The third national Japanese antimicrobial susceptibility pattern surveillance program: Bacterial isolates from complicated urinary tract infection patients.

The antimicrobial susceptibility patterns of bacterial pathogens isolated from patients with complicated urinary tract infections were analyzed using national surveillance data. The data consisted of 881 bacterial strains from eight clinically relevant species. The data were collected for the third national surveillance project from January 2015 to March 2016 by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Disease, and the Japanese Society of Clinical Microbiology. Surveillance was undertaken with the cooperation of 41 medical institutions throughout Japan. Fluoroquinolone required a MIC90 of 2-64 mg/L to inhibit the 325 Escherichia coli strains tested and the proportion of levofloxacin resistant E. coli strains increased to 38.5% from 29.6% in 2011 and 28.6% in 2008. The proportion of levofloxacin resistant strains of Pseudomonas aeruginosa and Enterococcus faecalis decreased from previous reports and the proportion of multidrug-resistant P. aeruginosa and carbapenem-resistant Enterobacteriaceae remained low. Among methicillin-resistant Staphylococcus aureus (MRSA) strains, strains with reduced susceptibility to vancomycin (minimum inhibitory concentration, 2 µg/mL) increased to 14.7% from 5.5%. Bacterial strains that produced extended-spectrum ß-lactamase included E. coli (79 of 325 strains, 24.3%), Klebsiella pneumoniae (9 of 177 strains, 7.7%), and Proteus mirabilis (6 of 55 strains, 10.9%). The proportion of extended-spectrum ß-lactamase producing E. coli and K. pneumoniae strains increased from previous surveillance reports.

Decrease of bone mineral density in Japanese patients with non-metastatic prostate cancer treated with androgen deprivation therapy.

The aim of this study was to conduct a cross-sectional survey of investigations related to the bone mineral density (BMD) of both non-metastatic prostate cancer (NMPC) patients who have not yet received androgen deprivation therapy (ADT) and patients receiving prolonged ADT in Japan. Japanese male patients with NMPC who received continuous ADT or who were planning to receive ADT were enrolled in this study. Lumbar spine and femoral neck BMD was measured using dual-energy X-ray absorptiometry (DEXA). To assess patient characteristics, we searched medical records and questionnaires to determine whether they had any factors that could possibly affect BMD. A total of 230 patients with a mean age of 76.6 ± 6.4 years were evaluated. Of these, 151 (65.7%) were receiving ADT, and 79 (34.4%) had not yet received ADT. The mean duration of ADT was 37.4 ± 30.7 months. DEXA showed that as the duration of ADT increased, lumbar spine and femoral neck BMD decreased gradually (p = 0.0005 and p = 0.0014, respectively). Stepwise regression analyses revealed that the duration of ADT was a significant variable of both lumbar spine and femoral neck BMD. Moreover, as the duration of ADT increased, the prevalence of osteoporosis increased statistically (p = 0.0002). This study showed that ADT negatively affected lumbar spine and femoral neck BMD. It also showed a progressive increase in the prevalence of osteoporosis in Japanese NMPC patients with ADT.

[Tadalafil Ameliorates Symptoms of Patients with Benign Prostatic Hyperplasia Complicated by Chronic Pelvic Pain Syndrome].

To examine the efficacy and safety of tadalafil in the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia with chronic pelvic pain syndrome, we treated 23 Japanese men with tadalafil 5 mg once daily for 4 weeks. The mean age of the participantswas58.7 yearsand the prostate volume was25. 2 ml. Significant improvementsin total International Prostatic Symptom Score, International Prostatic Symptom Score Quality of Life Index, total National Institutes of Health Chronic Prostatitis Symptom Index score, pain subscore, urinary symptom subscore, and quality of life impact subscore, were observed for tadalafil versus before treatment. These findings confirm that tadalafil is a valuable new treatment option for patients with benign prostatic hyperplasia complicated by chronic pelvic pain syndrome.

[A Case Report of Pyothorax Due to Pyonephrosis].

A 77-year-old woman was referred to our hospital with complaints of fever and left chest pain. Computed tomography showed left pyothorax and left pyonephrosis with left ureter calculus. After admission, drainage of the left thoracic cavity was performed and she was treated with antibiotics. On the third hospital day, debridement for pyothorax was performed because her condition had not improved. During surgery, we found perforation of the diaphragm, and abscess appeared from the perforated area. We suspected that perforation of the diaphragm from the left pyonephrosis caused left pyothorax, and performed left nephrectomy. After the operation, relapse of the pyothorax and surgical wound infection occurred, but her condition improved and she discharged on the 46 th hospital day. Relapse of the abscess has not occurred.

[A Case of Urothelial Carcinoma of the Bladder in an Adolescent Detected by Microhematuria].

A 14-year old female was referred to our hospital with the chief complaint of microhematuria. A bladder tumor of the right wall was detected by abdominal ultrasonography and cystoscopic examination. Transurethral resection of the bladder tumor was performed. Pathological examination showed urothelial carcinoma, low grade (grade 1＞grade 2), pTa. She was free of recurrence at 2 years and 5 months postoperatively.

[Clinical consideration of percutaneous renal biopsy for renal tumor].

We performed ultrasound-guided biopsies on 14 patients having tumors that were difficult to distinguish as benign or malignant on computed tomography. The study took place from January 2004 to December 2011. Of the 14 tumors biopsied, 12 were malignant, 1 was benign, and 1 was a sampling error. Of the 12 malignant tumors, 7 were primary kidney carcinomas. Six patients received radical or partial nephrectomies, and all had a good prognosis. Three patients with metastatic kidney cancers died of the primary disease. Eleven patients (85.5%) were diagnosed pathologically by biopsies, allowing us to decide the course of treatment. However, because our tests also revealed one sampling error and one unspecified cancer, we determined that there are limitations to a renal biopsy.

Associations of urinary 6-sulfatoxymelatonin with demographics, body mass, sex steroids, and lifestyle factors in preschool Japanese children.

PURPOSE: We aimed to assess the associations of sex, age, body mass, sex steroid hormones, and lifestyle factors with the levels of melatonin in young children. METHODS: This study followed a cross-sectional design and was conducted two preschools in Japan. Subjects were 235 boys and 203 girls, aged 3-6 years. Information related to demographics, body mass, and lifestyle factors was obtained from parent-administered questionnaires. The levels of 6-sulfatoxymelatonin and dehydroepiandrosterone in first-void morning urine were measured by radioimmunoassay. Urinary estrone, estradiol, testosterone, and 5-androstene-3ß, 17α diol levels were measured by liquid chromatography-electrospray ionization tandem mass spectrometry. RESULTS: The creatinine-corrected 6-sulfatoxymelatonin levels and the estimated value of 6-sulfatoxymelatonin excretion were higher in girls than in boys. After adjustments for age, the creatinine-corrected 6-sulfatoxymelatonin was negatively associated with weight and body mass index among boys and with weight and height among girls. However, the estimated value of 6-sulfatoxymelatonin excretion was not associated with any indices of body mass. No significant relationships of urinary sex steroids, light exposure at night, sleep time, sedentary lifestyles, or passive smoking with urinary 6-sulfatoxymelatonin were observed. CONCLUSIONS: Our findings suggest that melatonin levels depend on sex and body size among young healthy children. Our results should be confirmed in future researches.

Associations of birth weight and physical activity with sex steroids in preschool Japanese children.

PURPOSE: We aimed to assess the association of body size at birth or physical activity with sex steroid levels, independent of body mass among young children. METHODS: The cross-sectional study was conducted in 2006. Subjects were 230 boys and 198 girls, aged 3-6 years. Birth weight was based on parents' reports. Questions about physical activity focused on outdoor playtime. Urinary estrone, estradiol, testosterone, and 5-androstene-3ß,17α diol (3ß,17α-AED) levels were measured by liquid chromatography-electrospray ionization tandem mass spectrometry. Urinary dehydroepiandrosterone level was measured with a radioimmunoassay. RESULTS: After adjustments for age and BMI, girls with lower birth weight had higher testosterone (trend p = 0.038) and 3ß,17α-AED (trend p = 0.028). Girls with low birth weight and high birth weight had higher estrone (p = 0.014) and estradiol (p = 0.074) than those who had middle birth weight. Boys who were physically active had lower testosterone (p = 0.028) and 3ß,17α-AED (p = 0.003) than those who were not active. Girls who were physically active had lower estrone (p = 0.015). CONCLUSIONS: Sex steroid levels in childhood might be affected by body size at birth or by physical activity during childhood. These effects might differ by sex.

Associations of urinary 6-sulfatoxymelatonin with biomarkers related to cardiovascular disease in Japanese women.

Melatonin's potential preventive effect against cardiovascular disease (CVD) remains hypothetical. No study has evaluated the relationships between endogenous melatonin and the established blood biomarkers related to CVD. The objective of the present study is to examine the association between the endogenous melatonin level and various established blood biomarkers of risk of CVD, including white blood cell (WBC) count and plasma concentrations of lipids, homocysteine, uric acid (UA), and high-sensitivity C-reactive protein (hs-CRP). This cross-sectional study included 181 Japanese women who attended a health checkup program provided by a general hospital between March 2005 and March 2006. All study subjects responded to a self-administered questionnaire and were measured for weight, height, and blood pressure. Venous fasting blood and first-void morning urine were obtained from all subjects. Statistically significant inverse correlations were observed between urinary 6-sulfatoxymelatonin (aMT6s), the major metabolite of melatonin in urine, and WBC count, UA, and hs-CRP after controlling for age, body mass index, menopausal status, smoking status, diet, sleeping habits, and exercise (r = -0.19, -0.21, and -0.24, respectively). There were no significant correlations between urinary aMT6s and plasma lipids and homocysteine. These data suggested that the urinary aMT6s level was inversely associated with established independent risk factors for CVD, such as WBC, UA, and hs-CRP. Endogenous melatonin may have implications for the risk of CVD.

Soy intake and urinary sex hormone levels in preschool Japanese children.

The authors investigated whether soy intake is associated with sex steroid levels in Japanese children. This cross-sectional study was conducted in autumn 2006. Subjects were substantially healthy preschoolers, 230 boys and 198 girls, aged 3-6 years. Dietary data, including soy intake, were assessed using 3-day dietary records. Each child's dietary intake was controlled for total energy intake using the Willett method (Nutritional Epidemiology. Oxford, United Kingdom: Oxford University Press; 1990:245-271). Urinary estrone, estradiol, testosterone, and 5-androstene-3ß,17α diol levels measured using liquid chromatography-electrospray ionization tandem mass spectrometry, and urinary dehydroepiandrosterone level measured with a radioimmunoassay, were adjusted for urinary creatinine levels. In the analysis of covariance for sex steroids after adjustments for age and body mass index, soy intake was significantly negatively related to estrone and estradiol in boys and positively related to testosterone and 5-androstene-3ß,17α diol in girls. Isoflavone had a significant tendency to be negatively associated with estradiol in boys and to be positively associated with testosterone in girls. Total energy intake was not associated with any sex steroids in boys or girls. These results suggest that soy intake might affect the secretion or metabolism of sex steroids in childhood and that the effects might differ by sex.

Efficacy of combination therapy with tamsulosin and zolpidem on nocturia in patients with benign prostatic hyperplasia.

INTRODUCTION: We examined the efficacy of combination therapy with α1-blocker tamsulosin and hypnotic zolpidem in patients who had suffered from sleep disturbance associated with nocturia. MATERIAL AND METHODS: A total of 35 patients diagnosed with nocturia with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) were studied. After treatment with tamsulosin for 4 weeks, 16 patients dissatisfied with nocturia (nocturiaquality of life index ≥4) and suspected to have sleep disturbance (Athens Insomnia Scale ≥6) received additional treatment with tamsulosin and zolpidem for 2 weeks. Outcomes were evaluated by the International Prostate Symptom Score (IPSS) and quality of life index (QOL), Athens Insomnia Scale (AIS) and nocturia-quality of life index (nocturia-QOL). RESULTS: After monotherapy with tamsulosin, significant reductions in IPSS (18.9 ±3.8 to 9.9 ±3.0, p <0.001), QOL (4.5 ±0.9 to 3.2 ±0.9, p <0.001) and nocturia episodes (3.4 ±0.7 to 2.6 ±1.0, p <0.001) were observed. However 20 patients were dissatisfied with nocturia (nocturia- QOL ≥4). Among 20 patients, 16 patients were suspected to have sleep disturbances (AIS ≥6). In these patients, additional therapy with tamsulosin and zolpidem significantly reduced nocturia episodes (3.3 ±0.8 to 1.9 ±0.7, p <0.001), AIS (10.6 ±2.9 to 6.8 ±25, p <0.001) and nocturia - QOL (5.6 ±0.5 to 3.6 ±1.1, p <0.001) compared with patients after treatment with tamsulosin only. CONCLUSIONS: Combination therapy with tamsulosin and zolpidem may be useful for patients with BPH dissatisfied with nocturia and suspected to have sleep disturbance.

Emergence of clinical strains of Mycoplasma genitalium harbouring alterations in ParC associated with fluoroquinolone resistance.

Surveillance for antimicrobial resistance in Mycoplasma genitalium clinical strains is extremely limited as culturing of strains from clinical specimens is still difficult. We therefore conducted a non-cultural assessment of fluoroquinolone resistance of M. genitalium clinical strains by analysing the quinolone-resistance determining regions (QRDRs) of the gyrA and parC genes. The QRDRs amplified from M. genitalium DNA taken from urine specimens of 28 men with non-gonococcal urethritis positive for M. genitalium by polymerase chain reaction were sequenced. An amino acid change (Phe-108-->Iso) in GyrA was found in one specimen, and the same change was accompanied by an amino acid change (Lys-97-->Arg) in ParC in another specimen. A single amino acid change (Ser-83-->Asn, Asp-87-->Tyr or Asp-87-->Val) in ParC was also found in three other respective specimens without alterations in GyrA. No alterations in GyrA and ParC were found in the remaining 23 specimens. The alterations of Ser-83-->Asn, Asp-87-->Tyr and Asp-87-->Val in ParC found in 3 (10.7%) of 28 specimens were analogous to those commonly observed in fluoroquinolone-resistant mutants of other Mycoplasma and Ureaplasma spp. M. genitalium harbouring mutations associated with fluoroquinolone resistance in the parC gene may have emerged clinically and the prevalence may be ca. 10% in Japan.

Lifestyle and health factors associated with stress urinary incontinence in Japanese women.

OBJECTIVES: Studies focusing on lifestyle and health factors and stress urinary incontinence (SUI) are scarce in Japan. The aim of this study is to examine the association of lifestyle and health factors in SUI. METHODS: Study subjects were retrieved from Japanese women participating in a health checkup program provided by a general hospital between October 2003 and March 2006. The presence of SUI was confirmed by responses to a self-administered questionnaire assessing lower urinary tract symptoms. The questionnaire included other questions on lifestyle and health factors. Each subject underwent weight and height measurements. RESULTS: A total of 823 women completed the questionnaire and were included in the analyses (the response rate was 62.6%). Of them, 70 (8.5%) women had SUI. BMI and parity were significantly positively associated with SUI (OR=3.47 and 7.17, 95% CI 1.65-7.33 and 1.71-30.04, respectively). Multiple logistic regression analysis controlling for age, parity, and BMI showed that first delivery at age >27 (OR=1.82, 95% CI 0.97-3.41), past estrogen use (OR=2.50, 95% CI 1.14-5.47), and unilateral ovariectomy (OR=3.07, 95% CI 1.16-8.13) were also significantly associated with SUI. CONCLUSIONS: The data suggested that lifestyle and health factors such as parity, BMI, age at first delivery, past estrogen use, and unilateral ovariectomy were associated with SUI in Japanese women.

Epithelioid angiomyolipoma associated with a classic angiomyolipoma.

We report a case of renal epithelioid angiomyolipoma that arose in association with a classic angiomyolipoma in a 54-year-old Japanese man without tuberous sclerosis. Histologically, the tumor was composed of polygonal cells exhibiting diffuse hemorrhage, multifocal necroses, and vascular invasion. Immunohistochemical staining was positive for melanoma specific antibody and focally positive for smooth muscle actin. On the basis of a review of the literature, we suggest that large epithelioid angiomyolipoma may have malignant potential and therefore requires close follow up.

[Prostate cancer detected from pleural effusion: two case reports].

Prostate cancer is rarely detected from abnormal chest radiographs. We report two cases of prostate cancer detected from pleural effusion. Case 1 is a 76-year-old man who consulted the department of internal medicine of our hospital with dyspnea and abdominal fullness. Pleural effusion and multiple hepatic tumors of unknown origin were pointed out, but he refused any further investigation or treatment for them. Six months later, he consulted a family doctor with urinary frequency and lumbago. Increased serum prostate specific antigen (PSA) level to 864 ng/ml was recognized, then he was referred to our department. Under diagnosis of prostate cancer, T4NOM1c, maximal androgen blockade (MAB) was performed. Serum PSA level was decreased once to 8.1 ng/ml, but then rose gradually and he died 13 months after the beginning of the therapy. Case 2 was a 78-year-old man who was referred to our department to determine the origin of carcinomatous pleuritis detected in a routine general check up of hepatitis C. The serum PSA level was increased to 12,900 ng/ml, and the diagnosis was prostate cancer, T3aNOM1c. Although MAB was performed, the serum PSA level did not decrease markedly. He died 16 month after the beginning of the therapy.

Comparison of two alpha1-adrenoceptor antagonists, naftopidil and tamsulosin hydrochloride, in the treatment of lower urinary tract symptoms with benign prostatic hyperplasia: a randomized crossover study.

OBJECTIVES: To compare the efficacy of two alpha(1)-adrenoceptor antagonists, alpha(1A)-adrenoceptor-selective tamsulosin hydrochloride and alpha(1D)-adrenoceptor-selective naftopidil, in the treatment of lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Thirty-four patients (mean age 72.4 years, sd 4.3, range 66-79) with LUTS (International Prostate Symptom Score, IPSS >8) secondary to BPH were enrolled in a randomized crossover study. Seventeen patients were initially prescribed naftopidil 50 mg for 4 weeks, followed by tamsulosin 0.2 mg for 4 weeks (group A); another 17 were initially prescribed tamsulosin 0.2 mg, followed by naftopidil 50 mg (group B). Patients changed to the alternative treatment after a 1-week washout period. Efficacy criteria were improvement in LUTS (IPSS), quality of life (QoL), uroflowmetry, and pressure-flow study (PFS) values based on the treatment with each agent. RESULTS: At baseline there were no significant differences between the groups in IPSS, QoL, uroflowmetry values or PFS values, except for the volume at maximum desire to void. After treatment with each agent, the IPSS and QoL were significantly improved and the reduction in bladder outlet obstruction confirmed by PFS. Naftopidil was significantly more effective than tamsulosin in relieving nocturia. The increases from baseline (before treatment) to the endpoint (after treatment with each agent) in the volume at first desire and maximum desire to void were significantly higher with naftopidil than with tamsulosin. Involuntary contractions disappeared in two patients with relief of nocturia with naftopidil, but not with tamsulosin. The decrease in other symptoms of the IPSS, QoL, increase in uroflowmetry values and changes in other PFS values were similar for both agents. CONCLUSIONS: The two agents provided similar efficacy in the treatment of LUTS with BPH. However, naftopidil was better than tamsulosin for nocturia. The disappearance of involuntary contraction and the greater increase in first-desire volume with naftopidil may be associated with the relief of nocturia. The alpha(1D)-adrenoceptor antagonist is effective in alleviating both voiding and storage symptoms. The alpha(1D)-adrenoceptor antagonist may be more effective than the alpha(1A)-adrenoceptor antagonist in LUTS with BPH.

[A case report of sarcomatoid carcinoma of the bladder with metastasis to small intestine].

A 67-year-old male presented to our clinic with gross hematuria. Cystoscopic examination revealed a broad-based tumor of 2.5 cm in diameter on the lateral side of the right ureteral orifice. Under the clinical diagnosis of TCC G2 > G3, T3bNOM0, radical cystectomy with orthotopic bladder substitution was performed. Pathological diagnosis was TCC G3 with sarcomatoid carcinoma, pT2pR0pL1 pVlpN0. Adjuvant chemotherapy was not performed because of his transient poor conditions. Lung metastasis was observed 6 months postoperatively. Despite of M-VAC therapy and radiation therapy, additional metastases to brain and liver were observed. One month later, partial ileectomy specimen for occlusive ileum revealed the same histologic findings, TCC G3 with sarcomatoid carcinoma. He died 9 months postoperatively. To our knowledge, this is the first case of sarcomatoid carcinoma of the bladder with metastasis to small intestine, although 6 cases of transitional cell carcinoma of the bladder with metastasis to small intestine has been reported in Japan.

[Multiple metastases of the penile cancer: an experience of combination chemotherapy].

A 49-year-old man with penile cancer (cT3N1M0) was referred to our hospital. The pathologic diagnosis was squamous cell carcinoma. The patient underwent penectomy and bilateral inguinal lymphadenectomy without postoperative adjuvant therapy. Six months later, we found multiple metastases of the penile cancer in the lungs. The patient was then treated with combination chemotherapy of cisplatin, methotrexate, bleomycin. However, the tumors were aggressive and did not respond to the therapy. We discuss the use of combination chemotherapy in the case of advanced penile cancer.