博史 大下’s scientific contributions

複雑性尿路感染症の21例に対して,T-2588を投与した.1)総合臨床効果は著効7例(33.3%),有効8例(38.1%),無効6例(28.6%)と総合有効率は71.4%でった.2)疾患病態群別における有効率は,第1群100%,第3群100%,第4群83.3%,第5群16.7%,第6群100%であった.3)分離された35株中27株(77.1%)が消失した.グラム陽性菌は8株中5株(62.5%)グラム陰性菌は27株中22株(81.5%)であった.4) MIC値が6.25 μg/ml以下の細菌はすべて陰性化し,MIC値と細菌の消失率はよく相関していた.5)自・他覚的副作用及び臨床検査値異常はすべて認められなかった The clinical effectiveness and safety of T-2588 were evaluated in 21 patients with complicated urinary tract infections. Six hundred mg of T-2588 per day was administered orally in three divided doses for 14 days. The results were excellent in 7 cases (33.3%), moderate in 8 cases (38.1%) and poor in 6 cases (28.6%), and the effectiveness rate was 71.4%. The effectiveness rates of the single infection group and mixed infection group were 91.7% and 44.4%, respectively. The overall bacteriological eradication rate obtained was 77.1%, and those of gram-positive cocci and gram-negative rods were 62.5% and 81.5%, respectively. None of the 21 cases, had any significant side effects and abnormal laboratory findings. From the above results, T-2588 is considered to be a useful antibiotic in the treatment of complicated urinary tract infections.

1)TUR-P患者においてCDZMは,静脈内投与で速やかな前立腺内組織移行性を示した。2)CDZM 1gと2g投与間にdose responseが認められた。3)CDZMは,泌尿器科領域感染症の起炎菌に対するMICに比して,十分な組織移行性を示した。細菌性前立腺炎および前立腺疾患術後の感染予防に対し,CDZMは,有効な薬剤である Twenty-four patients suffering from prostate hyperplasia were given venous injections of CDZM of either 1 or 2 g at specific intervals (30 min, 1, 2 and 4 hr) before surgery. Blood samples from the injected vein and tissue samples from the prostate were subsequently taken. In this study, the concentrations of CDZM in the prostate tissue (P) and in serum (S), as well as the ratio of the tissue to serum concentrations (P/S) were determined. In patients given 1 g injections, P ranged from 5.26-48.10 micrograms/g, while S ranged from 25.40-130.00 micrograms/ml and P/S ranged from 12.6-37.0%. In the patients given 2 g injections, P ranged from 9.40-49.20 micrograms/g, S ranged from 62.30-234.00 micrograms/ml and P/S ranged from 9.3-29.1%. CDZM exhibited excellent transmigration to the prostate tissue. Inflammatory bacteria present in prostatitis and urinary tract infections are generally those of E. coli, Proteus sp., but because the P range was much higher than the ratio of MIC, CDZM is expected to be useful against infections in the field of urology.

74歳男,TUR施行後に広範な肺転移をきたし,急速に死の転帰をとった症例 A 74-year-old man with spindle cell carcinoma of the urinary bladder is reported. He presented to our clinic with gross hematuria resulting in bladder tamponade. Transurethral resection (TUR) was performed in order to control severe hematuria intractable with conservative therapy. Histologically the tumor invaded the muscle layer and was composed of two components, small foci of transitional cell carcinoma and numerous spindle cells with severe atypia and then the transition was recognized between them. Immunohistochemically transitional cell carcinoma was intensely positive for cytokeratin (CK) and epithelial membrane antigen (EMA), but negative for vimentin (VIM). Moreover some parts of spindle cells were weakly stained for CK and EMA. Three months after TUR, multiple pulmonary metastases and moderate right hydronephrosis occurred and he died of respiratory insufficiency one month later.