Matsuo Orito

Composition of urinary calculi related to urinary tract infection

The composition of 3,084 urinary calculi was determined using an infrared spectrophotometer. Mixed calcium oxalate-calcium phosphate stones were most frequently implicated. Of the urinary calculi analyzed 199 were associated with urinary tract infection. Escherichia coli was most frequently isolated (43 strains) and urease-producing organisms, such as Proteus mirabilis, were cultured from 40 patients. The core culture of 20 staghorn calculi yielded 15 isolates from 14 stones. There were 13 identical species isolated from the urine and stone specimens of 13 patients (65%), including 7 strains of P. mirabilis. These results suggest that cultures of urine specimens of urolithiasis patients, especially those with staghorn calculi, may help to elucidate the bacteriology of the stones.

Pharmacokinetics of Ceftazidime in Patients with Renal Insufficiency and in Those Undergoing Hemodialysis

The pharmacokinetics of ceftazidime, a new cephalosporin antibiotic, were studied in 7 healthy volunteers and 32 patients with renal insufficiency after a single 500-mg intravenous injection. The mean plasma half-life during beta-phase was 1.67 h in normal subjects and was prolonged to 15.09 h in hemodialysis patients. There were significant correlations between the elimination rate constant and the creatinine clearance, and between the beta-phase rate constant and the creatinine clearance. The mean urinary recovery during 24 h amounted to 89.6% of the dose in normal subjects and decreased with the lowering of renal function. The plasma levels during hemodialysis were lower than those between hemodialyses.

Bacteremia Resulting from Prostatic Surgery in Patients with or without Preoperative Bacteriuria under Perioperative Antibiotic Use

We investigated the source of organisms detected in blood specimens obtained during and immediately following prostatic surgery under perioperative antibiotic use, as related to the results of cultures of preoperative urines and prostatic tissues. Ninety patients with benign prostatic hyperplasia were studied. The incidence of bacteremia was 28.9%: 53.7% in patients with preoperative bacteriuria and 8.2% in those without bacteriuria, a significant difference (p < 0.01). Of these bacteremic patients, 5, who had preoperative bacteriuria, developed septicemia. Bacteremia developed more frequently in patients with positive than in those with negative prostatic cultures; this difference was significant (p < 0.05). The species in 80.8% of the isolates from blood specimens were identical with those isolated from preoperative urines, and the species in 53.8% were identical with those from prostatic tissues. These results indicate that in patients with urogenital infection, especially bacteriuria, septicemia can result from prostatic surgery even under perioperative antibiotic use. The incidence of postoperative bacteriuria was approximately 20% in the preoperative nonbacteriuric patients regardless of the duration of chemoprophylaxis.

Spontaneous passage of upper urinary tract calculi in relation to composition

The composition of 2,755 calculi obtained from the upper urinary tract (1,409 by spontaneous passage and 1,346 by urological procedures) was analyzed using an infrared spectrophotometer, and the spontaneous passage rate was investigated in relation to the composition as well as other variables, such as stone size, and patient age and sex. Mixed stones of calcium oxalate and calcium phosphate were most frequently found, followed by those of calcium oxalate. The mean size (the maximum diameter) was largest in struvite stones and smallest in calcium oxalate ones. The sizes of stones from women were significantly larger than those from men (p < 0.01). As expected, the stone passage rates were inversely related to increasing stone size. The size of 55.6% of the stones passed was < or = 5 mm, and that of 96.6% of the stones < or = 10 mm.

Randomized study on the effect of zoledronic acid treatment for prostate cancer with bone metastasis during initial combined androgen blockade.

48 Background: Zoledronic acid (ZA) eventually reduces risk of skeletal morbidity carries beneficial effect on bone pain. Moreover, ZA eventually extends a period to bone pain and the SRE onset after CRPC (castration-resistant prostate cancer) and improves the QOL of the patients. ZA, therefore, has become a standard supportive therapy for CRPC with bone metastasis. However, it remains unclear when the physicians should start ZA treatment for prostate cancer (PCa) patients with bone metastasis. In the present study, we investigated whether we could extend a period before androgen sensitive PCa with bone metastasis becoming CRPC by ZA treatment. METHODS The patients were randomly classified in two groups (combined androgen blockade (CAB) alone group and CAB + ZA treatment group) based on Gleason score (less than 7 or more) EOD score (less than 2 or more). Four mg ZA treatment was conducted every 4 weeks. We evaluated serum PSA value, bone-related markers, and SRE. The first end point was a period before androgen sensitive PCa with bone metastasis becoming CRPC. RESULTS Untreated 59 PCa patients with bone metastasis were enrolled by 2011 from 2006. Thirty patients were classified in the CAB alone group and 29 patients in the CAB + ZA group. There were no significant difference in age (72,5 and 71.7 yo, respectively), PSA (381.3 ng/ml and 399.0 ng/ml, respectively), Gleason score, and EOD score between CAB alone group and CAB + ZA group. Although there was no significant difference in PSA-progression free survival (PFS) (p=0.14), tendency that CAB + ZA shows better PFS than CAB alone group was observed (time to 50% PFS was extended 9.4 months than CAB alone group). Moreover, the sub analysis using the patients with more than Gleason score 7 or with more than EOD score 1, CAB +ZA group showed better PFS (p=0.074 in Gleason score and p=0.028 in EOD score. CONCLUSIONS This result indicates that CAB with ZA from initial treatment can extend a period before PCa, especially high advanced PCa recurring.