Hirokazu Goto

Mosaic-Like Structure of Penicillin-Binding Protein 2 Gene (penA) in Clinical Isolates of Neisseria gonorrhoeae with Reduced Susceptibility to Cefixime

ABSTRACT Neisseria gonorrhoeae strains with reduced susceptibility to cefixime (MICs, 0.25 to 0.5 μg/ml) were isolated from male urethritis patients in Tokyo, Japan, in 2000 and 2001. The resistance to cephems including cefixime and penicillin was transferred to a susceptible recipient, N. gonorrhoeae ATCC 19424, by transformation of the penicillin-binding protein 2 gene (penA) that had been amplified by PCR from a strain with reduced susceptibility to cefixime (MIC, 0.5 μg/ml). The sequences of penA in the strains with reduced susceptibilities to cefixime were different from those of other susceptible isolates and did not correspond to the reported N. gonorrhoeae penA gene sequences. Some regions in the transpeptidase-encoding domain in this penA gene were similar to those in the penA genes of Neisseria perflava (N. sicca), Neisseria cinerea, Neisseria flavescens, and Neisseria meningitidis. These results showed that a mosaic-like structure in the penA gene conferred reductions in the levels of susceptibility of N. gonorrhoeae to cephems and penicillin in a manner similar to that found for N. meningitidis and Streptococcus pneumoniae.

Usefulness of tamsulosin hydrochloride and naftopidil in patients with urinary disturbances caused by benign prostatic hyperplasia: A comparative, randomized, two-drug crossover study

Background:  The aim of the study presented here was to stratify drug therapy for patients with benign prostatic hyperplasia (BPH) displaying various voiding symptoms.

Gender as a prognostic factor in patients with renal cell carcinoma

Objective  To evaluate gender as a prognostic factor in patients with renal cell carcinoma (RCC), using a retrospective review of patients with RCC stratified according to gender and analysing factors affecting prognosis.

Cyst‐associated renal cell carcinoma: Clinicopathologic characteristics and evaluation of prognosis in 27 cases

No consistent clinicopathologic characteristics of cyst‐associated renal cell carcinoma (CRCC) have previously been determined.

Histological features of hypovascular or avascular renal cell carcinoma: the experience at four university hospitals.

AbstractBackground. We aimed to evaluate the pathological features of hypovascular or avascular renal cell carcinoma (RCC), by the retrospective review of the histological features that coincide with hypovascular or avascular RCC. Methods. Seven hundred and ninety-one patients who underwent both preoperative angiography and nephrectomy were examined. Of these patients, the 126 patients (15.9%) who showed hypovascular or avascular angiographic features were selected. Patients with hemorrhage or cyst(s), or with at least 50% necrosis or more in the tumor, and those with renal tumor metastatic to the kidney were excluded. The criteria proposed by the World Health Organization (1998) were adopted for the histological classification. Results. Papillary RCC was the most frequently observed hypovascular or avascular renal tumor (44 cases; 34.9%). The vascularity differed among the variants, i.e., some cases had a basophilic and solid variant with avascular features, while the remaining cases had wide stromal organization showing hypovascular features. The second most frequently observed hyporascular or avascular RCC was chromophobe cell carcinoma (35 cases; 27.8%). No difference in vascularity was detected between variants, except for 2 cases with sarcomatoid changes (avascular features). The third most frequently observed hypovascular or avascular RCC was cyst-associated RCC (29 cases; 23%). All of the 7 RCCs originating in a cyst showed avascular features, and the remaining 22 cystic RCCs showed hypovascular features. The remaining hypovascular or avascular RCCs were cases of clear cell carcinoma accompanied by sarcomatoid changes (8 cases; 6.3%), spindle cell carcinoma (5 cases; 4.0%), and collecting-duct carcinoma (5 cases; 4.0%). Conclusion. Hypovascular or avascular RCC can be categorized as non-clear cell carcinoma and some clear cell carcinoma accompanied by sarcomatoid changes.

An assessment of the immunological status of patients with renal cell carcinoma based on the relative abundance of T-helper 1- and -2 cytokine-producing CD4+ cells in peripheral blood

Objective To assess the immunological status of patients with renal cell carcinoma (RCC), by analysing the proportion of cluster‐of‐differentiation 4‐positive (CD4+) cells showing intracellular cytokine production, i.e. interferon‐γ derived from T‐helper (Th) 1 and interleukin‐4 derived from Th2 cells, among peripheral blood lymphocytes from these patients

Metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland after nephrectomy

AbstractBackground. Metachronous solitary metastasis of renal cell carcinoma (RCC) to the contralateral adrenal gland is very rare. We assessed the clinocopathological findings of such patients who received adrenalectomy. Methods. We retrospectively reviewed the records of all 495 patients who underwent nephrectomy for RCC; excluding those in stage IV, between 1980 and 1993. Of these patients, 5 who showed metachronous solitary metastasis to the contralateral adrenal gland, and also received adrenalectomy were the subjects of this study. Results. The adrenal metastasis was found between 14 and 132 months (median, 81 months) after nephrectomy. After the solitary adrenalectomy, patient survival ranged from 450 to 2160 days (median, 660 days); 2 patients were alive with no evidence of disease at 660 and 1830 days, respectively, and 3 patients died of this disease, at 450, 480, and 2160 days, respectively, after adrenalectomy. The overall survival rate was 100% at 5 years, 80% at 6 years, 60% at 7 years, and 40% thereafter. The 2 patients with no evidence of disease did not receive steroid supplementation, because they had not received ipsilateral adrenalectomy. No significant difference was observed between survivors and non-survivors in terms of clinicopathological factors such as affected side, location of the tumor, tumor size of primary/metastatic lesion, and stage or grade of primary/metastatic lesion. From the viewpoint of outcome, patients with early recurrence tended to show an unfavorable prognosis compared with prognosis in those with late recurrence. Conclusion. The prediction of outcome in patients with RCC who undergo, adrenalectomy for metachronous solitary metastasis to the contralateral adrenal gland is difficult. Although the factors that affect prognosis are uncertain, long-term observation for unusual metachronous metastasis to the contralateral adrenal gland is mandatory in patients with RCC.

Clinical Efficacy of a Single Two Gram Dose of Azithromycin Extended Release for Male Patients with Urethritis

To clarify the clinical efficacy of a single oral 2 g dose of azithromycin extended-release for heterosexual male patients with urethritis, and the current antimicrobial sensitivity of Neisseria gonorrhoeae to azithromycin, a prospective clinical trial was conducted from 2011–2013. In patients with gonococcal urethritis, the eradication rate was 90.9% (30 of 33). The susceptibility rates of isolated Neisseria gonorrhoeae strains to ceftriaxone, spectinomycin, cefixime and azithromycin were 100%, 100%, 95.3% (41/43) and 37.2% (16/43), respectively. In the patients with nongonococcal urethritis, the eradication rate was 90.0% (45 of 50). The microbiological eradication rates for the pathogens were 90.9% (30/33) for Neisseria gonorrhoeae, 91.5% (43/47) for Chlamydia trachomatis, 71.4% (5/7) for Mycoplasma genitalium, and 100% (13/13) for Ureaplasma urealyticum. The main adverse event was diarrhea and its manifestation rate was 35.2% (32 of 120). The symptom of diarrhea was mostly temporary and resolved spontaneously. The conclusion was that the treatment regimen with a single oral 2 g dose of azithromycin extended-release would be effective for patients with urethritis. However, the antimicrobial susceptibilities of Neisseria gonorrhoeae and Mycoplasma genitalium should be carefully monitored because of possible treatment failure.

A CASE OF A CARCINOSARCOMA OF THE PROSTATE

Carcinosarcoma of the prostate is a rare but aggressive tumor characterized by combination of malignant epithelial and mesenchymal cells. We encountered a case of carcinosarcoma of the prostate. A 78-year-old man with urinary retention was diagnosed with benign prostatic hyperplasia on the basis of the ultrasonography and rectal examination findings, negative result of prostate biopsy. Transurethral resection of the prostate was performed, and the pathological diagnosis was carcinosarcoma of the prostate with squamous cell carcinoma. The patient died of disease 5 months after the diagnosis of carcinosarcoma. A total of 17 cases of carcinosarcoma of the prostate including the present case, have been reported in the Japanese literature to date. Herein we review the 17 cases and discuss the clinical features.

Combination treatment with interleukin-2 and interleukin-12 for murine renal cell carcinoma

Abstract Background. We studied the anti-tumor effectiveness of treatment with interleukin-2 (IL-2) and/or IL-12 for a spontaneously arising murine renal cell carcinoma (RC-2). We also analyzed the immunological effects induced by the treatments. Methods. One week after RC-2 inoculation, treatment with IL-2 (1 × 104 U or 5 × 104 U/mouse, every day for 3 weeks) and/or IL-12 (1 μg/mouse, once a week for 3 weeks) were started. We analyzed the relative mean tumor weight ratio (tumor relative weight/control relative weight [TRW/CRW]), the degree of tumor degeneration (grade), and the survival rate of the mice. We also analyzed the expression of various T-helper (Th)1-derived cytokine mRNAs (interferon-γ, IL-2, tumor necrosis factor-β) and Th2-derived-cytokines mRNAs (ILs-4, 5, 6, 10) in the spleen by reverse transcription-polymerase chain reaction. Results. The combination treatments were effective in terms of the TRW/CRW ratios (4.8% for IL-2 5 × 104 U/mouse plus IL-12 and 8.9% for IL-2 1 × 104 U/mouse plus IL-12) and showed superior survival of mice compared with results for the control mice and those treated with a single agent. However, a small amount of viable tumor cells still remained (grade IIb), indicating the treatment was ineffective. Control spleens expressed Th2-derived cytokine mRNAs predominantly, in accordance with tumor growth. In mice that had combination treatments, the spleen expressed Th1-derived cytokine mRNAs, except for IL-10. Conclusion. We conclude that combination treatment with IL-2 and IL-12 has potent anti-tumor effectiveness, based upon the induction of cellular immunity implying cross-regulation with humoral immunity.