Search

Objectives and methods of the study: Although superficial bladder carcinoma can be surgically eliminated by TUR, recurrence is common. Various attempts have been made to prevent recurrence, but to date an excellent prophylactic method with few adverse reactions has not been established. We conducted a clinical trial study for prophylaxis of bladder carcinoma recurrence, using intravesical instillation of bleomycin, a drug which cause little local irritation, in combination with bestatin, a recently developed immunomodulator. Bleomycin was selected on the bases of experimental results. That is, in beagle dogs, the 1-hour intravesical instillation of bleomycin gained a drug concentration in the bladder wall of 2.08 micrograms/g, which is approximately 4 times higher than that in the intravenous administration of the same dose. The above bleomycin concentration was thought enough to obtain a good clinical effect. A total of 124 patients were randomly divided into the two treatment groups: An only bleomycin intravesical instillation group (60 mg on each treatment day) (58 patients) and a bleomycin with bestatin (60 mg per every day) group (66 patients). In the 2-year follow-up period the recurrence of bladder carcinoma in the two treatment groups was studied. Analysis of non-recurrence rate by life-table method and Kaplan-Meier method: The non-recurrence rate of the bladder carcinoma every three months was calculated by the life-table and Kaplan-Meier methods. The non-recurrence rate in the bleomycin group was approximately the same as the rates in adriamycin or mitomycin reported in the literature. In the bleomycin + bestatin group, the recurrence rates at 9 months and 12 months were significantly (at P = 0.09 and P = 0.08, respectively) lower, and in addition, even the 2-year overall non-recurrence rate curves showed a nearly significant difference (P = 0.179). Especially in the case of papillary pedunculated tumors, the difference in the non-recurrence rate curves was almost statistically significant (P = 0.104). The stratified analysis on the basis of various tumor factors, were as follows. Pathological grade: Although no differences were found in Grades 1 and 2, the bleomycin + bestatin group had a lower recurrence rate in Grade 3 cases (P = 0.1).(ABSTRACT TRUNCATED AT 400 WORDS)

P. aeruginosaによる複雑性尿路感染症に対するCPMの治療効果と副作用を評価する目的で, CPM 2g/日とCFS 2g/日の二重盲検法による比較試験をおこなった.総投与例数は274例で, うち効果を判定し得たのはCPM群136例, CFS群118例であった.1) P. aeruginosaを含む感染症では, CPMあるいはCFSを1日2g, 5日間投与時の効果では, 前者の有効率が有意に高かった.2) P. aeruginosaのみを対象にした場合も同様であった.3) P. aeruginosaを含む感染で細菌尿の陰性化率はCPM群はCFS群より有意に高かった.4)交代菌の出現は, CFS群でS. faecalisの出現率が有意に高く, 全体的にもCFS群の投与後の細菌出現率が有意に高かった, 5)薬剤投与開始前の分離菌のMICでは, CPM群の方がCFS群よりもMICの低いものが多かった.6)副作用発現率, 臨床検査値の異常化は両群間に差はなかった, The therapeutic efficacy and safety of Cefpiramide (CPM, SM-1652) at a 2 g/day dose were objectively compared with those of Cefsulodin (CFS) at a 2 g/day dose in patients with chronic complicated urinary tract infections (UTI) by P. aeruginosa in a double-blind study at 46 institutions in Japan. The results are as follows: The therapeutic efficacy was analyzed in 254 patients (136 cases administered CPM and 118 cases administered CFS) after excluding 20 cases as drop-out. Among 254 cases, the number of patients with infection of P. aeruginosa was 190 cases (100 cases administered CPM and 90 cases administered CFS), while that with infection of organisms other than P. aeruginosa was 64 cases (36 cases administered CPM and 28 cases administered CFS). By the administration of a 2 g/day dose for 5 days, the overall clinical effective rate of CPM was significantly higher than that of CFS in total patients. When the patients were classified into 2 groups with respect to causative organisms (P. aeruginosa and others), the clinical effective rate of CPM in patients with infections of P. aeruginosa was significantly higher than that of CFS, while the clinical effective rate of CPM in patients with infection of other organisms than P. aeruginosa was the same as that of CFS. As to the bacteriological effect on bacteriuria, the eradication rate of CPM was significantly higher than that of CFS not only against all causative organisms but also against P. aeruginosa. The rate of replacement by S. faecalis was significantly higher in the CFS-treated group than in the CPM-treated group. The same result was obtained on the rate of replacement by other organisms. The MIC values of CPM for isolated organisms before drug administration were lower than those of CFS. The incidence rates of side effects and the abnormal findings of clinical laboratory tests were the same for the CPM- and CFS-treated groups. From the results, it was concluded that CPM is a useful drug for the treatment of patients with chronic complicated urinary tract infections caused by P. aeruginosa.

1981年10月～1982年2月の間の札幌での淋菌性感染症178例(男158例, 女20例)につき, 疫学的, 治療学的に研究した.男158例は全例急性尿道炎で, 最年少は15歳で, 10歳代が20.3%であった.男子例の感染源は, 10代では, ほとんどがディスコなどでpick upしたかりそめの女友達であるが, 20歳代はトルコ, バーなどの接客婦がふえ, 25歳以上ではそれが半数以上となる.最近ふえ続けるトルコ風呂接客婦の占める割合が多くなっている.女子20例中1例は1歳の腟外性器炎を除き子宮頸管炎で, 16～19歳が半数を占めた.潜伏期がはっきりしている男141例で中, 5日以内83例, 6～10日39例, 11～20日13例, 21～30日4例, 30日以上2例と潜伏期の長いものが増えつつある.また菌量106 cells/ml接種で, MIC 1.56 μg/ml以上の12株はβ-lactcmase産生株であった.このβ-lactamase産生株は同時にDoxycyclin (DOXY)のMICはすべて1.56 μg/ml以上で, AMPCとDOXYとの耐性獲得機序の相関性を示した.男133例, 女15例に持続性アモキシシリン(L-AMPC) 1 g/日(500 mg×2)を原則とし7日間投与し, L-AMPCによる淋菌性感染症の治療プランを提唱した, During the period from October of 1981 through March of 1982, our research group in Sapporo treated 178 patients (158 males and 20 females) for gonorrheal infections. We performed epidemiological and therapeutic studies on these patients. The youngest of the 158 male patients with acute gonorrheal urethritis was 15 years old. The age distribution was 32 patients (20.3%) under 20 years, 46 patients (29.1%) aged 20 to 24, 34 patients (21.5%) aged 25 to 29, 22 patients (13.9%) aged 30 to 34, 10 patients (6.3%) aged 35 to 39, and 14 patients (8.9%) aged 40 to 54. The fact that 20% of gonorrheal urethritis occurred in youths under 20 years of age, is especially noteworthy. The infection in the teenage boys was found to be picked up mostly from girls met at discos , etc., On the other hand, the patients in their 20s, were infected more frequently by contact with hostesses at massage parlors and bars, these sources making up the majority of male patients who were 25 years or older. These findings are quite interesting because they reflect the socio-economic status of the patients. In addition, the fact that hostesses working at massage parlors are a frequent source of gonorrheal urethritis infections can represent a considerable problem in terms of public hygiene. The 20 female patients with gonorrheal infections were all found to be cases of cervicitis, except for a 1-year-old girl with gonorrheal infection of external genitals. The fact that about half of these female patients were teenagers, aged 16 to 19 years is worth special note. The duration of the latent period was less than 5 days in 83 male patients (58.9%) with urethritis, 6 approximately 10 days in 39 patients (27.7%), 11 approximately 20 days in 13 patients (9.2%), 21 approximately 30 days in 4 patients (2.8%), and over 30 days in 2 patients (1.4%), It can thus be said that the number of cases showing a long incubation period is increasing. The MICs of 154 gonococci strains isolated from the urethral or vaginal discharge were determined. Thirteen (8.4%) of these clinically isolated strains were found to be beta-lactamase producers. When a bacterial inoculation level of 10(6) cells/ml was used in the in vitro MIC determination, the MIC was 1.56 micrograms/ml or higher for 12 of these beta-lactamase-producing strains; the MIC of the 13th strain was 0.78 microgram/ml. At the same time, the MICs of these beta-lactamase-producing strains to doxycycline were also high; 1.56 micrograms/ml or higher.(ABSTRACT TRUNCATED AT 400 WORDS)

In a rare case of germinal tumor, the patient usually presents complaining of an abdominal mass as an initial symptom without an apparent tumor in his testis. Clinical strategy for such patients is based on that for testicular cancer. However, it often fails to produce a satisfactory response. The poor response may contribute to several "poor prognostic feature" found in most of these patients.

To study the changes in sexual function, especially potency in males with age, 3, 389 married male patients who visited the urological department were inquired about their sexual behavior, and the following results were obtained. Sexual intercourse was performed once a week or more in 95.2% of those aged under 30 years, 84.2% of those aged between 30-39 years, 55.2% of those aged between 40-49 years, 26.3% of those aged between 50-59 years, and 10% or less of those aged 60 years or more. Conversely, the percentage of those reporting no sexual intercourse increased with age, especially markedly after 50 years of age: 10% or less in those under 50 years, 21.1% in the 6th decade, 44.8% in the 7th decade, and 69.5% in the 8th decade. The awareness of morning erection decreased gradually with age. In those 60 years or older, the percentage of those without morning erection was higher than those with morning erection. The association between the testicular volume and potency was unclear in those under 50 years of age. However, in those between 50-69 years, potency tended to be reduced with the decrease in the testicular volume. The frequency of sexual intercourse in infertile patients with testicular dysfunction was nearly equal to that in those with normal testicular function. The decrease in sexual activity with age appears to be complicated associated with sociological and psychological factors in addition to aging. In a society where the proportion of the aged is increasing, evaluation from various aspects is needed.

We carried out operative insertion of Jonas penile prosthesis in 10 cases with organic impotence. Erection had been incomplete due to radical surgery for bladder or rectal cancer in 5, pelvic fracture in 1, diabetes in 1, Peyronie's disease in 1 and unknown in 2 of the operated cases. Nine of the 10 cases were able to have sexual intercourse at 5-16 weeks after the operation, but the prosthesis was taken off in the remaining one due to long-lasting pain in the penile and perineal region. We have confirmed that the implantation of Jonas prosthesis is a safe and useful procedure for organic impotence.

Ketalar was used for anesthetic purpose in minor operations, examinations and treatments. Twenty-five out of 27 cases showed excellent result. Minor operations included open renal biopsy and external genital surgery. Endoscopic examination, urethral dilation and change of nephrostomy tube in children were all well performed under Ketalar anesthesia. Side-effects such as nystagmus, elevation of blood pressure and dream were noted but only transient and required no treatment. In two cases, examination was given up because of untoward movement. It was concluded that Ketalar is safe, easy to use, and adequate for short urological surgery, examination or treatment.