Shuji Tokunaga

Percutaneous injection sclerotherapy with minocycline hydrochloride for simple renal cysts

Minocycline hydrochloride as a sclerosant for the treatment of simple renal cysts was evaluated. Cyst puncture was performed, and minocycline hydrochloride solution for intravenous administration was injected after aspiration. Of 154 cysts evaluated by ultrasound after 3 months or more, 69 were no longer demonstrable, 49 showed 50% or greater reduction in the maximum cyst diameter, and only 8 were unchanged or slightly increased in size. In constrast, only 1 of 20 cysts aspirated without minocycline hydrochloride injection (controls) showed 50% or greater reduction after 3 months. There was a significant difference in the reduction rates between the minocycline-treated group and control group (p<0.01). These results suggest that minocycline hydrochloride is an effective sclerosant to treat simple renal cysts.

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.

Antimicrobial treatment for chronic prostatitis as a means of defining the role of Ureaplasma urealyticum

A study was conducted to assess the clinical and microbiological effects of antimicrobial treatment for chronic prostatitis as a means of defining the role of Ureaplasma urealyticum. Significant U. urealyticum cells were considered to be isolated from the prostates of 18 of 143 prostatitis patients. These patients with ureaplasma-associated prostatitis were randomly treated with either ofloxacin or minocycline for 2 weeks; 4 patients were excluded due to voluntary withdrawal. U. urealyticum was eradicated in all the patients. Symptoms were resolved in 10 patients, and leukocytes in expressed prostatic secretion were cleared in 4 patients; both drug treatments revealed similar results. Even if we exclude 3 patients with significant coexistent Staphylococcus epidermidis cells before treatment, 3 of 11 patients evaluated showed complete resolution of symptoms and clearance of leukocytes in expressed prostatic fluid. These results suggest that U. urealyticum is a causative organism in some patients with chronic prostatitis.

Clinical Significance of Measurement of Serum D-Arabinitol Levels in Candiduria Patients

D-Arabinitol, a major candidal metabolite, is reported to be a useful parameter to diagnose disseminated candidiasis. Conventional determination of serum D-arabinitol levels using gas-liquid chromatography is complicated and time-consuming compared with the enzymatic fluorometric assay, newly available in kits. D-Arabinitol concentrations were determined by both enzymatic fluorometric assay kits and gas-liquid chromatography, and a significant correlation (r = 0.943, p less than 0.01) was found between the two methods in 25 sera from 15 patients with candiduria. D-Arabinitol/creatinine ratios were determined using the enzymatic fluorometric assay in 39 candiduria patients (21 febrile and 18 afebrile) and 22 patients without candiduria as the control. The ratios in the febrile patients were significantly greater than those in the afebrile and the nondocumented candidiasis groups. These results suggest that knowledge of the serum D-arabinitol concentration may help to promptly diagnose invasive candidiasis, particularly Candida pyelonephritis. In addition, enzymatic fluorometric assay kits are considered to be advantageous in that they require little time and are simple to use, as compared with gas-liquid chromatography.

Crystal Adherence to Urinary Catheter Materials in Rats

Crystal adherence to the surfaces of indwelling urinary catheter materials was investigated by scanning electron microscopy and immunofluorescence method. Small sterile disks were inserted into the rat bladder transvesically. Crystals were frequently associated with fibrillar material, some of which was believed to be fibrin. Increases in fibrillar materials were paralleled by increases in crystal adherence. On the other hand, a decrease in the amount of fibrin adhering to the surfaces of heparinized material, resulting in a decrease in the quantity of encrusting deposits on these materials, was found as compared with other catheter materials, including latex, silicone and nonheparinized material. These findings suggest that early adherence of fibrin to the surfaces of indwelling urinary catheter materials plays an important role in the development of crystal adherence and encrustation on catheter materials. It is also suggested that heparin inhibits the adherence of fibrin, resulting in decreased encrustation on the surfaces of the heparinized material.

D-arabinitol versus mannan antigen and candidal protein antigen as a serum marker for Candida pyelonephritis.

To evaluate serum markers for the diagnosis ofCandida pyelonephritis, levels of D-arabinitol, candidal mannan antigen and candidal protein antigen were measured using an enzymatic fluorometric assay, an enzyme immunoassay and a latex agglutination assay, respectively. The study group comprised 36 patients with candiduria (11 disseminated candidiasis, 9Candida pyelonephritis and 16 colonization) and 27 without candiduria. The D-arabinitol/creatinine ratio was the only marker that differentiated betweenCandida pyelonephritis and colonization (p<0.01). Using the cut-off values (1.4 µmol/mg of D-arabinitol/creatinine ratio, 0.28 of mannan/creatinine ratio (×104) and 1:4 of protein antigen titer) D-arabinitol/creatinine ratio showed the highest sensitivity inCandida pyelonephritis (77.8 %) as compared to mannan/creatinine ratio (55.6 %) and protein antigen titer (11.1 %) although there were no differences in specificity, positive predictive value or negative predictive value. These results suggest that D-arabinitol/creatinine ratio is the most useful marker ofCandida pyelonephritis.

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.

Elimination Kinetics of Cefotaxime and Desacetyl Cefotaxime in Patients with Renal Insufficiency and during Hemodialysis

The pharmacokinetics of cefotaxime, a new semi-synthetic cephalosporin for injection, was studied in 30 subjects with various degrees of renal function after a single 1-gram intramuscular injection. Serum and urinary concentrations of cefotaxime and desacetyl cefotaxime were determined by high pressure liquid chromatography. The pharmacokinetic parameters of cefotaxime were obtained using a one-compartment open model. The mean serum half-life of the parent compound (cefotaxime), 0.87 h in normal subjects, was prolonged to 2.35 h in hemodialysis patients. There was a significant linear correlation between the elimination rate constant of cefotaxime and creatinine clearance. The mean cumulative urinary recovery of the administered dose in the 24-hour urine was 51.7% as cefotaxime and 25.6% as desacetyl cefotaxime in normal subjects.

In vitro susceptibility testing of Candida isolates from clinical specimens to four antifungal agents.

A total of 231 isolates of Candida species including 163 of Candida albicans (132 of serotype A and 31 of serotype B), 42 of Candida tropicalis, 17 of Candida glabrata, 7 of Candida parapsilosis and 2 of Candida krusei were collected from clinical specimens in two medical centers, one in Japan and the other in the United States. The in vitro antifungal activities of amphotericin B, 5-fluorocytosine, miconazole and fluconazole were evaluated for the above isolates by means of a photo-read broth microdilution method for determination of the 30% inhibitory concentration (IC30). The results showed that IC30 values of fluconazole were generally great compared with those of the other drugs, regardless of Candida species. The isolates of C. albicans serotype B showed a significantly lessened susceptibility to 5-fluorocytosine compared with those of serotype A (p less than 0.01). This method has the advantage of objective measurement, thus minimizing observer variability as compared with the agar dilution test.

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.