秀亀 玉井’s scientific contributions

MK-0787/MK-0791をUTIを主とした感染症や,感染防止目的で35例36回,原則として1日0.5 g×2を10日間以上にわたり投与した.1)評価可能26例で有効以上は,治療初期で88.5%,終了時で92.3%であった.有用性についても全く同様の成績を得た.P. aeruginasa等を含む分離菌35株の全てが治療後除菌された.投与後出現菌は,真菌類が多かった.2)長期投与の方が短期投与に比べて,有用性が高い傾向を認めた.3)副作用として,嘔吐による中止例が1例あった.臨床検査値異常では,血小板減少1件,好酸球増多1件,GOT上昇2件,GPT上昇3件,γ-GTP上昇1件をみたが,変動幅は小さく,中止により可逆的であった MK-0787 (Imipenem)/MK-0791 (Cilastatin sodium), a new compound of Thienamycin, was administered in treatment of 35 patients (36 cases) with chronic complicated UTI or for prevention of serious infections with much complicated factors. The patients were principally treated at a daily dose of 1 g for over 10 days. The efficacy rate of 26 patients who were evaluable in the early phase (4-7 days) was 88.5%, while it became up to 92.3% in the final phase judgment. As for clinical usefulness, the result was obtained to be as high as that of the clinical efficacy. In bacteriological study, 35 strains were clinically isolated including 7 strains of P. aeruginosa from UTI. All the strains disappeared with an eradication rate of 100% after treatment. Strains appearing after Imipenem/Cilastatin sodium treatment mainly consisted of fungi. Usefulness judgements tended to be greater in the final phase than in the early phase. As for side effects, vomiting was recorded in one case, in which the administration was discontinued. In laboratory findings there were 3 cases with elevated GPT, 2 cases with elevated GOT, one case with elevated gamma-GTP, one with thrombocytopenia, and one with eosinophilia each, but these abnormal values were slight and transient. In summary our clinical study showed that Imipenem/Cilastatin sodium was a very effective antibiotic in treatment on moderate or serious UTI or preventive use for infections in compromised hosts. Considering the features of this agent, it might be more effective and useful for clinical use in treatment on polymicrobial infections including stubborn organisms than any other antimicrobial compounds. Furthermore, it was safe and well tolerable in a long term treatment.

前立腺肥大症を主とする下部尿路通過障害に対してTURを施行した355例について,術前の尿路感染,術後の化学療法,術後の尿路感染への対応と手術効果について検討した.1)術前感染について:カテーテル留置症例の91%に感染を認めたことより,カテーテル管理は重要である.術前感染群では非感染群に比し明らかに排尿障害の程度は強いが,術後の排尿状態にそれ自体影響を及ぼす結果は得られなかった.2)術後の化学療法について抗生物質の投与は術後細菌尿の発生を予防する意味では有効であった.3)術後感染について残尿の持続する症例で術後感染が持続したことより,尿流の改善,つまり前立腺組織の適切な切除が術後感染を抑える重要な因子である Three hundred and fifty five patients were treated with transurethral resection of the prostate for the relief of partial urinary obstruction. Of these, 188 had suffered from bacteriuria before surgery and the remaining 167 had been free of urinary infection before surgery. Urinary infection was caused by urethral instrumentation including indwelling catheter for various periods of time. A significant correlation between volume of residual urine and preoperative infection was demonstrated. No correlation between preoperative infection and postoperative voiding efficiency was however noticed though significant improvement in voiding was demonstrated by postoperative uroflowmetry.

34例の複雑性因子が多く,かつ重症な感染症の治療や感染防止にCAZ 1回1 gを1日2回9～30日にわたり静注または点滴静注し,感染症25例に対して著効6例,有効14例,やや有効例4,無効1例であり,また,術後感染防止上も75%の有効率を得た.副作用は無かったが,検査上肝機能異常4例,及び白血球減少症1例が認められた CAZ was administered to 34 patients in the field of urology for treatment or prevention of serious infections with many complicated factors. The duration of treatment ranged from 9 to 30 days, the most frequent being 14 days, which was the duration originally set as the standard. As the results CAZ was considered to be one of the drugs of choice in the cases requiring long-term treatment, from the viewpoint of both efficacy and usefulness.

A case of hemangiopericytoma arising in the prostate is presented. The patient, a 67-year-old male, was admitted to the hospital for difficulty in urination and underwent transurethral resection of the prostate. The pathological diagnosis was "well-differentiated adenocarcinoma and focal hemangiopericytoma". To the best of our knowledge, the only four cases of hemangiopericytoma of the prostate have been reported in the English literature so far and none in the Japanese literature.

ofloxacinを22例の細菌性前立腺炎の治療に用いた.GNB感染8例に対し,全例に有効であった.GPC感染(感染症の疑い5例も含む)14例に対する効果は,有効10例,無効4例で有効率71%であった.副作用として消化器症状(下痢)2例をみたが中止例は1例のみであった Ofloxacin (OFLX), a new pyridonecarboxylic acid derivative for oral use, was administered in the treatment of 22 cases of bacterial prostatitis (acute 4, chronic 18). In advance of the clinical trial, the concentration of OFLX in prostatic fluid (PF) was determined following administration of the drug to 3 patients with chronic bacterial prostatitis at a stationary phase. Assays revealed antibiotic concentrations of a mean level of 1.34 micrograms/ml in 3 PF samples. The ratios to the plasma antibiotic level (R value) averaged approximately 1.10. In clinical use, the drug was given at a daily dosage of 300-600 mg for 5-21 days. The bacteriological response of the infections caused by gram negative bacteria, in all eight patients (100%) was complete eradication, whereas that in 14 cases (including 5 mild infections) caused by gram positive cocci, was excellent or moderate in 10 (71%) and poor in 4 cases. Adverse reactions were observed in 2 cases; complaint of diarrhea (drug administration was discontinued in 1 case). No abnormal values such as of kidney or liver functions or of peripheral hematology were encountered. From the data obtained ofloxacin was concluded to be highly effective, safe and useful in treatment of bacterial prostatitis.

A 19-year-old male was admitted with left lower abdominal pain and dysuria. Excretory urograms showed only a right kidney. V.C.G. showed a cystic mass lesion over the bladder. Computerized tomography revealed a huge retroperitoneal cystic mass located near the bladder. It seemed to be a huge bladder diverticulum, but the diagnosis was not clearly confirmed before operation. Through a lower abdominal midline incision, the cystic mass structure was removed. The specimen was a left ectopic pelvic kidney with non-functioning hydronephrosis. The removed mass was 91 X 85 X 78 mm in size, and 120 g in weight. The intrarenal fluid was 350 ml. A brief discussion and review are made. To our knowledge, only 3 such case have been described in the Japanese literature.

Prior to clinical investigations, in vitro activities of 5-fluorocytosine (5-FC), ofloxacin (OFLX), and the combination on a strain of E. coli and of C. albicans were tested. The two drugs showed highly active on each target strain without any interaction. In clinical studies, 5 female adult patients with persistent uncomplicated UTI (3 of cystitis, 2 of pyelonephritis) caused by polymicrobial organisms (including bacteria and fungi) were treated in combination of 5-FC and oral chemotherapeutic agent. The results were both bacteriologically and symptomatically successful in all of 5 cases. Those had been poor by other antibiotic drugs in single use or 5-FC alone. Consequently, 5-FC and oral antibacterial drug combination was useful in therapy on even uncomplicated UTI due to polymicrobial organisms including fungi.

1970年～1980年までの過去11年間に経験した腎腫瘍71例につき検討した.発生頻度は外来患者総数の0.22%,入院患者総数の1.72%であった.全症例のうち腎腺癌が41例(57.7%),腎盂移行上皮癌が23例(32.4%),左右差は無く,男性にやゝ多く,平均年齢55.9歳であった.臨床症状としては肉眼的血尿が73.2%,腎部腫瘤45.1%,発熱36.6%で,腎腫瘍の古典的三大症状は2例に認めたのみであり,大部分が初発より1年以内に来院していた.転移は42.2%に認め,肺転移が23.1%に見られた.診断には1VP,血管造影法が有用で,腎盂悪性腫瘍ではこれらの他尿細胞診が有用であった.予後判定には検査成績のうち,血清蛋白分画,血沈値が役立った.手術療法では根治的腎摘出術が83.0%に,腎尿管全摘除術が88.5%にそれぞれ行なわれていた.5年生存率は腎腺癌で42.7%,腎盂悪性腫瘍で53.0%,共に放射線療法の併用の予後が最も良かった Seventy one patients with renal tumors treated at our clinic during the 11 years from 1970 to 1980 were clinically examined. The results are summarized as follows. The frequency of patients with renal tumors was 0.22% of the outpatients and 1.72% of the inpatients. Of the 71 renal tumors, 41 were renal adenocarcinoma, and 26 were renal pelvic tumors of which 23 were transitional cell tumors, 2 were squamous cell tumors, and 1 was adenocarcinoma. The other tumors were 1 adenoma, 1 hemangioma, 1 hematoma, and 1 foreign body granuloma. The right and left kidneys were affected at equal frequencies. Male patients were more commonly affected, the sex ratio being 39 to 32. The youngest case was a 29-year-old female, and the eldest was a 84-year-old male. As the initial symptoms and chief complaints, gross hematuria was most frequent (52 cases, 73.2%), followed abdominal tumor mass (32 cases, 45.1%), and fever (26 cases, 36.6%). Only 2 cases showed the classic triad, while 1 case had none of them. The period between onset of symptoms and admission, was within 1 year for all patients except for 2 cases. Metastasis was found in 52 cases. The lung was the most frequent site of metastasis (12 cases, 23.1%), followed by lymphnodes, bones, and liver. The clinical examinations performed and diagnostic techniques used were, renal function (BUN, Serum Cr), Hb, WBC, liver function (T. Bil, GOT, GPT), serum protein fraction, serum LDH, serum Ca, ESR, tumor marker (AFP, CEA), urine cytological examination, blood pressure, IVP (or RP), angiography. As the therapeutic method, nephrectomy was performed in 25 cases (35.2%), combined nephrectomy and irradiation therapy in 12 cases (16.9%), combined nephrectomy and chemotherapy in 11 cases (15.5%), combined nephrectomy and other therapy in 15 cases (21.1%), and conservative therapy in 8 cases (11.3%). For the entire traced series of renal tumors, the 1-, 3-and 5-year survival rates were 72.3, 49.8, and 49.8% respectively. For renal parenchymal tumors (renal adenocarcinoma), the 1-, 3-and 5-year survival rates were 77.8, 53.0, and 53.0%. The most important factor of prognosis was the stage of tumor. Patients with elevated erythrocyte sedimentation rate, and dysproteinemia also had distinctly unfavorable prognosis. In this study of therapy, the highest survival rate was seen for the patients treated by combined nephrectomy and irradiation therapy of both renal parenchymal and pelvic tumors.