Makoto Sumitomo

Prostatic penetration of meropenem in humans, and dosage considerations for prostatitis based on a site-specific pharmacokinetic/pharmacodynamic evaluation

The aims of this study were to investigate the penetration of meropenem (MER) into human prostate tissue and to assess MER regimens for prostatitis by performing a site-specific pharmacokinetic/pharmacodynamic evaluation. Patients with prostatic hypertrophy (n=49) prophylactically received a 0.5-h infusion of MER (250 mg or 500 mg) before transurethral resection of the prostate. MER concentrations in plasma (0.5-5h) and prostate tissue (0.5-1.5h) were measured chromatographically. Concentration data were analysed pharmacokinetically with a three-compartment model and were used to estimate the drug exposure time above the minimum inhibitory concentration for bacteria (T>MIC, % of 24h) in prostate tissue, an indicator for antibacterial effects at the site of action. The prostate tissue/plasma ratio was 16.6% for the maximum drug concentration and 17.7% for the area under the drug concentration-time curve, irrespective of the dose. Against MIC distributions for clinical isolates of Escherichia coli, Klebsiella spp. and Proteus spp., 500 mg once daily achieved a >90% probability of attaining the bacteriostatic target (20% T>MIC) in prostate tissue, and 500 mg twice daily achieved a >90% probability of attaining the bactericidal target (40% T>MIC) in prostate tissue. However, against the Pseudomonas aeruginosa isolates, none of the tested regimens achieved a >90% probability of attaining the bacteriostatic or bactericidal targets.

Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload

To compare perioperative, oncological and functional outcomes of robot‐assisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload.

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision

BackgroundThe aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004.MethodsThe subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment.ResultsAt 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each.ConclusionsESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Enhancement of enterohemorrhagic Escherichia coli O157:H7 stress tolerance via pre-heating

Enterohemorrhagic Escherichia coli O157:H7 infection causes several hundred cases of food poisoning every year in Japan. In severe cases, this type of food poisoning can be fatal. In the present study, we examined the induction of HSP70 in E. coli O157:H7 cells at various temperatures and the thermotolerance of E. coli O157:H7 cells alone and in contaminated food following pre-heating. We evaluated the possibility that thermotolerance by E. coli O157:H7 increases the likelihood of food poisoning. E. coli O157:H7 cells were heated at 43-51 °C, and the survival rate was examined. The temperature of highest induction of HSP70 was used as the pre-heating temperature. We measured the thermotolerance of E. coli O157:H7 cells following pre-heating as the survival after heating at 53 °C (lethal temperature). Additionally, we evaluated the thermotolerance of E. coli O157:H7 cells in ground beef following pre-heating. Heating at 47 °C for 30 min caused the highest induction of HSP70 and this temperature was selected as the pre-heating temperature. The survival rate was significantly higher for 0-90 min compared to that in cultures incubated at 53 °C without pre-heating indicating thermotolerance. Additionally, in ground beef, thermotolerance in E. coli O157:H7 cells was induced by pre-heating. We showed that E. coli O157:H7 cells acquired thermotolerance after pre-heating, which significantly increased survival after a lethal temperature, and increased the likelihood of food poisoning.

Optimal method for measuring tumor extent in needle biopsy specimens to identify small-volume prostate cancer.

To compare various methods for measuring tumor extent in prostate biopsy specimens to identify small‐volume prostate cancer.

Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration

To assess normal fertilization, clinical pregnancy, and live birth rates after the use of microscopic epididymal sperm aspiration (MESA).

Impact of a novel biopsy instrument with a 25‐mm side‐notch needle on the detection of prostate cancer in transrectal biopsy

To evaluate the impact of a novel biopsy instrument that extends the length of the side‐notch on the detection of prostate cancer in transrectal needle biopsy.

Leydig cell tumor of the testis, presenting with azoospermia

A case of Leydig cell tumor, associated with azoospermia, is presented.

Treatment for Non-clear Cell Renal Cell Carcinoma

Non-clear cell (NCC) renal cell carcinoma (RCC) is less common and accounts for 25 % of all patients with metastatic RCC. Metastatic NCCRCC and clear cell (CC) RCC both respond infrequently to cytotoxic and cytokine therapy; however, compared with CCRCC patients, NCCRCC patients have a poorer prognosis. Tyrosine kinase inhibitors (TKIs) such as sorafenib and sunitinib have significant activity in metastatic NCCRCC, but the efficacy of each agent seems to vary between different NCCRCC forms. Preliminary clinical data for temsirolimus, one of the mammalian targets of rapamycin (mTOR) inhibitors, appear to be promising, but future phase III trials should include patients with RCCs with NCC histology as well as CCRCC, with appropriate stratification to take the balance between each treatment arm. Many ongoing phase II trials should provide interesting preliminary insights into the antitumor efficacy of particular agents in these tumors. These approaches will lead us to improvements in the management of NCCRCC so as we have already achieved with the more common CCRCC.

Axitinib-induced reversible posterior leukoencephalopathy syndrome in a patient with metastatic renal cell carcinoma

A 61-year-old woman with metastatic renal carcinoma was treated with axitinib as a second-line tyrosine kinase inhibitor. Thirteen days after the treatment, the patient developed reversible posterior leukoencephalopathy syndrome (RPLS). Her symptoms and imaging findings resolved after withdrawal of axitinib, blood pressure control, and administration of glycerin and levetiracetam. RPLS should be kept in mind as a possible rare adverse event after axitinib administration.