the remaining 2 strains. The MICs of the 5 T. beigelii strains tested were between 3.12 and 6.25 micrograms/ml. As adverse reactions, only 2 patients (3.8%) experienced diarrhea but did not require treatment cessation. These results suggest that flucytosine is an effective drug for urinary fungal infections.

[Giant hydrocele: two case reports].

Two cases of giant hydrocele, having more than 1,000 ml of contents, are presented. The first patient was a 77-year-old man with the complaint of urination difficulty and a very swollen left scrotum of three years duration. Mild prostatic hypertrophy, mild renal dysfunction and hypertension were seen during hospitalization. A scrotal puncture gave 2,100 ml of serous fluid. Radical hydrocelectomy and plastic operation for surplus scrotal skin were done, and difficult urination improved markedly. The second patient was a 77-year-old man with the complaint of right scrotal swelling of fifteen years duration. He had developed pollakisuria and urination difficulty three years previously. When he was transferred our hospital on emergency due to engorgement, the diagnosis of giant hydrocele was made. Right orchidectomy was performed because of marked testicular atrophy and old hemorrhagic fluid of 1,200 ml. Urination difficulty and pollakisuria disappeared postoperatively.

MR imaging of neurilemoma arising from the renal hilus.

The authors present the radiologic findings of a neurilemoma arising from the kidney. Ultrasound, CT, and angiography could not exclude the diagnosis of renal cell carcinoma (RCC). Magnetic resonance (MR) imaging at 1.5 T showed an isointense tumor on T1-weighted images and a high signal intensity on T2-weighted images compared with normal renal parenchyma. The MR findings were helpful in the differentiation from RCC.

[Prophylactic effect of UFT on the recurrence of bladder cancer].

To evaluate the effect of UFT, a mixture of ftorafur and uracil in a ratio of 1:4, in preventing postoperative recurrence of bladder cancer, we performed a randomized controlled study with a non-medication group as control. UFT was given orally 400 mg a day for 6 months. Of 111 patients, 56 were given UFT and 55 were followed up without any medication. The non-recurrence rate in the group treated with UFT was 62.8% after 1 year and 36.3% after 2 years of follow up, and that of the control group was 45.7% and 39.5%, respectively. The rate of non-recurrence in the UFT group was significantly higher (p less than 0.05) than that of the control group during the period of follow up for 2 years. The incidence of side effects was 6.8% in UFT patients. These results indicate the clinical usefulness of prophylactic administration of UFT for bladder cancer patients.

[Hemorrhagic cyst of the cavum tunica vaginalis testis: a case report].

The patient, an eight-year-old boy, visited our clinic with the chief complaint of right painful scrotal swelling persisting for two days. A scrotal puncture yielded 9 ml of bloody fluid. Afterwards a small cystic mass was detected near the epididymal head on palpation and by ultrasonography. Laboratory test results including bleeding tendency were normal. A pedunculated red cystic mass originating from the parietal lamina of the tunica vaginalis testis was found on emergency operation. Histological examinations revealed hemorrhagic cyst of the tunica vaginalis testis with no malignancy.

Primary retroperitoneal teratoma in an adult: ultrasonographic, computer tomographic and magnetic resonance imaging demonstrations.

A 25-year-old male patient with a primary retroperitoneal teratoma is described. The chief complaint was right hypochondralgia during exercise for seven days. Various diagnostic imagings disclosed an expansive, heterogeneous and fat-rich mass associated with multiple cystic lesions in the right suprarenal fossa. Sagittal, transaxial and coronal magnetic resonance imaging scan visualized the extent and character of the tumor very clearly. Histological examination of the tumor removed through a thoracoabdominal approach showed cystic teratoma with out malignant transformations.

[Successful percutaneous drainage for infected cysts in polycystic kidney disease in a case of chronic hemodialysis].

A 60-year-old woman, who had been receiving chronic hemodialysis for chronic renal failure due to polycystic disease for 7 years, was admitted to our hospital with the chief complaints of right flank pain and high-grade fever on February 3, 1986. She had a family history of polycystic kidney disease and her elder sister has been undergoing chronic hemodialysis. The patient has had repeated episodes of urinary tract infection. The right markedly distended kidney was palpated with severe tenderness, and the performance status was poor. Computerized tomography showed the right kidney enlarging beyond the median line, but localization of the infected cysts was not clear. The 7-day intensive antibiotic therapy had no beneficial effect. On the 8th hospital day, percutaneous drainage, which was carried out for a large cyst with low-level echoes using ultrasonic guidance, yielded 600 ml of hemopurulent fluid. Bacterial culture of the aspirated fluid was positive for Escherichia coli. As the clinical symptoms did not improve after the 8th day, 10 Fr. catheter placement, percutaneous drainage and catheter placement were added for other cysts containing hemopurulent fluid. Although hematopyuria persisted, the patient became afebrile and the right kidney became smaller and softer. Both catheters were removed on the 30th hospital day. Repeated computerized tomography or ultrasonography revealed a few hyperdense or hyperechoic cysts in the right kidney. However, no recurrence of high-grade fever or right flank pain has been seen for 3 months. Ultrasonic-guided percutaneous drainage has a great potential for patient care of infected cysts in polycystic kidney disease.

[A comparative double-blind trial of HSR-902 and butylscopolamine bromide for relieving colic in ureteral stone patients].

The clinical efficacy and safety of HSR-902 (tiquidium bromide, Thiaton) in patients with spastic pain caused by ureteral stones were evaluated in a double blind comparative trial. A daily dose of 30 mg HSR-902 or 60 mg butylscopolamine bromide as a control drug was orally administered for 7 days. With either drug marked improvement of spastic pain was observed. The time to obtain relief from spastic pain and utility rating were significantly more excellent with HSR-902 than with butylscopolamine bromide. With all other parameters used no significant difference was observed between the two drugs. Mild adverse effects such as abdominal discomfort and constipation were observed in 2 of the 87 cases in the butylscopolamine bromide group but none of the 83 cases in the HSR-902 group. Taking efficacy and safety of the treatment into consideration, no significant difference was observed in usefulness between the two drugs, and we were able to confirm the usefulness of HSR-902 for relief from spastic pain caused by ureteral stones.

[A randomized controlled study to compare 1-hexylcarbamoyl-5-fluorouracil (HCFU) and 1-(2-tetrahydrofuryl)-5-fluorouracil (Tegafur) for the prevention of post-operative recurrence of bladder cancer].

To evaluate the effect of 1-hexylcarbamoyl-5-fluorouracil (HCFU), a derivative of 5-fluorouracil (5-FU), in preventing postoperative recurrence of bladder cancer, a randomized controlled study with 1-(2-tetrahydrofuryl)-5-fluorouracil (Tegafur) as the reference standard was performed. HCFU was given orally 600 mg a day and Tegafur was given orally, 800 mg a day. The following results were obtained: Of 103 patients, 51 were given HCFU and 52 Tegafur, the non-recurrence rate in the group treated with HCFU was 70.8% after 1 year and 54.9% after 2 years of follow up, and that of the group treated with Tegafur was 56.5% and 46.2% respectively. The rate of non-recurrence in the HCFU group was significantly higher (p less than 0.01) than that of the Tegafur group during the period of follow up between 450 and 539 days. Of the 87 patients, who took the drugs for more than 90 days, the rate of non-recurrence in 43 patients receiving HCFU was 79.2% after 1 year and 60.4% after 2 years, compared to 62.5% and 50.0% respectively for 44 patients receiving Tegafur. The non-recurrence rate of the HCFU group was also significantly higher than that of the Tegafur group in the period between 450 and 539 days after operation (p less than 0.05). The incidence of side effects was 35.6% and 51.7% in HCFU and Tegafur patients, respectively. No significant difference of side effects was found between HCFU and Tegafur.

[Combination chemotherapy with adriamycin, carboquone and 5-Fu for bladder cancer].

We treated 25 bladder cancer patients with combined cytotoxic chemotherapy of adriamycin (10--20 mg/day administration on days 1, 2 and 3), carboquone (4 mg/day administration on day 1 of weeks 3, 4 and 5 and 5-Fu (200 mg/day for 5 weeks) or futraful suppositories (750 mg/day for 5 weeks) as one course. According to the Koyama - Saitoh criteria, CR + PR was observed in 4 (17.4%) of 23 patients excluding the 2 dropout patients. According to Karnofsky's criteria, an effect with chemotherapy was observed in 9 (39.1%) of the 23 patients. There was a relatively good response rate in a group of 12 patients with the superficial tumors as compared with a group of 11 patients with the deep tumors. There were no severe adverse reactions.

[Renal tuberculosis with a contralateral renal adenocarcinoma: a case report].

A 62-year-old man, who complained of gross hematuria, was admitted because of a space occupying lesion of the right kidney and left non-visualizing kidney on IVP. The right pyelogram was compressed laterally, and the left pyelogram showed a moth-eaten appearance of the middle and lower calyces which was consistent with tuberculosis. Abdominal aortography revealed a hyperneovascularization over the middle and upper portions of the right kidney. CT-scan revealed a low density area of the right kidney and left atrophic kidney. No distant metastases were disclosed by bone scanning, liver scanning, lymphangiographic and chest X-ray studies. Bilateral nephrectomy was performed because the right renal tumor occupied the main renal artery. Hemodialysis was started on the next day. Postoperative course was uneventful. Histological examinations of the surgical specimen revealed a right renal adenocarcinoma and left renal tuberculosis. We discuss the pathogenesis and treatment of the combination of renal tuberculosis and malignant tumor.

[A double blind clinical trial of cefamandole and cefmetazole in complicated urinary tract infections].

We conducted a randomized double blind comparison of cefamandole (CMD) and cefmetazole (CMZ) in the treatment of 193 patients with complicated urinary tract infections. The patients received 1 gram of CMD or CMZ twice a day intravenously by drip infusion over 1 hour for 5 days. Pretreatment urinary leukocyte counts and urinary bacterial counts were at least 5 cells/hpf and 10(4) bacteria/ml, respectively. Each patient was randomly allocated either to CMD or CMZ group. There were 93 patients in CMD group and 100 patients in CMZ group. Clinical efficacy was evaluated based on the effect of treatment on bacteriuria and pyuria according to the criteria set by the UTI Committee, Japan. The response to CMD treatment was excellent in 18 cases (19.4%), moderate in 38 cases (40.9%) and poor in 37 cases (39.8%) with an overall effectiveness of 60.2%, whereas the response to CMZ was excellent in 19 cases (19.0%), moderate in 40 cases (40.0%) and poor in 41 cases (41.0%) with an overall effectiveness of 59.0%. No statistical significant difference was found between 2 treatment groups. Comparison of the bacteriological response between 2 groups showed that the eradication rate for strains of Gram-positive cocci were significantly higher in those patients treated with CMD. Gram-negative rods were eradicated from 68.4% of cases treated with CMD, and 78.0% of those with CMZ, but the difference was not significant. Adverse reactions were observed in 3 patients receiving CMD 1 case each of diarrhea, eruption and epigastric pain. Abnormality in laboratory tests was found in 6 patients in each treatment group. The results indicate that CMD is effective, safe and useful in the treatment of patients with complicated urinary tract infections, and its efficacy, safety and usefulness are comparable with those of CMZ.