Third nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2020 and 2021: Antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus.

The Japanese surveillance committee conducted a third nationwide surveillance of antimicrobial susceptibility of acute uncomplicated cystitis at 55 facilities throughout Japan between April 2020 and September 2021. In this surveillance, we investigated the susceptibility of Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Staphylococcus saprophyticus (S. saprophyticus) for various antimicrobial agents by isolating and culturing bacteria from urine samples. In total, 823 strains were isolated from 848 patients and 569 strains of target bacteria, including E. coli (n = 529, 92.9 %), K. pneumoniae (n = 28, 4.9 %), and S. saprophyticus (n = 12, 2.2 %) were isolated. The minimum inhibitory concentrations of 18 antibacterial agents were determined according to the Clinical and Laboratory Standards Institute manual. In premenopausal patients, there were 31 (10.5 %) and 20 (6.8 %) fluoroquinolone (FQ)-resistant E. coli and extended-spectrum ß-lactamase (ESBL)-producing E. coli, respectively. On the other hand, in postmenopausal patients, there were 75 (32.1 %) and 36 (15.4 %) FQ-resistant E. coli and ESBL-producing E. coli, respectively. The rate of FQ-resistant E. coli and ESBL-producing E. coli in post-menopausal women was higher than that for our previous nationwide surveillance (20.7 % and 32.1 %: p = 0.0004, 10.0 % and 15.4 %; p = 0.0259). For pre-menopausal women, there was no significant difference in the rate of FQ-resistant E. coli and ESBL-producing E. coli between this and previous reports, but the frequency of FQ-resistant E. coli and ESBL-producing E. coli exhibited a gradual increase. For appropriate antimicrobial agent selection and usage, it is essential for clinicians to be aware of the high rate of these antimicrobial-resistant bacteria in acute uncomplicated cystitis in Japan.

[A case of xp11.2 translocation renal cell carcinoma].

Xp11.2/TFE3 translocation renal cell carcinoma (RCC), a recently classified distinct subtype, is a rare tumor that usually affects children and adolescents. The morphology and biological behavior are not widely recognized, Xp11.2 translocation RCC is suggestive of early metastases despite the small tumor size. The definitive diagnosis requires the evidence of several different reciprocal translocations involving the TFE3 gene located on chromosome Xp11.2. Here, we present a case of Xp11.2 translocation RCC in an 18-yearold male. He was referred to our hospital because of a right renal tumor with macroscopic hematuria and right flank colic. The radiographic evaluation including magnetic resonance imaging (MRI) suggested it to be a typical papillary renal cell carcinoma or benign renal tumor. He underwent laparoscopic nephrectomy against the repeat symptom in spite of small tumor (3.5 cm in diameter). The immunohistochemical study revealed nuclear staining for TFE3 protein in the cancer cells. The urologic and radiologic outcomes were satisfactory after more than 1 year of follow-up.

[A case of primary retroperitoneal mucinous cystadenocarcinoma].

The present report describes a 31-year-old Japanese woman with a retroperitoneal cystic mass adjoining below the left kidney. No disseminated tumors were observed, and resection of the tumor only was performed laparoscopically. The surgical specimen showed a well-differentiated papillary mucinous cystadenocarcinoma of the ovarian type. Additional gynecological examination, including positron emission tomography-computed tomography, showed no malignancy at other sites. Recurrence or metastasis has not been observed after more than 1 year of follow-up. Primary retroperitoneal mucinous cystadenocarcinoma is a very rare tumor. Thirty-six and 55 cases have been reported previously in the English and Japanese literature, respectively. The pathogenesis of the disease remains unclear and controversial. A standard treatment has not been established in the literature, and a consistent prognosis has not been reported. Therefore, close post-operative follow-up is strongly recommended.

Acute renal failure due to bilateral ureteral stone impaction in an HIV-positive patient.

A 51-year-old HIV-positive man treated with atazanavir for 9 months presented with anuria following right flank pain. Laboratory examination indicated renal insufficiency, and abdominopelvic computed tomography scanning showed bilateral hydroureteronephrosis, but no stones were visualized. Endoscopic procedures were performed to investigate the causes of ureteral obstruction and, if possible, to insert Double-J stents in the ureters. A yellowish stone composed of pure atazanavir was found at the right ureteral orifice, and retrograde pyelography revealed a filling defect in the left ureter found to be caused by an atazanavir stone. The patient's renal function recovered after removal of these stones.

[Does early vascular access intervention therapy reduce acute obstruction and reconstruction of arterial-venous fistula?].

Acute vascular access (VA) obstruction is one of the most common complications for hemodialysis patients and medical professions. We performed early vascular access intervention therapy (VAIVT) to reduce the incidence of acute VA obstruction, VAIVT and fistula reconstruction. During a 2-year period, we performed 125 procedures of VAIVT in 145 cases in 50 patients who underwent arterio-venous fistula angiography. We performed early VAIVT within two weeks since we clinically found VA stenosis. The 125 procedures of VAIVT (95 non-thrombosed cases, 30 thrombosed cases) involved 86 native fistulas (74 non-thrombosed, 12 thrombosed) and 39 graft fistulas (21 non-thrombosed, 18 thrombosed). Prevalence of thrombosed cases was significantly higher in graft fistula than in native fistula (P<0.001). The primary patency rate in 50 patients at 6, 12 and 24 months was 62.1, 46.9 and 41.7%, respectively, while the secondary patency rate was 93.7, 90.7 and 86.6%, respectively. The highest primary patency rate was found in the non-thrombosed group with native fistula and the lowest secondary patency rate was found in the thrombosed group with graft fistula. By comparing the results of this study with the events for the previous 2 years, the total VAIVT number was almost the same. The number of non-thrombosed cases increased significantly from 54 to 95, and those of thrombosed cases decreased from 68 to 30 (P < 0.001). The number of fistula reconstructions significantly decreased from 59 to 22 (P<0.001). Early VAIVT for VA stenosis could decrease acute VA obstruction and fistula reconstruction without increasing the total number of VAIVT.

Prognostic factors for survival of patients after curative surgery for renal cell carcinoma: multivariate analysis of 482 cases.

BACKGROUND: Even with curative surgery, renal cell carcinoma occasionally recurs in other organs, with fatal results. In this study, we identified independent prognostic factors for survival in patients with renal cell carcinoma after curative surgery. METHODS: The records of 482 patients (mean age, 61.0 years; range, 17-90 years) who underwent curative surgery for renal cell carcinoma at Gifu University Hospital and its affiliated hospitals between 1991 and 2000 were reviewed. The average follow-up period was 42 months (range, 10-140 months). Clinical characteristics of the 482 patients were divided into three categories: patient factors (sex, age, performance status, and mode of tumor discovery), tumor factors (T classification, N classification, mode of infiltration, histological grade, and venous invasion), and treatment factor (whether or not adjuvant therapy with interferon-alpha was used). Stepwise multivariate Cox proportional hazards regression modeling was performed to identify independent determinants of survival. RESULTS: Of the patient factors, performance status and mode of tumor discovery were independent factors predicting survival. Of the tumor factors, venous invasion and mode of infiltration were independent factors predicting survival. Use or non-use of adjuvant therapy was not significantly associated with survival. Overall, performance status, venous invasion, mode of infiltration, and histological grade were shown to be independent prognostic factors, in descending order of importance. CONCLUSION: Performance status, venous invasion, mode of infiltration, and histological grade, in descending order, were the most important factors predicting survival after curative surgery for renal cell carcinoma.