ABSTRACT
Susceptibility testing was conducted on 1357 isolates of Neisseria gonorrhoeae isolated from 1993 through 2002 in Japan to assess the antimicrobial resistance. Selected isolates were characterised by auxotype and analysis was done for mutations within the quinolone resistance-determining region (QRDR) in the gyrA and parC genes, which confer fluoroquinolone resistance to the organism. Isolates with ciprofloxacin resistance increased significantly from 6.6% (1993-1994) to 73.5% (2002). The proportion of plasmid-mediated penicillin-resistant isolates (PPNG) decreased significantly from 7.9% (1993-1994) to 0.9% (2002). The percentage of chromosomal-mediated resistance to penicillin decreased from 27.4% in 2000 to 12.0% in 2001 but increased to 28.9% in 2002. The proportion of isolates with any type of resistance to tetracycline decreased from 24.7% in 2000 to 13.9% in 2001 and then increased to 22.3% in 2002. The proportion of prototrophic isolates significantly decreased from 84.4% in 1992-1993 to 7.7% in 2001, while that of the proline-requiring isolates significantly increased from 4.4% in 1992-1993 and 80.8% in 1998. The proline-requiring isolates were less susceptible to ciprofloxacin than the prototrophic or arginine-requiring isolates. Of 87 isolates resistant to ciprofloxacin, 2 (2.3%) contained five amino acid substitutions within the GyrA and ParC proteins, 76 (87.4%) contained three or four amino acid substitutions and 9 (10.3%) contained one or two amino acid substitutions.
Subject(s)
Anti-Infective Agents/pharmacology , Ciprofloxacin/pharmacology , Drug Resistance, Bacterial , Gonorrhea/epidemiology , Neisseria gonorrhoeae/drug effects , Amino Acid Substitution , Arginine/metabolism , DNA Gyrase/genetics , DNA Topoisomerase IV/genetics , Drug Resistance, Bacterial/genetics , Fluoroquinolones/pharmacology , Gonorrhea/microbiology , Humans , Japan/epidemiology , Microbial Sensitivity Tests , Neisseria gonorrhoeae/classification , Neisseria gonorrhoeae/enzymology , Neisseria gonorrhoeae/genetics , Proline/metabolismABSTRACT
PURPOSE: We clarified the risk of elevated creatine kinase (CK) and myoglobulinemia during incised muscle urological operations. MATERIALS AND METHODS: We retrospectively reviewed 58 consecutive cases of radical nephrectomy with muscle incision and 89 consecutive radical prostatectomies or radical cystectomies without muscle incision. Operations with or without muscle incision were divided into 2 groups depending on operative time (200 minutes or less and 201 to 400). Increases in CK and myoglobin were compared between the 2 groups, and between muscle incision and no muscle incision at each operative time. RESULTS: CK and myoglobin were proportionally increased according to operative time in operations without muscle incision but not in muscle incision operations, in which high CK and myoglobin were seen even with short operative times. CK and myoglobin were more increased in muscle incision operations than in those without incision with significance at each operative time. However, maximum CK and myoglobin were 2,220 IU/L and 3,600 ng/ml, respectively, in muscle incision operations. CONCLUSIONS: Even with short operative times surgeries with muscle incision are associated with a marked increase in CK and myoglobulinemia. However, CK and myoglobin are not sufficiently high for rhabdomyolysis with acute renal failure to develop.
Subject(s)
Creatine Kinase/blood , Muscle, Skeletal/surgery , Myoglobin/blood , Urologic Surgical Procedures , Cystectomy , Humans , Nephrectomy , Prostatectomy , Retrospective Studies , Risk AssessmentABSTRACT
Cutaneous ureterostomy is a simple procedure to perform, but has some morbidity owing to stomal stenosis. We describe a new and simple technique applied to the stomal stenosis for cutaneous ureterostomy.
Subject(s)
Cyanoacrylates/therapeutic use , Postoperative Complications/therapy , Ureter/surgery , Ureterostomy/methods , Urinary Bladder Neoplasms/surgery , Aged , Aged, 80 and over , Constriction, Pathologic/therapy , Dilatation/methods , Humans , Male , Palliative Care/methods , Treatment Outcome , Ureterostomy/adverse effects , Urinary Bladder Neoplasms/pathologyABSTRACT
Bacillus Calmette-Guérin (BCG) immunotherapy is increasingly being accepted for management of some bladder transitional cell neoplastic lesions. Mild adverse reactions occur frequently. However, an unusual complication of tuberculous epididymitis is reported. A 64-year old man presented with bilateral epididymal mass. Four months earlier he had seven treatments with intravesical BCG instillation (Tokyo 172 strain) for a grade 2 transitional cell carcinoma in situ. Bilateral epididymectomy was performed. Microscopic examination of the epididymis revealed chronic inflammation and necrosis with granulomas and Langhans' giant cells. After the operation, there were no further complications.
