Toshiaki Sugata

Bacterial and Crystal Adherence to the Surfaces of Indwelling Urethral Catheters

Bacterial and crystal adherence to the surfaces of indwelling urethral catheters was investigated by scanning electron microscopy and immunofluorescence method in relation to microbiological examination. Gram-negative bacteria were isolated more frequently than gram-positive bacteria in urine and catheter cultures. Microorganisms and crystals frequently were associated with fibrillar material, some of which was considered to be fibrin. On the surfaces of catheters indwelling for more than 1 week bacteria often were embedded in an amorphous matrix. It was believed that the thick coherent matrix adherent to the catheter served as a protected reservoir of microorganisms that persisted despite antimicrobial chemotherapy. Additionally, urease-producing bacteria attached to the catheter could have an important role in the development of calculous incrustation.

Adrenal androgen levels as predictors of outcome in castration‐resistant prostate cancer patients treated with combined androgen blockade using flutamide as a second‐line anti‐androgen

Objectives:  To analyze the clinical effects of flutamide as a second‐line anti‐androgen for combined androgen blockade in patients with castration‐resistant prostate cancer (CRPC) initially treated with bicalutamide as a first‐line anti‐androgen.

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.

Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced urothelial cancer

SummaryA series of 31 patients with advanced urothelial cancer were treated with combination chemotherapy consisting of 1–4 cycles of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC). Of the 31 patients, 29 had measurable and evaluable lesions. A complete remission was achieved by 4 of these 29 patients (14%) for 1–46 months. A partial remission was observed in 14 of the 29 patients (48%) for 1–9 months. Whereas bony and hepatic metastatic lesions did not respond, some nodal (7/12), pulmonary (4/8), and pelvic lesions (2/3) as well as primary bladder tumors (4/6) and a tumor marker (1/2) responded. Complete tumor remission was observed in nodal (2/12) and pulmonary (1/8) metastatic lesions, in invasive lesions to the prostate and seminal vesicle (1/1), and in primary lesions in the bladder (2/6), ureter (1/1), and urethra (1/1). Two of three patients with non-transitional cell tumors attained a partial remission for 1–7 months. Complete remission of the pulmonary lesions was obtained in a case of squamous cell cancer of the bladder with pulmonary metastases. The toxicity of this regimen was generally tolerable and included moderate to severe myelosuppression, mild to moderate nausea and vomiting, renal toxicity, and mucositis. These results suggest that the M-VAC regimen holds promise for the treatment of advanced metastatic transitional cell cancer as well as nontransitional cell cancer of the urothelium.

Pharmacokinetics of Cefpiramide in Healthy Volunteers, Patients with Various Degrees of Renal Dysfunction, and Patients on Hemodialysis

The elimination kinetics of cefpiramide, a parenteral semisynthetic cephalosporin derivative, were studied in 6 healthy volunteers and 31 patients with renal dysfunction after a single 500-mg intravenous injection. Cefpiramide concentrations in serum and urine were determined by an agar-well diffusion method. The serum levels in patients with renal impairment were slightly higher than those in volunteers during the period from 30 min to 24 h after the administration. The mean serum half-life during the beta-phase was 4.06 h in the volunteers and was slightly prolonged in the patients. The mean urinary recovery during 24 h amounted to 21.5% in the volunteers and decreased with reduced renal function. Hemodialysis did not enhance the clearance of cefpiramide.

Primary Carcinoma in Situ of The Ureter: A Case Report

A case of primary carcinoma in situ of the right ureter without a history of bladder tumors is presented. Cytological investigation of the right ureteral urine specimens revealed malignant cells and computerized tomography showed focal thickening of the upper portion of the right ureter. The patient underwent right nephroureterectomy, including excision of a bladder cuff. The diagnostic role of exfoliative urinary cytology is emphasized.